In April, deaths of those receiving domiciliary care services were 2.7 times higher than the three-year average, an excess only slightly lower than in care homes. Yet there has been little focus on this sector during the pandemic.
The infection control issues reported by workers, lack of PPE and inadequate sick pay, are common across social care. The neglect from government has been even starker for home care workers than for care homes.
Over half of domiciliary care providers report having no allocation from the national infection control fund, which specified 75% of the money for care homes. Many people receiving home care have cancelled their service for fear of contracting the virus from carers.
Up to 73% of domiciliary care workers are on zero hours contracts. Time in the sector is highly fragmented, with “spot” rather than “block” commissioning, and travel time between clients and gaps between scheduled visits often unpaid.
A regular client admitted to hospital may equate to no pay, despite the employer receiving a retaining fee. The 15 minute visit has largely been removed from the sector in recent years, but as cuts raise the eligibility criteria, increased duties per call intensify labour.
Those conditions hurt the service as well as the workers. Care in the home is held up as allowing frail people to keep their independence, but service users report conflicts over intrusive scheduling and generic care. Developing trusting relationships with workers is vital for clients, and consistency is key, but there are high levels of turnover and vacancies. 36% of workers have reported to Unison that they are not scheduled with regular clients.
Union organisation, notoriously low across social care, is largely concentrated in care homes. Pockets of organisation exist in publicly run services, for example in intensive discharge teams, where workers in Birmingham had a successful dispute in 2019.
But there has been a 37% decrease of publicly provided care over the last 10 years. Workers are isolated. 44% of workers surveyed by Unison said they only ever saw their immediate fellow worker. Bullying is common.
The whole of social care is now in crisis, financial as well as medical. Political campaigning for public ownership must include domiciliary care, and unions need organisation drives like those used in Deliveroo to reach care workers.