Five challenges of arranging home care for an older person

During the coronavirus crisis, a large proportion of COVID-19 deaths sadly occurred in care homes. Which? research* revealed that since the pandemic 31% of people are now less likely to seek residential care for an elderly relative.

A care home isn't the only option for extra support in later life. Some older people receive care in their own homes to help them stay as independent as possible - known as home care or domiciliary care. Home care might be a good idea for an older person who is finding it difficult to cope with daily routines (such as washing, dressing or getting out and about), provided their home still largely meets their needs.

But navigating the home care system can be fraught with difficulty, according to a survey of 367 Which? members who have had experience of arranging this type of care.**

Here are the five main problems that came up time and time again:

1. A complicated system

Setting up home care can be a bit of a minefield, with many people not sure where to turn. Half of our respondents (50%) said they found navigating the home care system 'difficult' or 'very difficult'. Some 30% said they found it hard to know what sort of support was most appropriate for their older relative. And 48% of people said it was 'difficult' or 'very difficult' to find out which different care options were available.

One person told us: 'I was a GP - so I know a bit about this - but I was not prepared for the complexity of managing the service for my 90+-year-old mother.'

2. Concerns about the quality of care

In our survey, 29% of people said they had concerns about the home care service they received in the past 12 months.

Ensuring that an older person gets the best standard of care is obviously a priority when arranging extra support in later life, but out of those who had a concern in the past year, 39% had concerns about the quality of care they received.

Common issues were: lateness and cancellation of visits; care needs not being fully met or care plans not followed; visits rushed or at unsuitable times; and untrained staff.

One person said their loved one's carers 'paid little attention to following the correct procedures' and 'blatantly disregarded' the instructions in the care plan.

• Find home care agencies in your area and check their inspection ratings with the Which? Care Services Directory

3. Lack of continuity

A constant turnover of care staff was another common problem. Some 46% of those who had concerns in the past year said there was a lack of regular carers, which can make it harder for an older person to build up a relationship with the professional supporting them. One respondent said their loved one's carers 'changed frequently and turned up at random times'.

Health body NICE says the continuity of home care workers is important because getting to knowing your carer well builds up confidence and helps people feel safer. It also allows the carers to learn how to communicate best with the person they are supporting and deliver care in the way the person wants.

Another respondent said they were told their relative's care would be provided by a maximum of four different carers, but instead they received 25 different care staff within a short period.

4. Unclear prices

Organising care for an older relative can feel overwhelming, so it was disappointing to learn that some agencies had pricing that was hard to follow - making the experience even more stressful. Some 24% of people who expressed a concern about their care service said they had found a mistake on their bill.

Common areas of confusion were fees for cancellations or changes to the schedule, and price increases for weekends, bank holidays and outside normal working hours.

Someone told us they experienced a shock when they received their first invoice, as the difference between hourly and half-hourly rates hadn't been discussed. They were horrified to learn that 'the half-hourly rate was 88.2% of the hourly rate', rather than the 50% they had reasonably assumed.

• Find out more: The hidden costs of home care

5. Poor communication

If you're arranging home care for yourself or an older loved one, you'll want to know that any problems you run into will be promptly dealt with. But many people told us they had struggled to get the information they needed from their home care provider or have their queries resolved.

Of our survey respondents who had concerns about the service they received, 45% said they had concerns about communication with the office staff of the agency arranging the home care. Others found a frustrating disconnect between dealing with head office and speaking to the individual carers.

One respondent told us: 'We got no responses to requests and questions kept getting referred back up the line with no response.'

What to ask a home care provider

Although navigating the home care market can be complicated, there are a few ways you can make the process easier.

Before you commit to a provider, think about what you want from a professional carer, such as what you need help with and how often you'd want them to visit. Then work out your budget and how many hours a week you can afford to have the extra help.

Next, download our checklist of the questions to ask a home care agency - this handy list of the key things to think about covers questions about the staff, the care service, visits, charges and T&Cs. It will help you to focus on the things that are most important for your needs.

Download the checklist: Questions to ask a home care agency

You'll want to find out how the agency ensures the carer they choose for an individual is a good match, or if a regular carer will visit. Make sure you know in advance what happens in the event of sickness or staff shortages, as well as info about any extra costs you might face.

Once you've made a rough plan, it's time to look at home care agencies in your area that meet your needs. Search for local home care agencies using our directory.

• Find out more: How to choose a home care provider

Alternatives to home care agencies

Not all home care is provided by agencies. Some organisations (called introductory agencies or service brokers) act as a matching service and will introduce self-employed carers to people who need them. You can also employ a private care worker directly without going through a broker or an agency.

This way, the family or person receiving the care is legally involved in a direct contract with the carer. They are directly responsible for paying the carer, rather than the agency. There are pros and cons to this approach, so make sure you read our guide to employing private carers before you go down this route.

Know your rights

Always ask to see a copy of a standard contract before you decide on a home care agency and keep an eye out for hidden charges. Check that the prices quoted include National Insurance contributions, travel and VAT. Also,check if the prices are higher for evenings and weekends.

And remember, home care agencies should always carry out an assessment before deciding on a care plan. This should look at the help required, whether the older person poses a risk to themselves or others by living at home, the safety of carers visiting and arrangements for getting access to the house.

* An online survey of the Which? Connect panel conducted in June 2020.

** The results are based on an online survey of the Which? Connect panel conducted in February 2020.