I have worked in home care since 2009, initially running my own agency and then moving to set up our Home Care Direct platform with the aim to transform how home care is delivered in Ireland, through bettering the lot of carers.
In that time, one thing that I have noticed about the quality of home care provision, is that the greatest influence over the quality of care, comes from families having ownership of the care delivered to their loved ones.
That ownership can come from two main sources. Firstly, through families paying for care privately and therefore demanding and expecting certain standards in return. Where care is funded by the State, ownership comes from families assuming responsibility and control, by channelling funding through true personal budgets or self manged care. That is, the means of giving families the ability to choose how and by whom care is delivered, rather than having that imposed from outside. Importantly, it needs to be real CHOICE, not artificially restricted by limited lists of approved providers or pre-set standardised models of provision.
It was under either of these two conditions, that entities I was involved in, were challenged the most to provide great care.
Having all care depending on third party systems of oversight reliant on form filling and honest reporting to deliver quality care, is a recipe for disaster. It is an invitation to game the system and find the loopholes that allow corners to be cut. It also needs a large and costly oversight regime to do audits and checks.
When families are empowered and are in direct control, that room for manoeuvre for companies is cut down drastically. Families in control can be a profit obsessed corporate provider’s worst nightmare. Much more so than toothless regulations, that they have departments set up to manage and in some cases circumvent.
Of course, not everyone needing care has support from family or an advocate and in those cases yes, they need to depend on regulation and systems in place from third parties. However, at least if large numbers are opting for personal budgets, that regulatory system can concentrate it’s resources on those cases that really need their support.
In the UK, their 2014 Care Act recognised this fact and enshrined in law everyone’s right to opt for a personal budget where appropriate.
In Australia and the US, they also have a much more developed option of self manged care which considerably lessens the burden on central regulation.
If we want to drive real quality in our home care sector, we have to provide choice, and trust in families abilities and interest, to manage the care of their loved ones. In one word, give them Ownership.