THE plight of a Ropley couple, who require the services of round- the-clock carers, has served to highlight the findings of a major report criticising the delivery of vital, but often rushed, domiciliary care. Released last month by the Commission for Social Care Inspection (CSCI) the report urges councils to rethink the way they organise home care services. But while Hampshire County Council's aim is to give every vulnerable adult the right to request not to live in residential care, it is not an easy passage. According to an HCC adult services spokesman, on occasions it is difficult to maintain care packages within people's own homes, particularly if the individual lives in a rural area - a fact that can be compounded by the national shortage of people being recruited to the care profession. For Alan and Sheila Capehorn this fear became a reality when an agency ran short of staff and the care stopped. So desperate did they become that their 22- year-old son had to come to the rescue, stepping in to provide the essential morning and evening service usually provided by a qualified professional. And although their problem is now sorted, they are concerned for those who might be landed in a similar situation but with no family backup. Sheila Capehorn, 63, suffered a major stroke five years ago and spent a year in hospital before returning home. She is paralysed down one side and requires 24/7 care. According to husband Alan, 65, while he can do most things, he has a bad back and cannot do lifting. A carer is needed to help his wife in and out of bed and with personal care at the beginning and end of each day. But two months ago the agency providing that care experienced a staffing problem and withdrew its service. Fortunately for the Capehorns, their youngest son stepped into the breach and with his girlfriend has been providing morning and evening care - fitting it in with their full time jobs. While it is not a job they in any way begrudge, it is one which they feel they should not have to do. And the blame, they believe, lies with a system that is not good enough to cope with government policy to treat more patients at home. Alan Capehorn agrees. He may be full of praise for the help he and his wife get from social services in purchasing the care on their behalf, but he is not impressed with the agencies. While the fear of a carer failing to turn up is distressing, equally so is a carer who is rushed or not up to the job. Since his wife returned home the couple have experienced the services of a number of carers, some excellent but some who, they feel, were not trained or able to give the time to administer to Mrs Capehorn's complex medical needs. Furthermore, while Alan Capehorn elected to give up his job to look after his wife when he turned 65 and became of pensionable age, his £46 carer's allowance was cut. And it is this that has most angered his son. Nick Capehorn is incensed that, having spent a lifetime paying into a pension fund, that money is now being set against the carer's allowance. He believes that, by withdrawing the allowance, it has undermined his father's value as a carer and is penalising him for taking on the bulk of the caring himself. In drawing attention to the government's current emphasis on domiciliary care, Nick suggests that it would cost considerably more if his mother was in a nursing home. He is further concerned that, because the care agencies are so short of staff, they are effectively holding social services to ransom over provision of carers. "It should be the other way round. Social services should be calling the shots. They are the ones who are paying," said Nick who, like his father, believes the system needs a major shake-up. It is a view expressed by the CSCI report entitled Time to Care. The report sets out how agencies are endeavouring to meet government standards, while probing the experience of older people who receive care at home. It says that many people find their care workers are too rushed. The "15 minutes slot" model of service, where a care worker is allotted only a few minutes to get a person up, washed and dressed before heading for the next client can, the report says, "be undignified and unsafe". Furthermore, lack of time to provide a quality service was felt to be demotivating and demoralising, leading to serious problems in recruiting, training and retaining good quality staff - a key problem when younger people can find better wages working in their local supermarket. While home care is said to provide a vital service to thousands of people every day, councils are urged to consider new ways of organising these services, so they respond more sensitively to people's needs. Hampshire County Council adult services department says it does all it can to maintain safe services for every individual who falls into its eligibility area. And in this particular case had worked in a flexible way with the family to meet their care needs. In a statement it added: "If a provider cannot provide carers to an individual then we would ensure care for that individual continued, and this would continue, to be funded by HCC. This may involve the care manager organising for another care provider to provide the care or they may offer the individual the option of the Hampshire Direct Payments Scheme (HDPS)." HDPS is designed to put people in control of their own lifestyle by providing them Continued page 3 with the finance to employ the people or services they choose. According to HCC it commissions CSCI registered services on the basis of price and quality, with providers setting their costs as they feel fit. Any complaint received about a care provider would be the subject of an internal investigation and if necessary would be referred to the CSCI. It further explained that the weekly carers allowance was distributed by the Benefits Agency. Its own Financial Assessment and Benefits team (FAB) did its best to ensure that anyone receiving a care package from HCC also received the maximum benefits they were entitled to. Of the comparison in costing between home care and care in a residential or nursing home, it said: "If an individual with complex and high care needs wishes to remain in their own home rather than be placed in a residential environment, the cost of meeting their needs in their home is often comparable to the cost of a bed in a nursing or residential home. In some instances it may be higher."
