1. Shifting the Balance of Care: Enabling independent living: A focus on home care / support at home Kathryn Mackay Lecturer in Social Work, University of Stirling k.j.mackay@stir.ac.uk 01786 467714

2. Service by age: Is this still acceptable? Once over 65:  Greater limits will be placed on the cost of your care plan  Services come into your home more than support you to go out  Assessment and care plans are often basic in comparison to those of younger, disabled people

3. What service users say about home care: Care Commission Inspection Reports Good care, but same old problems remain: - Missed appointments - Erratic timekeeping - Lack of consistency of carer - Carer not knowing about the person they are visiting

4. What service users say about home care: Care Commission Inspection Reports “Not all staff are aware when they come that myself is totally blind….sometimes items not left where found” “I find that care workers tend to change very regularly and therefore instruction and requests have to be repeated at every visit”

5. Reasons behind the home carer problems: What the research says  Adverse pay and working conditions - non payment for travel and meetings - zero hours work contracts  Marked geographic variations in supply of workers  Purchasing and contracting culture > specific tasks and minimal time units  Adoption of a ‘Health and safety’ first approach by all agencies – basic minimum

6. Care at Home: Scotland’s goal?  Meeting survival and safety needs or  Providing flexible person-centred care at home (Patmore and McNulty, 2006) And it does not need to be much more expensive

7. Improving home support: Gaining access Looking but not seeing:  Some people are still not thinking beyond the presentation of the medical problem  For example - accident and emergency departments - GPs  If someone can barely walk, how are they going to get to the toilet at home?

8. Improving home support: ‘low level work’  This was one recommendation from Joint Futures Report (1999) that got lost?  Currently community care teams only allocate high priority referrals  So who is doing the important early intervention: house safety and security, changing fuses, small piece of equipment, advice and guidance etc?

9. Improving home care: Looking at the whole person People get divided into units of need  For example, eating is about more than putting food on the plate: intellectual stimulation, exercise, social interaction, community presence as well as sustenance.  What do older people get offered? Frozen meal service Shopping service Day care centre

10. Improving home care: Developing a stable, competent and confident work force  Home care has the least skilled workforce But how to tackle it? - agree minimum training standards Yes BUT - Who provides the training? And critically who pays for it? Pay for travel time Pay a ‘decent’ wage Provide development money for rural areas

11. Improving home care: Listening and responding to the older person  Assessment and care plans written where possible in the person’s own words - especially how they wish to be supported  A realistic time units for care work  Add 5 minutes to each day of the care plan to simply ask ‘How are you?’ and then listen to the response  Need to tackle the communication gap between the person and home carers and the provider manager and the purchaser