The CEO of the United Kingdom Homecare Association (UKHCA) has expressed fears for vulnerable people with coronavirus dying unseen in their own homes, if their care providers can’t get enough PPE or go out of business.
Speaking on Good Morning Britain, Dr Jane Townson said that while there has been substantial media attention on hospitals and care homes, her concern is that the “third scene in this unfolding tragedy” is in people’s own homes.
“[We fear for] people dying unseen because the home care workers that normally support them won’t be able to go anymore because the companies that they work for will go bust and family carers will be unable to cope.
“The death statistics don’t look good – 4,570 people are dying of all causes in their homes. The [ONS] data suggests about 20%, 883, are from COVID-19, but we honestly don’t know because no testing has been done.”
In a blog posted earlier this week, Dr Townson urged the government to invest in the home care sector to prevent multiple provider failures “within eight to 12 weeks”.
She warned that costs incurred by home care providers due to the coronavirus pandemic equate to an extra £3.95 per hour of home care delivered, but many councils are failing to pay care providers enough to even cover the rise of the National Living Wage (NLW) that came into effect on April 1.
Key drivers of rising costs related to COVID-19 are PPE and staffing – sick pay and over time – with extra costs including transport, training, remote working and IT being “collectively significant”.
According to the UKHCA, staff absence among a sample of larger home care providers was between 11 and 16% in the week commencing April 13, with substantial regional variations.
“The commitment to cover the costs of Statutory Sick Pay does not apply to employers with more than 250 staff. In either case, home care providers will be paying the care worker who covers the visit, who may also require an overtime payment. This means that many have at least double the staff costs whilst only receiving income for a single visit,” said Dr Townson.
The costs of PPE are also continuing to rise due to an increased requirement for use as COVID-19 has spread and guidance changed, variation in distribution and price gouging.
What’s more, from data collected, it is estimated that COVID-19 has had a negative impact of 15% on home care revenues.
This is due mainly to councils suspending care visits to create capacity for hospital discharge, which Dr Townson says did not materialise at scale, and citizens cancelling their care calls because they are self-isolating and are fearful that their care workers don’t have appropriate PPE.
The government has allocated £3.2 billion to local authorities in the past two months, as they respond to the pandemic.
But, to date, this additional funding has failed to reach home care providers, even after ADASS and the Local Government Association issued guidance recommending an increase in fee rates of 5% to cover the NLW rise and up to 10% to cover increased costs during the pandemic.
UKHCA data on 131 councils shows that as of April 7, the median fee rate for home care was just £16.96 per hour, substantially below the UKHCA Minimum Price for Homecare of £20.69 per hour.
And independent analysis of provider costs, commissioned by UKHCA, estimates that costs due to COVID-19 have increased by nearly 25% against the median fee rate.
Dr Townson says this means that most small home care providers will run into solvency risks after eight to 12 weeks if they have one month’s savings on hand to cover costs.
“Those with smaller reserves may face insolvency sooner,” she said.
With this in mind, Dr Townson said urgent action is required to avert business failures, which risk harm to people who need and support care, and to the NHS.
“It is critical that additional funding reaches homecare providers without delay,” she urged.
Given the pressures on local government and the nature of the emergency, UKHCA has called on the government to mandate and fully fund, in a ring-fenced manner, a national minimum rate for home care.
It has also urged the government to pay additional costs incurred during the COVID-19 pandemic, particularly PPE and sick pay, regardless of the size of employer.
Other demands include an exemption from business rates to create parity with care homes and for the government to cover the costs of the CQC to enable temporary suspension of regulatory fees.
Dr Townson has also urged the government to recognise home care sector in preventing unnecessary admissions to care homes and hospitals, where there is currently an increased risk of COVID-19 infection and death.
“Investing adequately in enabling people to live well and independently at home, could improve quality of life, extend healthy lifespan, reduce pressure on the NHS and save money for the health and care system,” she said.
The UKHCA has calculated that to support 8,600 new patients from the NHS at an hourly rate of £24.63 per hour (UKHCA Minimum of £20.69 per hour plus £3.95 per hour of COVID19 costs), the home care sector would require approximately £424,000 per day compared with £2.9m in the NHS system.
“Home care needs to be centre stage in a national social and healthcare strategy, where care homes and hospital are seen as a last resort,” said Dr Townson.