Basic human rights of older people are abused in home care

BMJ 2011; 343 doi: (Published 25 November 2011) Cite this as: BMJ 2011;343:d7678
  1. Adrian O’Dowd
  1. 1London

The needs of older people receiving home care in England are often unmet and there are too many examples of physical and financial abuse, claims a report.

A highly critical report from a year long inquiry into the home care system in England has found evidence of “serious, systemic threats to the basic human rights of older people” who receive home care services.

The final report of the Equality and Human Rights Commission’s inquiry says the poor treatment of many older people breaches their human rights and too many find it difficult to voice concerns about their care.

Poor standards of care and little support have also led to some cases, says the report, of older people experiencing severe weight loss and dehydration, affecting their health.

One case described an older man with dementia who lost so much weight, because he was not being supported properly by home care workers to eat, that he was admitted to hospital and died three days later.

An estimated 20% of older people living at home receive care services and in 2009-10, around 453 000 people received home care through their local authority.

The report describes home care as help with personal care, which can include bathing, dressing, getting into and out of bed or on and off the toilet, preparing meals, housework, going to the doctor, and shopping.

A small number of cases identified of physical abuse were most often in the form of rough handling or unnecessary physical force directed against older people.

Around half of the older people, friends, and family members who gave evidence to the inquiry team expressed satisfaction with their home care.

However, the inquiry also found many examples of older people’s human rights being breached, including physical or financial abuse; disregarding their privacy and dignity; and failing to support them with eating or drinking.

The authors questioned commissioning practices that focused on a list of tasks, rather than what older people wanted, and that gave more weight to cost than to an acceptable quality of care.

There were also insufficient ways for older people to complain about their home care or these were not working well, said the authors.

The report recommends closing a loophole in the Human Rights Act under which people who receive care from local authorities are protected by the act, but lose this protection if the care is contracted out to an agency.

Other recommendations include better monitoring so that the government, Care Quality Commission, and local authorities worked together better to build human rights into home care.

Sally Greengross, commissioner for the Equality and Human Rights Commission, said: “It is essential that care services respect people’s basic human rights. This is not about burdensome red tape, it is about protecting people from the kind of dehumanising treatment we have uncovered.

“The emphasis is on saving pennies rather than providing a service which will meet the very real needs of our grandparents, our parents, and eventually all of us.”

The charity Age UK’s director Michelle Mitchell, said: “It is simply unacceptable that care in people’s own homes, where they can be at their most vulnerable, is often inadequate, disrespectful, and lacking in dignity.”


Cite this as: BMJ 2011;343:d7678