Is domiciliary care really the answer to the nursing home crisis?
The sorry state of affairs in nursing homes across Europe has been making troubling headlines for many months. Homecare and technology platforms claim to have the answer. But just how far can they really replace proper care in a purpose built environment?
Supporters say the elderly and infirm want to remain at home as long as possible and technology now enables this. But this week HBI spoke to a consultant who painted a particularly bleak picture not just for those being cared for, but also those caring for them: “Homecare is really tough on the individual; as a care worker it’s rushing under constant pressure. You are showing up for a 25-30 minute slot to give the elderly person a shower, throw breakfast into a microwave, then run out again to travel to another appointment – where you get stuck in traffic on the way.”
HBI hears care workers are routinely moving from nursing homes to domiciliary care platforms like Elder, Marta, and Birdie where they have the option of higher pay, more flexible hours, and more autonomy over which gigs they chose. (Subscribers can click here for more from the homecare technology panel at HBI 2023.)
But our source believes that however attractive they might appear at first glance, these offerings fail to account for day-to-day challenges that can morph into long-term issues: “You’re on your own. It’s much easier working with colleagues. Everyone talks about technology in homecare but it’s a lonely business and so isolating.”
They tell HBI live-in home care is even worse. “Frankly, it’s a nightmare for everyone. Yes, you’re not under as much time pressure, but 24-hour days with someone with dementia asking you the same questions every 15 minutes can make your life an absolute living hell. Staff are accused of stealing, have fights with families, and eventually quit.”
A huge part of homecare business models in many Western European countries is the recruitment of staff from elsewhere, particularly Eastern European countries like Poland, and increasingly from emerging market nations such as the Philippines and Kenya. This too can present problems: “Wealthy people are the ones who can afford live-in care. Live-out homecare is like a relay in the Olympics, live-in homecare is like Downtown Abbey. You can just imagine the cultural clashes with people calling staff offensive slurs. Imagine a lady who always lived a smart life in Surrey, grew up with five-star restaurants and fancy hotels ordering around a care worker as if it were a house in the 1930s.”
These on-the-ground realities do raise valid problems with the homecare model, not least for the care worker themselves. But could this just be part of the teething pains as we pivot away from an era of institutionalism?
According to Peter Dowds, founder of Elder: “There’s never been a better time to be building a home care business. The time is now. It’s what older people, carers, and families want and need. Especially in the UK, there are 200 years of behaviour from the Victorian era that has become the norm over decades, but our quality of life expectations have rocketed over the last 30 years. With the unsustainable costs associated with nursing homes and an ageing population, people living at home longer is the only way forward.”
The kind of technology platforms available today might not have worked 20 years ago, and global awareness of the drawbacks to domiciliary care may be low. But with bankruptcies and closures occurring almost on a weekly basis in the elderly care sector, the home care solution might not just be the best solution in some geographies – it could in time become the only one.
We would welcome your thoughts on this story. Email your views to Michaila Byrne or call 0207 183 3779.
