What can i do about poor standards/delivery of care from home care provider

Steve1310

Registered User
May 21, 2014
16
0
Basildon, Essex
My Dad has been having care delivered at our home as I work by a company thrust upon us by Social Services. Care started 04/06/14 but we only got their Care Plan and Risk Assessments yesterday which I feel have a lot to be desired!
I have been off work to see how well the service runs along with ensuring it meets my Dad's care needs. What I've seen and heard is all too stereotypical of the care industry and reflective of the various documentaries that have been aired about the treatment and neglect by care staff in handling vulnerable patients.
I have not witnessed any particular unlawful incidents, but knowing my Dad has dementia seems to fit the criteria for the carer to ask questions that are all too often answered by my Dad with a "No" and left at that. Things like "Would you like something to eat?" and "Do you need a wash?"
To me, these are basic fundamental elements of the care they have both been agreed to upfront and ones that I have specifically asked them to deliver. It took them 7 days to wash my Dad! (I had washed him in between because of this as well as air his bed which had been wetted during the night) When challenged, they citied that they have a 3 ask rule whereby they ask 3 times if the person wants a particular service and if they decline there is nothing they can do about it otherwise they can be cited for abuse? For their part too, they agreed that none of the requests made fell outside their remit of care and more importantly, responsibility and that with a little coaxing they would be able to ensure things like basic hygiene and personal care were met.
I really find this difficult to comprehend as I have given them the authority to carry out these tasks on behalf of my Dad given his mental capacity and have made it clear that he will often answer "No" when asked questions.
There have also been a succession of carers in such a short space of time which again, is not helping the situation as there is no familiarity being struck up and it seems the carers want to be in and out in as quick a time as possible.
A lot of the services they are suppose to carrying out such as washing and changing his soiled bedding is also not being done on consistent basis. This then falls upon myself to do but is starting to take its toll as it is getting more exasperating whereby I'm expecting to come home and more often than not, find these things have not been done as it has been passed on between carers and just left.
I have also found out that the care company has no dementia trained staff, which again, for a care company seems to be extremely odd?
I was initially told by Social Services that I could either have care provision put in place by them, which at this juncture is abysmally failing, or, they would pay us an amount to find our own care provider. This was too daunting at the time but now I'm thinking it might be for the best?
Has anybody similar views on care provide by Social Services, or also ideas on arranging your own care and how difficult (or straightforward) this is?
I suppose what I'm saying is that I don't want to jump out of the frying pan and into the fire, but with my work on top of this along with bringing up my Son on my own, the stress is getting to both of us and I'm worried and concerned for both my Dad and my Son and this in turn is starting to take its toll on me. Thanks in advance for any thoughts, views and suggestions.
 
Last edited:

Ann Mac

Registered User
Oct 17, 2013
3,693
0
I don't believe that the use of agencies will EVER provide a decent standard of care as the 'norm' - and I speak as someone who has worked for two agencies, and ultimately left the care service as a result of the conditions I encountered, after 22 years experience. These conditions are brought about because the primary function of an agency is to make a profit, and because they are allowed to impose work conditions that not only make it extremely difficult for decent carers to deliver the standard of care that they want, but also leave a lot of carers demoralized and feeling like its not worth the effort, sadly :( The pressure is on to get from job to job, with no allowance for travel time, and an insidious pressure is placed upon the carers to 'shave' time off from calls, so that they can cram the highest number in, in the time allowed. Complaints from carers about them not being happy about the standard of care they are able to deliver, when they are often on zero hour contracts, can and does lead to them being 'punished' by having their hours cut - happened to me, happened to a lot of other carers, that I saw. The 'ask 3 times' rule is a variation on this - I've actually been told by a manager that knowing that the client will say no habitually is how she reasoned I would be able to 'get out early' and be on time for the next call on my list :(

Dementia training is not one of the mandatory courses that a carer has to complete, btw - but even if it is, its completely inadequate, from my personal experience - a couple of hours being told about how AZ affects the brain doesn't help in dealing with the issues it can pose.

In my experience, it was those that 'shouted' the loudest got the better service - which is totally wrong, but sadly true in a lot of cases - a family member who was quick to complain/get on the phone inevitably would cause the managers to take issues a little more seriously - though always the first port of call was to berate and blame the carers!

I know that there are some good agencies out there, but IMHO, they are few and far between - and I have no idea how this can be improved upon :(
 

Steve1310

Registered User
May 21, 2014
16
0
Basildon, Essex
I don't believe that the use of agencies will EVER provide a decent standard of care as the 'norm' - and I speak as someone who has worked for two agencies, and ultimately left the care service as a result of the conditions I encountered, after 22 years experience. These conditions are brought about because the primary function of an agency is to make a profit, and because they are allowed to impose work conditions that not only make it extremely difficult for decent carers to deliver the standard of care that they want, but also leave a lot of carers demoralized and feeling like its not worth the effort, sadly :( The pressure is on to get from job to job, with no allowance for travel time, and an insidious pressure is placed upon the carers to 'shave' time off from calls, so that they can cram the highest number in, in the time allowed. Complaints from carers about them not being happy about the standard of care they are able to deliver, when they are often on zero hour contracts, can and does lead to them being 'punished' by having their hours cut - happened to me, happened to a lot of other carers, that I saw. The 'ask 3 times' rule is a variation on this - I've actually been told by a manager that knowing that the client will say no habitually is how she reasoned I would be able to 'get out early' and be on time for the next call on my list :(

Dementia training is not one of the mandatory courses that a carer has to complete, btw - but even if it is, its completely inadequate, from my personal experience - a couple of hours being told about how AZ affects the brain doesn't help in dealing with the issues it can pose.

In my experience, it was those that 'shouted' the loudest got the better service - which is totally wrong, but sadly true in a lot of cases - a family member who was quick to complain/get on the phone inevitably would cause the managers to take issues a little more seriously - though always the first port of call was to berate and blame the carers!

I know that there are some good agencies out there, but IMHO, they are few and far between - and I have no idea how this can be improved upon :(

Thanks Ann. I know exactly what you mean about the pressure on the carers and my rant and frustrations as such are in no way aimed a them. We have a carer in the morning who, in line with your message about cramming appointments, has 4 appointments at 8 o'clock! This is lunacy as they, as well as my Dad, are all time critical appointments. I did also think the 3 ask question rule was more suited to a get out quick rule. The guy we have in the morning for my Dad is only in his second week as a carer and has already told us that his notice has been submitted as he feels he doesn't get the time to deliver effective care. I read with my blood boiling, some of the rubbish that is being wrote to cover times and have been in my own bedroom on a number of occasions when a carer has turned up, been here for no longer than 5 minutes, but recorded a time of 30 minutes!
I'm told that the carer must spend at least 23 minutes here per 30 minute visit, but have averaged it, based on times recorded and number of visits to date, at 18 minutes, which I think may still be doing the Care Company a favour based on my 'covert' findings.
I am so lacking in confidence at both the Care Company and Social Services; whom I believe have discharged their duty of care now that they have found this poor-performing Care Company, but I equally know how right you are about shouting loudest as I done that for quite some time last week, in trying to establish some key care facts for my Dad as well as expectation of this Care Company in line with their promotional spill.
 
Last edited:

meme

Registered User
Aug 29, 2011
1,953
0
London
most of this is just common sense..no specialist training really required!...I found with my mothers care that I needed to ring the "office"/manager/whoever was in charge ..which meant speaking to several people but keep at it!! tell them what is needed and what is actually happening and by who....another fly in the ointment I found was me and my mother understanding carers etc whose grasp of English was not good ....however keep complaining and things will get ironed out...go for what is really important and don't sweat the small stuff...good luck
 
Last edited:

Steve1310

Registered User
May 21, 2014
16
0
Basildon, Essex
most of this is just common sense..no specialist training really required!...I found with my mothers care that I needed to ring the "office"/manager/whoever was in charge ..which meant speaking to several people but keep at it!! tell them what is needed and what is actually happening and by who....another fly in the ointment I found was me and my mother understanding carers etc whose grasp of English was not good ....however keep complaining and things will get ironed out...go for what is really important and don't sweat the small stuff...good luck
The blindingly obvious is all well and good but when the service paid by office staff/management; whatever you want to class them, is nothing more than lip service, the passing from one person to another within the office to get results simply doesn't happen. All it does is shift the issue at hand, between a number of people, none of whom when you ring back to complain again, are in possession of the full facts due to manner and way the calls are initially treated. I can assure you that the communication I've had with these people has been far more incendiary than what I've wrote in this post and replies
 

gerry200

Registered User
Jan 19, 2014
45
0
Cumbria
Hi! This sounds very familiar. My mother has had Carers for a year now, in a variety of packages - none of which have really worked, but are better than nothing at all. In mitigation, I understand that SS budgets are tight, and the companies have to shave their service to the bone to make the business worthwhile. There is also a two tier structure of private payers and SS funded, with the private payers having first call on a good service. The logistics of running such a business must be a nightmare, with clients dipping in and out of the service as their needs change or they go in and out of hospital. It is also a very difficult job and, certainly in our area, it is hard to recruit enough staff to meet the demand for services.

My experience is that for a multitude of obvious reasons, that they are just not as good as I am at getting my mother to comply with basic actions, eg getting up, toileting, washing etc especially as I can 'force' (as one Carer put it!) my Mother to do things whereas they can't! I often struggle myself to get her to do stuff, so it is much worse for them. When my mother has been in hospital or respite care, if they can't get her to do something, then they will go away and try again in a few minutes or so. An agency Carer doesn't have that option as they have another appointment to go to. I'm at home so I will just pick up the slack. So, for example, this morning my mother wanted to get up early so I 'd done most of it by the time the Carer came in. For the rest of her time, the Carer did some ironing for me.

If things aren't right, I make a lot of noise and, as the contract is between SS and the Agency, I contact the SS. I have generally found the Carers to be great and I have learnt a lot from them as to how to best care for my mother as her needs change as I can draw on their experience. They also look after me as well and check that I am ok - that means a lot. Inevitably, there are some not so good, but that's ok as I'm there to mitigate it which is the nub of it really. Occasionally I think it's not worth having them, but on some days they are a complete godsend and I am very grateful for them.

Gerry
 

Steve1310

Registered User
May 21, 2014
16
0
Basildon, Essex
Hi! This sounds very familiar. My mother has had Carers for a year now, in a variety of packages - none of which have really worked, but are better than nothing at all. In mitigation, I understand that SS budgets are tight, and the companies have to shave their service to the bone to make the business worthwhile. There is also a two tier structure of private payers and SS funded, with the private payers having first call on a good service. The logistics of running such a business must be a nightmare, with clients dipping in and out of the service as their needs change or they go in and out of hospital. It is also a very difficult job and, certainly in our area, it is hard to recruit enough staff to meet the demand for services.

My experience is that for a multitude of obvious reasons, that they are just not as good as I am at getting my mother to comply with basic actions, eg getting up, toileting, washing etc especially as I can 'force' (as one Carer put it!) my Mother to do things whereas they can't! I often struggle myself to get her to do stuff, so it is much worse for them. When my mother has been in hospital or respite care, if they can't get her to do something, then they will go away and try again in a few minutes or so. An agency Carer doesn't have that option as they have another appointment to go to. I'm at home so I will just pick up the slack. So, for example, this morning my mother wanted to get up early so I 'd done most of it by the time the Carer came in. For the rest of her time, the Carer did some ironing for me.

If things aren't right, I make a lot of noise and, as the contract is between SS and the Agency, I contact the SS. I have generally found the Carers to be great and I have learnt a lot from them as to how to best care for my mother as her needs change as I can draw on their experience. They also look after me as well and check that I am ok - that means a lot. Inevitably, there are some not so good, but that's ok as I'm there to mitigate it which is the nub of it really. Occasionally I think it's not worth having them, but on some days they are a complete godsend and I am very grateful for them.

Gerry

Hi Gerry
Although my Dad has had dementia for a number of years he was looked after by my sister. However, she suddenly emigrated totally out of the blue and without notice. I was then primary carer for my Dad despite being in full employment which is why we needed the assistance of the care company. I note what you say about thinking it's not worth having them and that on some days they are a complete godsend, if only they would do the basis things. I have been with them and assisted them these past ten days as I have taken annual leave, with washing and cleaning my Dad and likewise as I have been seeing how my Dad settles with the service and have often had things done by the time they're due or eventually arrived and so there's be no real need for their services sometimes when they have arrived way over the time expected.
I'm apprehensive that when I go back to work next week, I'll be walking in to things not done which I've experienced over the last 10 days.
My experience has been that not only am I looking after my Dad despite his care provision, I am also looking after the care company as they are not demonstrating that they are able, or have the time albeit they should, to look after my Dad's care needs which, as a moderate dementia sufferer are not that complex and on the whole he is compliant when it comes to washing etc... I'm not asking them to go above and beyond their care remit, I'm simply asking them to fulfil it using by a bit of coaxing and common sense as is sometimes needed to get participation of dementia patients
 
Last edited:

gerry200

Registered User
Jan 19, 2014
45
0
Cumbria
Hi! That's some way to spend your annual leave! That's really tough - I hope you've been able to spend some time on yourself as being a Carer and in f/t employment is no joke and you obviously deeply care for your Dad and it must be so difficult to see him not get the care that you feel he should have.

I gradually reduced my working hours to my present one and a half per week as my mother's needs became more demanding - I was lucky (open for debate!) that I could do that.

If your Dad is generally compliant and moderate AD, then to my mind the care should be relatively straightforward so if it's not happening how you want it then you should report it. My mother' care agency have said to me from the start that things should be done how I wanted them done and so I've written out the care plan for them. Then, of course not all of them read it- ah well!

I think It is really hard to understand how to deal with people with AD unless you've had a lot of experience with it. I complained about a doctor in our local hospital who asked my mother if he could stick a needle in her - no explanation why and she'd forgotten what it was all about so of course she said 'no'! Apparently all staff had had the Dementia training! You are so right when you say how you ask is important and one would expect Carers to know that ( and doctors).

I hope your return to work goes ok - at the end of the day you can only do so much and it sounds like you are doing masses.

Take care

Gerry
 

Beate

Registered User
May 21, 2014
12,179
0
London
I find this all a very worrying read. I don't employ carers for the home but based on this would be very reluctant now to do so. In my opinion, leaving someone in soiled clothing amounts to abuse too! I do not understand how they can get away with something like this, and as others have said, I would make a lot of noise if I was you to try and make things better!
 

carpe diem

Registered User
Nov 16, 2011
433
0
Bristol
My mum has a private care agency paid for by the LA.
The main problem is that all carers are just not paid enough, no travel time zero hour contract etc. So one the whole what can you expect if someone is getting paid £4 a visit.
The LA will probably help you find a private care agency and then you have to get a seperate bank account so the LA can pay you the direct payments and then you pay the agency from that.
You may want to find different agencys to provide different things, it's up to you how you spend the money as long as it is on care. You will have to show invoices of what you spend but its very easy.
You could google the agencys in your area and have a chat with them on the phone, see if you think care could be better provided else where.
I also have a sensit monitor which sends me a text when the front door opens, so I can tell when the carers arrive and leave and how long they are there.
 

love.dad.but..

Registered User
Jan 16, 2014
4,962
0
Kent
We have had recent experience of care agencies and carers live in for dad top end of moderate dementia but not aggressive and his needs/demands are very few. Neither carers we have used had a real understanding of dementia and I don't think the agencies delve into their carers' past dementia experiences deeply enough, they just accept what they say or on their CV and the training seems minimal and not that effective. We are self funding dad and it's no better than if SS place carers. It's so frustrating as they all say their carers are experienced with dementia but neither the agencies or carers have a true understanding, you just want them to be honest rather than then discover the carers aren't capable to managing dementia and they don't seem to have a pool of strategies to use like family members have learnt through experience and perseverance, this is what drives sufferers into care home and then that has it's own problems....we are edging, sadly, that way. Dad like everyone with dementia deserves good dementia care and should be able to get that in his own home.
 

Wolfsgirl

Registered User
Oct 18, 2012
1,028
0
Nr Heathrow, Mum has AD & VD
Mum had private carers and we paid for 1.5 hrs to ensure she had breakfast, medication and shower as well as bed changed if necessary (it usually was) and washing put on etc. Sometimes Mum 'refused' the shower.

I rang the agency and said we had booked sufficient time for the shower to take place and to ask the carers not to offer, just switch the shower on and say 'come along, the shower is ready' and she would comply if not actually asked directly. They did then manage to get Mum showered each day and she did need this as her bed was drenched usually despite using the best kind of pads as far as we knew.

I understand completely how you feel - this kind of care is neglectful and is just paying lip service.
 

StevieM

Registered User
Jun 17, 2014
4
0
Stroud
Reading through this thread saddens me greatly.

Some of the things mentioned here are totally unacceptable, they are in breach of contract with the Local Authority and in breach of the Social Care Act 2008.

Visits should be the required length, at the expected time and recorded accurately. Staff should be able to support a client to make choices by framing questions appropriately rather than accepting yes/no. They should be trained to properly deal with the needs of their clients.

If you look on the CQC website for the agency you are using you can find out the name of the Registered Manager. Make contact with them and ask for a copy of their complaints procedure. Armed with this you can set out your expectations and ensure the agency is absolutely clear you expect the service to be of a good standard.

Your primary focus should be on working with the agency to get things sorted. The Local Authority will also have a complaints procedure which you could follow. They may be inclined to simply suggest a change of agency which is an option to consider. You can also let CQC know about concerns (they won't pursue a complaint directly but will appreciate the feedback).

It's not acceptable to give poor care. Please take action to stop this happening as the poor practice is not only affecting your loved ones but also may be affecting others who don't have someone to speak up for them.
 
Last edited by a moderator:

Maldives13

Registered User
Feb 4, 2014
164
0
Hello StevieM
I read through these threads as well and it is worrying. I have reported Mums care agency to social services as the service was just unacceptable. Things are starting to get better slowly. I say that but it is still not good enough really. The carers themselves in the main are wonderful. It is the office people who seems to mess things up! Anyway we are working towards improving. Although my social worker is keen to push us towards direct payments.

I would say take your concerns to the manager and if you don't get any joy keep going! Report them to social services. It's hard and slow but it is worth it.
 
Last edited by a moderator:

Pickles53

Registered User
Feb 25, 2014
2,474
0
Radcliffe on Trent
Veer interesting to read your comments Stevie. We have not been using a care agency long and the main reason we wanted mum to have a care worker twice a day was simply that with no relatives living anywhere near it meant that at least someone had checked on her regularly. Apart from checking/prompting meds, they help with heating up meals and do othe little jobs as needed. They would do more, but mum is not at all keen to have them there (and thinks it's a waste of money) but if they offer something and she refuses or tells them to leave early I think it would just distress her more if they didn't just accept her wishes. If it was something really critical especially related to personal care or medication it would be different.
 

StevieM

Registered User
Jun 17, 2014
4
0
Stroud
@Maldives
They may be keen to push you to direct payments but please be aware they may have targets to meet on this and it isn’t necessarily the best option. Do ask your Social Worker who they feel are the best agencies in your area (perhaps firstly making it clear you’re not interested in Direct Payments).

@Pickles
It’s tricky when the family feel help is needed but Mum or Dad don’t! This can be a cause for conflict for the agency who do need to follow the client’s wishes. Sometimes package break down for this reason. There are other times when it’s perfectly appropriate to frame a question that leads to a desirable outcome – “What do you want to eat today?... this or that” (That you will eat something is not in question, just what it will be), rather than “Do you want something to eat?”

Anyone know how I can get updates to this thread to arrive as an email?
 
Last edited by a moderator:

jeany123

Registered User
Mar 24, 2012
19,034
0
74
Durham
Stevie if you click on Thread tools at the top right and chose Subscribe to this thread you can opt to receive email updates,