Homecare services are getting increasingly poor reviews from families and users of these vital services.
More than half of homecare reviewers rate agencies as poor or bad according to the latest evaluation of reviews left on the Good Care Guide site.
But interestingly reviews of care homes have improved in the last year. Those described as offering good or excellent care has gone up from 55% to 68%.
This contrast in satisfaction rates between homecare and care homes might seem counterintuitive. But there are some possible explanations.
First, over the last decade there has been a series of media exposures of care home scandals and associated action by the authorities. It's difficult to forget the sight of so-called carers hitting and abusing vulnerable older people, as shown on BBC Panorama and other TV programmes.
In response, the inspection regime has got tougher. The public and families using care are also a lot more aware of what is acceptable - and what is not. This has fuelled the use of new technology like CCTV in care homes. Expectations are now higher and care homes more open to scrutiny.
A second reason may have been the continuing rationalisation caused by the market, with a number of care home chains merging and other poor homes closing. Some of the larger chains of homes have also invested more in staff training and development, as a way of motivating staff and reducing turnover.
Thirdly, while care homes relying on council placements will have seen cuts in their fees in recent years, they also have used a variety of ways to offset this loss by increasing income from private fee payers.
Of course not all is rosy with care homes. Some one in five reviews rate homes as poor or bad for quality of care, value for money, and facilities and cleanliness.
It's these homes which should continue to be the target of much tougher inspection and commissioning regimes.
But the government should make improving homecare its top priority. The analysis of Good Care Guide reviews shows 51% rated the quality of homecare as poor or bad in 2015, compared to 23% in 2012.
With more older people needing homecare, this is not good news for them and their families or for the NHS which often picks up the care. The financial pressures on homecare providers caused by council cuts and commissioning have been well documented. The impact is increasingly evidenced by short visits, high turnover of staff and a host of user complaints.
Common comments from reviewers on the Good Care Guide website include staff who had failed to turn up either on time or at all, carers who had not given the correct medication or monitored an individual's food and fluid intakes which is crucial for an individual's condition, rudeness and neglect from staff and carers even falling asleep or stealing.
We need to provide carers with better training, more time and higher pay to do their jobs well. Local spending cuts have exacerbated problems; there is poor communication by carers and their managers, lack of training, lack of knowledge of their clients and often missed or late appointments. As a result, individuals are left risking their lives each day, not knowing if their care provider is going to turn up, if they're going to be given the correct medication, or experience rude or abrupt service as staff either don't have time to spend caring for them or the training to do their job well.
Homecare is the key way to support older people out of hospital, but the deteriorating quality and availability is undermining these aims. The solutions are more funding for councils beyond that already provided, joined up health and care budgets, better regulation of homecare by the Care Quality Commission and listening to the views of older people and their families.
With higher numbers of increasingly frail and vulnerable older people requiring homecare, this must be top priority. It is harder to inspect and police fragmented homecare provision that takes place in the privacy of older people's homes but the CQC has to get better at doing so. Just as they have in relation to care homes, families will have to get smarter at spotting and reporting when homecare is failing. And action on failing homecare agencies needs to be swifter and tougher by commissioners and regulators.
One final contrast. Yet again, the analysis indicates that children are receiving better quality of care than their grandparents and great grandparents. Analysis by the Good Care Guide found that 67% of nurseries and 62% of nanny and babysitting agencies were rated excellent for their quality of care. However, the biggest bugbear from reviewers was the high cost of childcare.
The funding of care - be it for children or older people - will continue to be the subject of intense political debate.