Squeezed funding and staff shortages are creating "extremely fragile" home care services, a report has warned.
A leading think tank and a university said fees for home care services are too low to maintain quality services for the more than 400,000 older and disabled people who need daily help with washing, dressing and eating.
In a report published on Tuesday, the King's Fund and York University found four in 10 home care workers leave their role every year and more than half of staff are on zero-hours contracts.
Researchers also found fears that some care staff are being paid below the legal minimum wage.
They warn this is creating a "relentless staffing" problem, leading to high turnover and reducing continuity of care.
The King's Fund's social care senior fellow Simon Bottery (pictured) said home care had "huge potential" to improve people's lives but needed a "fundamental overhaul" beginning with the expected social care green paper.
He added: "Squeezed funding and a shortage of workers have left the home care sector in a fragile state.
"Home care providers are competing for staff with other sectors paying higher wages, offering more stable employment and better working conditions.
"The system needs a fundamental overhaul, beginning with the upcoming green paper, but the prize of a better, more effective home care service is worth having."
The report said councils had seen a a £16 billion reduction in government grant funding since 2010.
This had led to council spending on social care falling 3% from 2009-10 to 2017-18.
The King's Fund and York University said this was leading to local authorities holding down the amount they pay for home care, with some commissioners sceptical that increased fees will go into providers' profit margins.
It said providers had handed back home care contracts in more than a third of local authorities and some of the largest providers had withdrawn from the publicly funded home care sector.
In 2016-17 about 500 new home care agencies registered every three months, but 400 left the market and 39% of council adult social services directors had seen a provider cease trading.
The Local Government Association and Association of Directors of Adult Social Services called for new cash to plug the funding crisis.
Shadow social care minister Barbara Keeley branded the report a "damning dossier" on the Government's failure to support people who depend on home care.
She said: "This Government's relentless pursuit of austerity, which has seen council budgets slashed and £7 billion lost from social care funding since 2010, has brought our home care sector to the brink."
The report is based on interviews with commissioners and providers of home care across the country.
Interviewees also criticised the "time and task" approach to commissioning home care where providers are paid per hour to provide care but no measurement of outcomes is achieved.
The report recommends home care needs to move away from these payments to commissioning services based on achieving outcomes.
A Department of Health and Social Care spokeswoman said it had given local authorities access to up to £3.6 billion of dedicated funding for social care.
She added: "We will soon set out our plans to reform the adult social care system to make it sustainable for the future.
"We want to promote adult social care as a rewarding career choice and attract and retain staff, and we will soon launch a national recruitment campaign to further raise the profile of the sector."
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