'Devastated' domiciliary care users voice concerns

Numerous domiciliary care users and their families have contacted The Derry News following major changes in provision in Derry’s cityside.

Introduced by the Western Health and Social Care Trust, the changes came into effect on Monday morning and have caused widespread distress for service users, families and carers.

Essentially the changes mean every service user will have completely new carers and will receive significantly shortened care visits.

Dr Imelda Foley, who joined the home care system following a two-month stay in hospital suffering from C. difficile, said she had always championed the Trust’s services, even when some people criticised them.

“I have received the best possible care and indeed become friends with some of my carers,” said Dr Foley.

“However, I have serious concerns about the Trust’s new home care arrangements, and I’m not alone. The Trust’s objective of discharging more hospital patients quickly is laudable, but the modus operandi does cause concern.

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“These changes mean a carer’s workload is to increase by 63%. This massive increase in productivity is expected to be achieved with the same resources as before, drawing on the energy of carers who are already run off their feet. I would ask the Trust to explain current or historic examples of such an endeavour working before.

“In addition, what consultation process has been conducted between users and providers? I received a letter informing me this was to happen: a letter, after the fact, does not constitute consultation.

“If the Trust’s changes have been “successfully introduced elsewhere”, how has this success been measured and by whom? And, during this pilot project, has the Trust measured an increase in staff turnover and leave due to stress and anxiety,” said Dr Foley.

Dr Foley also expressed concern no time had been allocated for carers to travel between calls. She was worried this would cause “danger in traffic”.

“I would also love to know how carers in the dedicated time of 25 minutes may undress, shower, dress and dry the hair of the client who relies on them?” asked Dr Foley.

Speaking about their experience on Monday morning, Dr Foley’s daughter said the new carers who came to her mother were forced to explain they had no time now to do some of the things with which she normally gets help.

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“For example, I cook fresh food the night before, so they can heat it on the hob for mum, while I am at university or work, but now they only have time to hand her a sandwich,” she said.

“This is mum’s main meal of the day because she can’t eat at night due to digestive issues, so she is looking at a couple of cheese slices for her day’s protein. That’s about 90% less protein than is healthy and is not going to help with her osteoporosis.

“They’ve been allocated just 15 minutes for this lunchtime call. Most of that time is eaten up by walking from the car park to the building, climbing the stairs to the flat, and back again. Someone hasn’t thought this through!

“Carers are also reporting their colleagues at the Waterside, where the ‘successful pilot’ happened, have quit their jobs in droves.

“What is the point of ‘increasing efficiency’ when it dismantles the actual value of the service offered? A cheese sandwich might be more efficient than a real meal, but the calories are empty and so is this whole efficiency drive. The efficiency-mongers forget that ‘care’ is the heart of what they do,” she said.

Another domiciliary care user who had to contend with Monday’s changes was Eileen Johnson (82), whose husband died this time last year.

Eileen’s daughter, Roisin Gallagher, said her mother, who gets four calls per day, received a letter from the Trust in February informing her about the changes.

“Mammy has onset dementia and has been receiving domiciliary care since February 2022. The changes have left her very disorientated this week,” said Ms Gallagher.

“I rang her social worker as soon as she got the letter. I explained mammy would be unsettled at this time as it was daddy’s first anniversary, and if there were any changes happening I would like to be informed so I could prepare mammy. I spoke to the social worker three times. She told me she was sending a letter to the Trust saying she wouldn’t recommend mammy’s carers changing because of her dementia, her situation - she just lost her husband - and she lives alone and would be frightened about new people coming into her home.

“I assumed because I didn’t hear anything, nothing was changing for mammy. It now appears the Trust did not send that information to the domiciliary care agency. Last Tuesday, one of the carers told mammy this would be her last week. Mammy was and is heartbroken.

“The girls that come into her, we class them all as family friends. They helped us look after my daddy in the final weeks of his life. We put complete trust in them and they are as devastated as us.

“Because we were not told anything by the Trust or the agency, we were not able to help mammy to transition. She is very worried and on Monday morning the new carers didn’t have the key for the door. I was assured on Friday evening when I was speaking to the social work manager, all the information, including a risk assessment, had been passed to the new agency. I reiterated to them, we hadn’t been informed. The letter was sent from the Trust and there was zero follow up,” said Roisin Gallagher.

“My mother who worked all her life, paid tax and national insurance, deserves to be treated with respect and dignity, as do all those needing domiciliary care,” she added.

Adrian Lynch’s mother Susan (93) is another of the Derry domiciliary care users affected by shortened calls and changed carers.

Speaking to The Derry News he said his family’s ultimate aim was to see their mother’s care “returned to what it had been”.

“We are mystified,” he added. “As the saying goes, ‘Why fix something that’s not broken?’ Effectively, the strong, caring relationship mum had built with her carers of 20 years has been fractured”.

“Mum’s carers are family to us. We get them Easter eggs. We get them Christmas presents. They know mum’s case inside out. They know her needs. They know everything about her. Sometimes they know more than us because she chats to them and they are able to relay information back to us and advise us what to do to make her as comfortable as possible. They are fantastic and they are all on first name terms with mum,” said Adrian Lynch.

“During covid we could not get near my mother and we would have been lost without her carers. They would have phoned us and said, ‘She’s doing grand’. They were unbelievable. They are devastated by these changes.

“As regards my mother, there is not a chance all her care needs will be met in the new 20 minute time frame. She has poor, poor mobility. She needs two carers in the morning. They go upstairs, they wake her, they wash (maybe shower) and change her, they bring her down and make her breakfast.

“Mum has Alzheimer's and sometimes might not know what’s going on but she knows the carers that are there. She will get confused with these new carers. 

“Mum’s carers were our family and our point is, for the amount of time my mother has left, why, in these circumstances, put her through this massive change?” asked Adrian.

The letter from the Trust’s director of community and older people’s services informing people of the changes to domiciliary care advised anyone with concerns to contact their social worker.

One service user, who wished to remain anonymous, told The Derry News she had wanted to keep her carers, who she now regards as her friends, because they provided personal care and it had taken her more than a year to trust anyone in this regard.

Her son said it had proved “absolutely impossible” to contact a social worker to speak to about their concerns because of the “huge backlog” in the Trust area in appointing social workers for domiciliary care users.

In response to an enquiry from The Derry News on the concerns of service users regarding the changes in domiciliary care provision, a WHSCT spokesperson said: “The Western Trust can assure that carer’s workload has not increased by 63%. 

“An analysis of the new arrangements indicates that the number of care calls has increased by around 15%. Typically this represents an additional 2 calls for each rota. The ability to accommodate these additional calls can be explained by the consolidation of rotas within defined geographical areas resulting in less time spent travelling and by better utilisation of gaps in carer’s rotas.

“Cityside is the eighth of nine fWestern Trust localities to undergo this change to homecare services. Since 2022 the change has been implemented in Enniskillen, Irvinestown, Limavady, Omagh, Waterside, Lisnaskea and Strabane. Feedback from these areas has been very positive from the range of stakeholders. 

“The Trust has monitored staff turnover and absence rates across the in-house service and independent sector providers who are contracted to deliver homecare services. There is no evidence of increased turnover or absence as a result of the change. 

“The Western Trust factors in travel time between calls. 

“The care rotas are constructed to ensure that there is sufficient time to accommodate the range of tasks required to be undertaken for each of the individuals.

“The Western Trust is unable to comment on individual cases.  The Trust does recognise that during the transition phase that it will take time for the new arrangements to bed in.  Affected service users should link with their social worker if they have concerns or are in need of support.”

The Derry News approached North West Care for comment.