The Care Sector
How the care sector works
The entire Health & Care sector are regulated by the Care Quality Commission (CQC). When a Care Provider employs one or more carers the Care Provider must legally be registered and inspected by the CQC. Inspections are carried out at varying frequencies that depend upon the Care Providers previous inspection reports. If a Care Provider is rated as GOOD or OUTSTANDING inspections are typically every 2 years, for Care Providers that are lower rated, then the frequency of inspections will vary depending upon how significant the CQC deem necessary. The CQC has the power to close any Care Provider by revoking their registration. All inspection reports can be viewed online at the CQC web site. CQC inspection reports are based on a “snapshot “of the Care Provider, smaller providers may have an inspector on site for a couple of days, with additional direct input from a sample of Clients and other Health Care Professionals. The reports may consequently be up to 2 years old and consequently may have changed since the report was produced.
The Big Picture
Historically most Home Care was provided by Social Services by their own staff, this is no longer the case, with the vast majority of Councils commissioning a range of private care providers to deliver the care. The fact a Care Provider is “approved” by any specific Council should not be interpreted as some form of quality badge. “Approved Provider” means the Care Provider has complied with the Councils contractual requirements. This would include submission of a huge amount of paperwork, including policies and procedures and a large number of tick boxes. The Council may have visited the Care Providers offices, it is highly unlikely the Council will have any direct experience of the actual care provided due to a lack of resources and are highly reliant on feedback from field-based staff and third parties. Complaints raised against Care Providers regarding Council Provided services do not generally appear in the public domain by the Council and may require a Freedom of Information request.
Care Providers vary significantly in size, the large organisations have needed to focus mainly on Social Service Clients to gain the volume they need to survive. As Councils have become more aggressive regarding contractual terms, often including penalties for not accepting new care packages or failing to start them within short time frames, the large providers have by necessity had to focus resources around Social Services. Small independent providers may be “approved” by the Council but usually have a different form of contract, where the Care Provider remains in control and can decline Care Packages from the Council without penalty. This is where 1 to 1 Care are currently positioned albeit the majority of the care we provide is supporting private clients.
The Public Perception
The Care Sector has regularly received poor media coverage, usually totally justified in the specific highlighted examples, however it needs to be taken in context of the size of the sector. Every sector has bad apples, but many sectors can deal with them “behind closed doors”, how many large corporations do you trust these days and how many have you had bad experiences with? The programs that expose bad care, often show truly awful examples, but these are a long way from the normal, they are exceptions. This could be down to poor quality individual carers and/or poorly managed and poorly operated Care Agencies. The vast majority of poor and substandard care is provided to Social Services clients, which has a correlation to the chronic under funding in the sector, despite what politicians would have you believe.
The criteria for qualifying for Social Care continues to get more and more onerous. To qualify for Social Services care two separate assessments will be undertaken by Social Services.
The first assessment will be a needs assessment to determine if the person meets the currently defined needs criteria to qualify for social care. The specific criteria are set locally (usually at County level) and have varied considerably historically for different Councils. The advent of continued cuts to Council funding has meant many Councils have increased the qualification criteria to mirror the minimum legal criteria defined in the 2014 Care Act. This approach has been used to reduce many other social support services historically provided by Councils, to the minimum legal requirement, other services that are not covered by legislation have been withdrawn completely and may never be replaced.
The second assessment will be a financial assessment to determine whether the person should financially contribute to their care. The assessment is based on the individual so when a couple are involved it can get complicated and sometimes subjective, you are strongly advised to ensure whatever information is provided to the Council Assessor is accurate and complete as it can be a very protracted process to get it amended later. If the Council Assessor determines that the person has more than £23,250*, the person will be deemed to be Self Funding and will not qualify for any Social Care funding until their financial position is depleted below the £23,250* threshold. If the person has between £6000 and £23,250* the person will have to contribute to their care costs on a scaled basis – the exact mechanism as to how this is calculated, when it is reviewed and how often, does not currently appear to be available in the public domain. If a person has less than £6000 they will be classified Fully Funded and assuming they meet and continue to meet the criteria of the needs assessment they will qualify for free Social Care.
When a person has more than the £23,250* threshold and does not qualify for any Social Services financial support, Social Services can still arrange a care package, however the person will be charged for Care Management in addition to whatever the costs the Council incurs providing the care. As with all Social Services Care, the person will not normally be offered a choice of Care Provider and consequently if a person is deemed as Self Funding it is difficult to see any advantage in using Social Services and several disadvantages.
The only potential advantage might be if the person was close to the £23,250* threshold and consequently after a relatively short period of paying for their care and their financial position became depleted they would then come within the limits and get some Social Care funding.
If the person is reasonably above the limit they would almost always be better of arranging their care privately. This will allow better control for the individual/ family as you could choose to use any Care Provider and change Care Provider if you were not satisfied, it would also allow other aspects of care to be included that would not be allowed under a Social Services controlled care package, this may include tasks/support activities that the person/family deem very useful and helpful but are not deemed sufficiently critical to be fundable by Social Services.
* The £23,250 limit does NOT include the value of the family home as regards Social Care provided in the person's home. The value of the family home is included when being assessed for a Social Care funded Care Home placement.
N.H.S. Continuing Care Funding
This is entirely independent from Social Care and is NOT means tested. It provides free home care when continuing medical intervention is deemed to be needed by a Health care Professional. There is an entirely different needs assessment process and to be considered the person will need to have been referred to the NHS Continuing Care service by a GP or other Health Care Professional such as District Nurses. The exact qualification criteria are set at by the local NHS, with funding normally controlled by the local commissioning group. Life expectancy is not relevant to qualification for NHS Continuing Care funding, it is the need for ongoing regular medical intervention that is relevant and consequently because someone is classified as palliative does not mean they automatically qualify – many do not. If funding is not granted there is an appeals process.
Private Care is provided by Care Providers who are legally required to be registered with and regulated by the Care Quality Commission. Private Care Providers vary in size from National organisations with thousands of carers operating in multiple locations to small independent Care Providers that only provide care locally within a relatively small geographic area. Despite the best endeavours of the Care Quality Commission the standard of care will vary quite significantly between care providers and in larger organisations the quality of care may vary across the organisation itself in different locations.
Guidance for Selecting a Private Care Agency
We have spoken to a lot of people looking for care with no previous experience of the Care Sector, most are unprepared, frustrated and confused by the myriad of web sites and frequently useless and irrelevant “information”, coupled with the poor media coverage the sector receives. It is hardly surprising that many people do not know where to start, other than a driving need for help means they have to.
A good starting point is the Care Quality Commission Web Site. This can be searched for Care Agencies by postcode (from the CQC home page, use the drop down arrow to select “services in your own home”, then another box will open that allows postcode). The Agencies listed may not cover your area as it is based on the registered location. The Agency listing will show their current rating by CQC – this could be 2 years out of date. The listing will also have the Agencies latest inspection report – this could be 2 years out of date.
The Homecare web site has a lot of information and again lists Agencies that have registered (not compulsory), it may also provide reviews, which may be helpful.
The best source is recommendation, do you know someone locally who receives care or someone who’s relative has care, if so ask them what they think. District Nurses are usually a good source of information as they are community based and will work along side care agencies, other health care professionals that are community based can also be very helpful. GP’s generally in our experience are not very helpful, quite a lot don’t have a clue how homecare works.
Before you call an Agency, try and get an idea of what you are trying to achieve. Do you require visits every day, including weekends, how many calls a day, an idea of how long those calls need to be and what needs to be achieved at each call and do calls need to be at specific times of day. Does the person needing care have any medical conditions that need to be taken into account, who will handle medication, do they have capacity to make decisions, it’s a time for blunt honesty.
In some areas of the Country and Oxfordshire is very high on the list there is a shortage of capacity, so if you only want a call at 7.30am and 7.30pm and you are not prepared to compromise you are likely to find it much harder to source care and certainly from a specific Agency that you may have chosen, care is in short supply at present and is likely to stay that way for the foreseeable future you may need to be flexible in the short term.
The larger care agencies will have glossy marketing with pictures, it is highly unlikely that anyone in any of the pictures is either one of their staff or one of their clients – they will be stock photos. They will have been prepared by professional marketeers – this sector is not about words – it is about actions, which goes back to recommendations being the most relevant and valuable information as it is based on personal experience.