الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Home health care clinicians seek to provide high quality, safe care in ways that honor patient autonomy and accommodate the individual characteristics of each patient’s home and family. Falls, declining functional abilities, pressure ulcers and non healing wounds, and adverse events related to medication administration all have the potential to result in unplanned hospital admissions.Such hospitalizations undermine the achievement of important home health care goals: keeping patients at home and promoting optimal well-being. Nevertheless, the unique characteristics of home health care may make it difficult to use—or necessary to alter—interventions that have been shown to be effective in other settings. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.
Many older people are very happy with the home care service they receive and value the autonomy it gives them to carry on living the lives they want. However there were many instances of home care which caused us real concern, where human rights were breached or put at risk because of the way care was delivered.
Many of these problems could be resolved by local authorities using opportunities to promote and protect older people’s human rights in the way they commission home care and the way they procure and monitor home care contracts. However it appears that commissioning is not being consistently used to protect human rights effectively. Indeed some commissioning practices make the negative experiences that some older people described more likely to happen.
There is a general lack of awareness among public authorities with responsibility for home care about what complying with the Human Rights Act (HRA), including their positive human rights obligations, actually means. Only around a quarter of local authorities train all elected members with lead responsibility for social care about their important role in protecting and promoting human rights. Our survey responses show that many local authorities commissioning home care would welcome practical guidance on human rights.
There are acknowledged difficulties in regulating this sector which by definition is delivered in the home.
Older people are very reluctant to make complaints, even when they are aware of how to do so. Therefore more sophisticated ways are needed to create an easy dialogue and flow of information between older people, care providers, local authorities and regulators so that any threats to human rights can be picked up and resolved as early as possible.
The majority of older people using home care services lack the protection of the HRA.
A number of other interlinked factors are contributing to the human rights risks identified in our findings:
Age discrimination is reflected in ageist attitudes towards older people, and there are indications that less money is spent on their care compared to other age groups, with care packages unlikely to include support for activities outside the home.
lack of suitable information on the different processes and options for obtaining care and on the quality and different specialisms of care providers, so as to allow older people to make informed choices.
Many older people and self-funders in particular require more guidance on local care providers. There is little or no advocacy or age appropriate brokerage support on offer to assist older people interested in self directed personalized home care in some areas. There is a lack of investment in care workers, influenced by commissioning practice and the workforce being predominantly female and part time, leading to low pay and status, in sharp contrast to the level of responsibility and skills required to provide quality home care. Poor pay and conditions also affect staff retention, causing a high turnover of care workers visiting older people.