Leading article: Neglect – in your own home

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That it took a review by the Equality and Human Rights Commission to expose the disgraceful state of home care for the elderly in England is in itself an indictment of the present system. It beggars belief that there is no routine means of monitoring the standard of the care provided by local authorities other than by invoking the Human Rights Act. That the care so often falls short – almost half the time – judged even by these most basic criteria says much about the priority it has been given.

The rapid growth in the elderly population is often cited as a long-term liability – though, of course, it also reflects the success that is longer life expectancy. The number of people requiring help to stay in their own homes is increasing, and this costs money. But it does not cost nearly as much to provide services that help people to stay in their own homes, in familiar surroundings, probably with friends and family close by, as it does to fund 24-hour care in a communal home. This is the benchmark against which the cost of care at home should be set, not outdated notions of how little it used to cost and how fewer people should qualify.

It is not hard to discern what is wrong with home care. It is mostly delegated to private companies or agencies – which would matter less if they were properly supervised by the local authorities that commission them. Staff are notoriously low paid, poorly trained and poorly managed. Many care workers rise above this; but many – as the EHRC report shows – do not. Rising bills, and now "the cuts", however, are not the only issues. Local authorities should examine the books of the companies from which they buy in services. They might be surprised, even shocked, to find out where the money goes.

Sooner rather than later, too, the greater number of older people in the population may have an upside as well as a downside. The generation whose life experience was stamped by the exigencies of war is giving way to that of the baby-boomers, who will expect more in return for the taxes and national insurance contributions they have paid. They need to speak up so loudly, and in such numbers, that their complaints cannot be ignored.

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