23 September 2015

Offer personalised care to support those who need help to live at home

Home care visits to elderly people should last for at least half an hour and focus on what they can or would like to do rather than on what they can’t do, says NICE.

Almost half a million people received home care in England in 2013/14, with 80 per cent of them at least 65 years old.

Demand for home care is expected to grow in the coming years due to England’s ageing population.  It is predicted that almost 1 in 4 people in England will be aged 65 and older by 2035.  This comes at a time when the social care sector is facing up to a funding crisis.

Aspirational but achievable

NICE’s first guideline for the social care sector sets out recommendations that are aspirational but achievable.  Many of the recommends require a change in attitude rather than additional funding.  What’s more, a number of local authorities are already getting it right and delivering high-quality services.

The guideline, which is also of relevance to Clinical Commissioning Groups and others who commission home care services, recommends that services support the aspirations, goals and priorities of each person, and that they and their carers are treated with empathy, courtesy and respect.

Home care workers should make sure their support focuses on what people can or would like to do rather than a “one size fits all” service. For example, if a person can still feed themselves then they should be supported to do this rather than being spoon-fed.

NICE recommends that commissioners ensure that home care workers should be given enough time to do their job without being rushed or compromising the dignity of the person who uses services. This includes having enough time to talk to the person and their carer, and adequate travel time between appointments.

Home care visits shorter than half an hour should only be made if the home care worker is known to the person and the visit is part of a wider package of support and the purpose of the visit can be properly undertaken in that time.

Continuity of care 

The guideline also highlights the importance of prioritising continuity of care by ensuring the person has the same home care worker or workers so that they can become familiar and build a relationship.

Professor Gillian Leng, deputy chief executive and director for health and social care at NICE, said: “The need for support at home is something that is likely to affect many of us. As we age, most of us will want to continue living in our own homes, surrounded by a lifetime of memories, for as long as we can.

"Helping a person remain as independent as possible is an important component to maintaining their wellbeing.

"Without good support, older people can suffer from social isolation, malnutrition or neglect. They may also be at risk of injuring themselves, perhaps from a fall or other accident, if they do not receive adequate help and could end up in hospital.”

Bridget Warr, chief executive of the United Kingdom Homecare Association (UKHCA) and chair of the guideline group, said: "The help each person needs will differ and it is important that the homecare delivered is tailored specifically to the individual; his or her needs, wishes and aspirations.

​“The guideline emphasises the importance of people receiving support from trained and competent staff with whom they are familiar. For this to happen, those commissioning and delivering home care must work together with the person wanting support to plan the right co-ordinated care in the way the person wants. They should be sure that there is adequate time allowed for the home care worker to provide good, sensitive support in a way that protects and enhances the person's dignity, wellbeing and independence.

​“The guideline spells out how this can be achieved and will, I hope, help to provide focus for those many providers and commissioners who want to ensure high quality, responsive, sustainable support at home is available to those who want it."

"I might be the only person they see that day"

Miranda Okon, a home care worker who helped to develop the guideline: “The role of a home care worker is a valuable one to many older people and their families. I see 3 or 4 people a day and help them with things such as doing their laundry or shopping, cooking meals, or helping them to wash. I also make sure I have time to chat to them as I might be the only person they see that day.

​“Visits of less than half an hour are not allowed in the area where I work and this makes sure I am able to do everything I need to for each person without rushing. But this isn’t happening everywhere and if workers are in a situation where they have to choose which task to do before they have to rush out of the door this isn’t acceptable. Home care workers deserve proper recognition and support to do their jobs well and giving them enough time is vital to this.

​"Regular training and development is also important: not only will it lead to a more skilled workforce, but may even help to retain staff by giving them a better defined career path.”

​Minister for Community and Social Care, Alistair Burt welcomed the guideline, added: “Most of us envisage spending our old age in our own home and we want to provide the great care that can make that a reality. We asked NICE to develop this guideline so that everyone involved in providing home care has clear standards that we will expect them to follow. This will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve.”

Read a summary of the key recommendations for commissioners and providers

Have your say on the development of a quality standard for home care that will focus on roughly 6-8 specific key areas of care most in need of improvement.

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Helping a person remain as independent as possible is an important component to maintaining their wellbeing

Prof Gill Leng, NICE

The help each person needs will differ and it is important that the homecare delivered is tailored specifically to the individual

Bridget Warr, United Kingdom Homecare Association

If workers are in a situation where they have to choose which task to do before they have to rush out of the door this isn’t acceptable

Miranda Okon, home care worker