Waiting for the Inevitable Collapse in Homecare Provision?

This week the Chancellor released his ‘Spending Review’ and ‘Autumn Statement’, which once more failed to even start to address the crisis of care for the elderly. This left me to question what will it take before the politicians see what is obvious to the rest of us? Once more a sticking plaster will be applied to the NHS, which fails to get anywhere near resolving the burden of the elderly on hospitals. It is only a matter of time until the effect of inadequate home care provisions results in Hospitals being used as poor elderly care providers.
Last year I wrote to our local MP asking for her support in appointing a Minister for the Elderly. She replied that this was all covered by various departments and wasn’t necessary. But I believe the absence of such a cabinet minister has allowed the Chancellor to ignore the consequences of underfunding in the care sector. This is already beyond deterioration in quality of care provided and is now affecting recruitment and even the financial viability of many care providers. The proposal that allowing local authorities to increase council tax by up to 2% to meet the cost of social care simply won’t undo the damage from rates stationary for the past 8 years. Some have estimated that it won’t even cover the increased cost from the imposition of the Living Wage by the very same Chancellor!
There are over 9,000 registered homecare providers across the UK, over 75% of which are independent businesses, the vast majority of which are less than 25 employees. About 70% of homecare visits are funded by the state (usually by local council social services departments) but delivered by independent providers working under contract. Last week the Chartered Institute of Personnel and Development predicted a shortfall of 200,000 care workers by 2020 and a potential gap as high 1,000,000 in the next twenty years, as the number of people aged over 80 is expected to double and demand increases significantly. We need to attract recruits. I personally don’t see the solution as lots of cheap foreign workers. This is a skilled job requiring higher communication skills.
After a thorough commercial examination, Halcyon reluctantly made the decision this year not to accept further work commissioned by local authorities. For us, there was no choice between paying our excellent workforce a decent rate for a difficult, essential job or to continue working on social services contracts. We realised that the consequences of this decision might mean a reduction in choice for people in Maidenhead, who might now need to move into residential accommodation. But we concluded that the reality of being unable to provide staff for these commitments produces exactly the same result as not accepting the commission in the first place.
Whether elderly are supported by social services or funding things themselves, our customers know we need a healthy homecare sector with good, well trained and supervised staff. So I listened with despair at the lack of imagination and application from politicians to help improve the situation.
There were no shortage of suggestions for him to consider, it wasn’t just about giving more money to local authorities.
My favourites include:
-We know that people receiving homecare are monitored for food and fluid intake and other personal care issues that reduce the number of hospital visits, so why can’t they have tax incentives to assist with the funding of their own social care?
-Why not change the VAT status of ‘welfare services’ to ‘zero-rated’ enabling care providers to reclaim VAT on the costs they incur?
-Why not “encourage” insurance providers to seriously consider the introduction of elderly care insurance products?
Really, Chancellor, how much longer can you and other politicians ignore the elephant in the room? Do we really have to wait for a collapse in homecare before you understand that it’s time to do something?

The Case for Introducing Technology to Social Care Operations

We’ve had an exciting time recently, implementing strategic improvements for the business after reviewing what has been successfully and unsuccessful in the way we do things.

Social Care has a reputation for being backward, lacking in innovation and resistant to change. Therefore, a proposal to move to handheld technology to organise staff schedules and record our visits with customers was considered highly ambitious by some of my contemporaries in other care agencies.

Our analysis showed that rescheduling happens frequently, due to customers being affected by illness or accidents, and running an operation based on paper instructions meant the rescheduling system wasn’t that effective. When we looked at the care information we gleaned from a visit, we concluded that we couldn’t expect to be highly responsive when we had to wait for paper copies of the reports to be brought in by the carers. Obviously, critical incidents were reported by phone but this was dependent on the experience and initiative of the carer to deduce that an emergency call was required. We also realised that reports submitted on paper remain on paper unless we transcribe them. Furthermore, without a contact system handwritten notes go into a file and rely on the person that put them there to remember or tell others or to be prompted at that moment when things go wrong!

Our solution has been to reorganise our operations (and our supervision of the team) to reflect the fact that we are a mobile workforce and not an office based team. With new software to design and implement, new phones for the carers, 3g technology, training for all the staff in new ways of working and all in an environment where we simply don’t have the option to fail to make visits to vulnerable elderly customers…. What could possibly go wrong??

But we managed it! We have already received some great ideas for improving the system but it works! And the benefits are already beginning to be realised…

Collecting digital data on the care visit means that the management have a view of the care situation from the time of the last visit. It allows us to proactively respond to a developing situation, either to get more clarity from the carer, to contact the family or health professionals in a timely way. Our next development is to share this data on-line with the families of customers who are often remote from the Maidenhead area offering reassurance of our care management.

The back office benefits of having real-time information on carer progress enables us to answer queries for customers when traffic or acute customer needs have caused delays. We are also able to answer directly requests from families asking for confirmation that the carer has been when their loved one, when they have been confused as to whether a visit has taken place or not.

Mobile technology and the use of 3g enabled tablets has also presented the management with the opportunity to take a lot of their work with them out to the customer’s home. We see this as entirely consistent with our aim to be there to support carers who often spend most of their day working alone with customers.

So, backward? Resistant to change? Not us! It may be challenging to do new things but if the prize is improved care, more effective operations and efficient back-office jobs how can you not manage the risks and make the effort?


15 Ways That 15-minutes Aren’t Enough: Insanity of 15-minute Elderly Care Visits

We spotted a big stream of twitter responses to a question posed by the Guardian Social Care    “should 15-minute care visits be banned?

Evidently we aren’t alone in having strong views on this. We reject the constant requests made by Local Authorities to deliver care in 15-minute slots – and would love the whole idea of 15-minute visits to be dismissed once and for all.

Check out these points that we think get the point across not just once but 15 times:

  1. Rushing through personal care such as toileting, washing and dressing for a frail, elderly person turns vulnerable, needy citizens into objects to be manhandled  – doing it all in 15-minutes would make a  sadist stop and think.
  2. If you only have 15-minutes to do multiple tasks then completing those tasks will always be prioritised over the needs of the individual – and their wishes must inevitably be ignored.
  3. 15-minute visits force elderly customers to choose whether they want to eat, go to the toilet, or stay clean. Which would you choose?
  4. Councils don’t fund travel time between care visits but often takes >15-minutes of unfunded travel time to attend a 15-minute call. It’s uncommercial for agencies, unacceptable for the environment and, above all, it’s totally ineffective at caring for those who need help.
  5. A significant benefit of a homecare call is to deliver relief from isolation and loneliness. Pausing for social interaction is impossible in an overloaded 15-minute call. The rush simply emphasises to the individual the lack of social interaction in their lives.
  6. Care workers hate 15-minute calls. They do the job to help, and give care – they get very upset by a customer asking them to stay longer: “but, you’ve only just got here – surely you can spare a few more minutes?”
  7. It can take the majority of a 15-minute call to microwave and lay out a meal for someone – there’s certainly no time to say and make sure it is eaten. Meal preparation isn’t the part that is vital to well-being and health.
  8. Carers would like to know where they find the “Go/Stop” Switch on an elderly person… so they can ensure they use a commode to order in the 15-minutes available.
  9. At least 4 minutes of the 15 are taken up with getting into and out of the premises leaving just 11 minutes left for “care”
  10. For an elderly person with (or even without) arthritis, it can take over 10 minutes simply to descend the stairs aided by a carer, and many do not have handy stair lifts.
  11. Care clients with dementia can be confused and require calm reassurance each time that the carer is familiar – a precious 5 minutes or much more may disappear reassuring them. What is a carer supposed to do, just forget a few of the essentials so they can leave on time?
  12. 5 minutes washing upstairs, 5 minutes washing downstairs and 5 minutes jamming a frail elderly person into clothes before running out of the front door does NOT constitute care.
  13. It is very hard to find carer recruits, especially those with the right practical and empathic qualities for this tough job. Many last a matter of days if forced to focus on processing tasks in a 15-minute rush, rather than providing caring relief. A nagging conscience does not make for job satisfaction. It’s not why they chose a caring career.
  14. 15-minute calls are always the result of attempts to cut budgetary corners and costs. The model is implemented as part of a local policy and therefore irrespective of individualised care needs – and with zero input or advice sought from professional home carers. Local Authority managers commissioning care should prioritise care for the individual over budget considerations.
  15. Rushed, multi-task 15 minute visits are unpalatable for everyone involved. The most significant barrier is sometimes the elderly care recipient themselves, who may actively obstruct the rushing through of tasks. Who can blame them? This is iniquitous – it puts them in the position of being ‘the problem’ and they can be reported as such, putting their care in jeopardy as a result. That’s unacceptable and extremely unfair.

We would love for some Directors of Adult Social Services Departments to be forced to follow this degrading routine for a week – they would very rapidly see how unreasonable, unworkable and unkind it is.

We are angry and confused as to why the insanity of 15-minute visits seems so hard for policymakers (at any level) to understand.  It is akin to state-sponsored human rights abuse: because demanding 15-minute care visits effectively encourages actions and attitudes that are entirely devoid of respect for the individual and have nothing to do with delivering real benefit.  It fails to deliver it’s most basic purpose.  This should have been addressed, along with putting Local Authority care activities under CQC scrutiny, via the new Care Bill, but it was not. What a disgrace that is.

It is long past time that the 15-minute care model was put to bed, firmly, and without regard to whether it wants to sleep yet. That is, after all, what we do to millions of our elders – every day.

Dementia Friends Simply Can’t Cope


It’s nice to see a flurry of interest in Dementia across the media recently, as the PR machine publicising the new Dementia Friends campaign did it’s job.

Of course we strongly support the idea that the whole country and whole community should get involved in helping to support those with Dementia, a debilitating and distressing experience for individuals and their relatives alike.  Greater education and awareness, encouraging volunteering and community support for those with Alzheimer’s is undoubtedly vital. It’s wonderful that people like Sir Terry Pratchett are helping to spearhead change, along with a vast array of kind, well-meaning stars.

We do feel it sad, however, that it takes the glitz of media and music simply to make the subject interesting to the media, unless, that is, they are salivating over some dreadful care home shock story. We also worry that — as good an idea as Dementia Friends is — it rather glosses over the far more pressing problems that surround our country’s planning for an ageing society.  It is not only support for the 800,000-plus people living with dementia today that we should be worrying about; it is the million-plus who will be living with it by as early as 2021, with those numbers destined to rise further.

We are glad to see that some smart reporters and channels are giving it a wider consideration too, but suspect such stories will receive much less discussion and debate.  We love the article by the Telegraph’s Laura Donelly, for example, which highlights a shocking statistic that over 50,000 people in Britain must give up work in order to care for a Dementia sufferer, because there is no other choice or support.

Jeremy Hunt, Secretary of State for Health, is vocal on this issue at present, but is failing to make the next logical connection in his arguments. We should not be looking only to communities and carers to fill the gap without also re-examining the entire fabric of how we deliver care to the elderly population.  It is simply not possible or fair to expect families, volunteers and communities to shoulder the entire burden of an increasingly aged, infirm and less able population. Dementia is becoming more and more discussed, but often as a form of ‘shorthand’ for old age, and there will be even greater numbers of those who are simply old who are not even being considered. Handling the challenges even of old age can be upsetting, as people decline in health, strength and energy.  Advanced dementia, though, is a serious and very hard-to-manage condition – viewers of the latest BBC ‘Protecting our Parents’ programme will have seen some examples of this.

Untrained volunteers, well-wishers and harassed relative carers simply cannot cope adequately with this condition, and certainly  not without a firm underlying foundation supported by the establishment. To cope with both the dementia and overall ageing challenge that faces Britainn, the systems that we have bear a serious rethink. It won’t be possible, and it isn’t right, to shuffle millions of elderly people into residential care as a default option: the ONLY logical way forward is to look at ways to enable them to live in their own homes and communities. But doing so will mean much, much more than volunteers can deliver, fresh approaches to managing limited public resources, and many, many more trained carers who must be attracted, trained, supported and with pay commensurate with this vital work.

Until the government wakes up to the need for a more holistic ageing strategy, and assigns someone to take real and active responsibility for it in the form of a minister for the Elderly, initiatives like today’s Dementia Friends launch will, sadly, remain only a patch and a PR exercise, unsupported by a real and workable social care framework. We need a strategy for dementia care AND we need an overarching strategy for the interests (and care) of the elderly. It’s time to stop assuming someone else will take care of it, and us, all.



Just STOP!

stopElderly care is all over the media – again! There’s a BBC series under way ‘Protecting our Parents.’ It’s all about shocking stuff – again!

I want to put it into perspective. The media must stop skewing the issue by focusing only on the sensationalist, negative side of the elderly care story. Well done, you are contributing to the collapse of social care. It is becoming almost impossible to recruit into care, which is exacerbating the already squeezed resources that are constrained from a financial perspective.

While awareness of issues is good, programmes like this and recent exposes unfortunately can harm more than they help. They can focus unfairly on carers in homes who are overstretched, and on the homecare businesses so thinly spread that they accept 15-minute calls even when they know it’s wrong (we refuse these however). All of them have fewer and fewer carers to call on, and little or no ability to cover no-shows, illnesses and absences – regardless, all face a scaling challenge in terms of demand. It’s not simply about zero hours contracts. It’s not just about substandard carers abusing elderly. It’s about a system that has too few resources, who are overstretched, overtired and underappreciated, too little money and no political will to change.

What will it take to find the way forward? Media to stop making it worse? Stop using stupid analogies and comparing the cost of care to the cost of hotel rooms? Social and healthcare need to stop fighting against each, and shuffling elderly people around like unwanted packages. There also some need for us as citizens to change our expectation. Everyone needs to wake up to the realities: every citizen of this country, especially those who are approaching the end of their earning years, must either adjust expectations of the quality of life and care that they might receive, or recognise that they will have to contribute more. The idea that somehow, sometime, the government will find a way to fund elderly care more is a pipe dream.

Local Authorities must stop demanding greater and greater care resource for less and less funding: they have already hit the barrier below which care can no longer be delivered. The politicians must stop avoiding the responsibility and appoint a senior minister for the elderly. They need to stop looking at this solely as an election issue and take a long-term view. By failing to do this they are helping perpetuate the fairy tale of what our future will really look like if we don’t take action now.

Longer life is an inevitability. UK Office for National Statistics tells us that the number of centenarians in the UK has risen by a staggering 73 percent over the last decade and that the number of people over 85 in the UK is predicted to double in the next 20 years and nearly treble in the next 30. Unless we do something now, it will be a longer life, but one of lower quality, less choice, less dignity and poorer health.

A Filing Cabinet and a New Chair

There are some business milestones they never teach you on a management course. I don’t recall any lecturer saying how the purchase of a filing cabinet and a new chair requires a reflection on the progress of the business.

But the new filing cabinet spoke to me today and said “Boy, do we desperately need more space for the information on the growing number of customers and staff we now have.”

So, why do we need more filing capacity? Because it appears that our past and present customers are telling others about the quality of the care we’re providing and our services.

And how are we achieving this reputation? Well, the only answer is to be found in the carers we employ and what they do. We make huge promises in our Care Plans when we commit to care for someone, but that’s all they are “promises” until we actually start to deliver. Our carers have to adjust to a different elderly person’s home environment in every call. There are general standards that we deploy but they have to adjust to a different care regime, different preferences with or without medication, with or without mental or physical capacity, in each call — and we recognise this. We have always acted upon a belief that the only way to look after our customers is through looking after our staff, by paying the best in the area, by nurturing their career ambitions and by trying to develop them as best we can. It didn’t take me too much strategic analysis to see that our staff are the reason why the business needs more filing space and is growing rapidly across Maidenhead, Windsor and Ascot!

Oh, and the new chair? Well, that was in homage to Zig Ziglar and his comment that “You don’t build a business. You build people and then people build the business.” Our success is Tracy’s. She controls the standards and the systems within which our carers operate, and she deserves a new chair … even if there was another two years left in her old one!

Paul Dunn-Sims

We’re Expanding and We’re Hiring!

400+ homecare hours a week, 25 staff — and growing

Thanks to our great reputation we’ve had a recent expansion in customer numbers. We’ve smashed through our 400 care hours a week target and that is set to rise even further in the coming months. Our growth has been phenomenal – 35% growth over last year in terms of care time and 35% growth in staff numbers. And what’s more – it’s only March!

Our massive growth surge is thanks to the quality and reputation of our carers. Our recent CQC inspection report findings support this:  “A very reliable, efficient and caring service” and “a very high standard of care based on regular and consistent staff who understood the needs of their customers.” Our own customers support it too, saying things like: “Staff are really lovely and go beyond the scope of what they need to do.”

We’re delighted – of course! But we need urgently to get more people of the same calibre on board. So we are recruiting right now. Our staff are what make us special. At Halcyon we place utmost importance on the quality of our care – our carers are with us because they really care about what they do. The most important aspect of care is Communication. We want carers who genuinely want to listen and talk to our customers, to get to understand them and their needs. We offer great training for everything else – but you can’t teach dedication.

We also offer good remuneration and we believe strongly in supporting our staff and rewarding them for outstanding work. If you think you have the right qualities to be a Halcyon carer – please give us a ring on 01628  298262



Our growth news coincides with CQC Inspection update


Good management of a domiciliary care agency takes more than just ticking boxes

The CQC inspectors have just returned our annual inspection report and we are delighted to announce that a great CQC report coincides with the news that we have just exceeded 400 care hours per week, and now employ 25 people  — a significant milestone we set out to achieve and are now surpassing.

We’d like to share some of the CQC findings with you. It just goes to show once again that boxes can be ticked, but to really come up to scratch you have to see the evidence in the comments behind the boxes. So we are happy to report that not only are we meeting all the standards, but have surpassed expectations in certain areas.

We were found to have met the standard for Respecting and Involving people, Care and Welfare of people, Safeguarding people from abuse, Supporting workers, Assessing and monitoring the quality of service provision — and we would expect nothing less. What really matters is what both our customers and their relatives, and our carers and their managers, told the CQC about us.

Here’s a summary of what they found:

From our customers:

“People were wholly complimentary about the quality of the service they received with one person describing staff as ‘really lovely’ and said staff went ‘beyond the scope of what they need to do.’

Other people described staff as ‘respectful’ and ‘very well trained.’

One person said the manager was ‘very particular about the staff they employed.’”

This is exactly one of our top priorities and it’s good to know it’s being noticed.

From our staff:

“Staff felt supported and one, who was new in the post, found the support helpful in making them feel comfortable in their role. Staff were also motivated and said they enjoyed their work.”

And here are some first-hand remarks that support our top priorities — the report highlights that we keep our promises.

Involving people in their care plan, giving them control and respect:  “We saw there was a clear schedule of support the person had planned with staff and the times this was to be delivered. The schedule was supported by detailed individualised care plans. People we spoke with said they had been involved in their care planning and were able to request changes and we saw these requests were acted upon.”

Treating people with dignity:  “Staff spoke with confidence about how they ensured people were treated with respect and dignity and gave examples of how they did this when supporting people with their personal care needs. People using the service, and relatives, said staff were always respectful and showed regard for people’s dignity and independence.”

Keeping people safe from abuse:  People who used the service told us they felt safe with the care staff allocated to provide their support. Staff told us they were up to date with their safeguarding training and we saw records of certificates, in staff files, to confirm this. The information provided, together with our observations demonstrated that people were protected against the risk of abuse.”

Regular vetting and training of staff:  “We saw that staff were regularly assessed. Managers carried out regular checks to assess staff performance and also to offer support and guidance to staff. Staff said they had enough time to carry out their duties effectively and we saw that staff always stayed at a person’s home for the allocated time to ensure they were providing the most effective care they could.”

It’s great when a homecare agency can be upfront about its operations; none should have anything to hide.



Will my carer help me with just the small jobs? I don’t want a full home care package


Some elderly people don’t want a full care service – what they really want is a bit of everything. This is sometimes difficult to articulate.

We know that the little things make all the difference, so no job is too small. It could be help with shopping, collecting pills from the pharmacy or surgery, helping them get upstairs at night, or just making a cup of tea and having a chat. Obviously, at the other end of the spectrum we have experience in dealing with customers suffering with severe illnesses, disabilities and dementia.

None of our commissions are the same. We build our care plans around what the individual wants and needs, and the home environment that they live in.


Am I at risk with a home carer?


There is always the fear that strangers coming into the home bring risk. An elderly person may be concerned that they don’t know them; that the carer doesn’t know what they like or don’t like; that they might even abuse the situation and steal from them or invade their privacy without consent.

Our care assessment is focused on identifying what someone wants and if possible providing an introduction to them as a person. As our CQC Inspection noted, our care plans are very detailed even down to telling the carer where to find the hoover or where the tea bags are kept.

A good, reputable carer agency, like ours, recruits staff that are good at getting to know our customers really well in terms of their personal tastes and expectations. This is their top priority. And we check, vet and train our carers very carefully. When interviewing we are looking at the values the candidate has in answer to the question: can you show complete respect for the person you are caring for and build lasting , trusting relationships?

This is the most important question to us because we are confident we can train them to effectively perform all the care tasks.