Home care: delivering personal care and practical support to older people living in their own homes

Recognise home care as an important component of care packages for older people.

Consider home care support for older people with low to moderate needs to avoid, delay or reduce future dependency on health and social care services.

Ensure home care packages address social care‑related quality of life and the person's wider wellbeing (for example home cleanliness and comfort) in addition to practical support. Recognise that people who use home care services often need support that goes beyond their personal care needs.

Give people choosing direct payments for home care the support and information they need to manage the payments effectively. This should be regardless of whether they buy care through a regulated provider, directly employ a personal assistant or choose another way to meet the agreed need.

Consider involving people with experience of using a direct payment for home care to help provide training, support or advice to others thinking of doing so.

Consider identifying a named care coordinator from among the people involved in delivering care to:

• lead home care planning and coordinate care

• ensure everyone involved in delivering care and support knows what they should be providing and when

• ensure everyone involved in delivering care and support is communicating regularly.

Ensure integrated care and support is delivered to the person through a coordinated group of workers (where care involves more than one practitioner). The composition of this group should reflect the person's needs and circumstances, and should recognise the expertise, knowledge and commitment of all members. Members might include, for example:

• home care managers and workers

• carers

• healthcare practitioners, for example district nurses, GPs

• social care practitioners, for example social workers

• people from voluntary and community organisations, befriending and specialist services, for example dementia advisers

• advocates, including those appointed by the Court of Protection.

Ensure that the named care coordinator and others involved in home care and support planning (in line with the recommendations in the section on ensuring care is person centred):

• understand the principles and importance of involving the person using services, and their carer(s), as appropriate, as an equal partner in specifying the support and services they receive

• know how to work in a way that maximises choice, control, dignity and respect for the person using services

• understand common conditions affecting people using home care services, for example, dementia, diabetes, mental health and neurological conditions, physical and learning disabilities and sensory loss. NICE has produced guidance that covers referral and management strategies for many of these conditions

• know about local and national organisations that provide specialist support

• know about the funding options available for care and support

• understand different funding mechanisms including the options available for people with personal budgets, for example having a managed budget, an individual service fund or direct payment.

Give named care coordinators and others involved in home care planning and support relevant information about a person's circumstances before the home care planning process is started.

Give the person using services and their carer information about how the home care plan will be developed, negotiated and reviewed and the options available to them. Ensure this information is made available to people before home care planning meetings and that they have enough time to read and understand this information.

Ask people if they want carers or advocates involved in their home care planning and support, and respect their choice.

Consider planning support that enables the person to take more responsibility, including for their own financial arrangements for care and support, to increase their independence over time.

Ask people about their aspirations, needs and priorities, as well as what gives them peace of mind, and makes them feel safe and unsafe. Ensure the home care plan:

• empowers the person as much as possible, by recognising what they can and want to do

• explicitly addresses safety, wellbeing, independence and any specialist needs

• is informed by the experience, skills and insight of carers, as appropriate

• addresses the full range of support needed to help the person to live how they choose, including practical support as well as personal care needs (this could include, for example, support to help a person manage their own financial and personal affairs, do their own shopping and cooking, or socialise, or other help depending on the person's needs and preferences)

• makes explicit the role to be played by family and other carers, and the need for review if their circumstances change

• describes how success and outcomes will be measured

• is clear, concise and easy to navigate

• has a summary at the start, with links to more detailed information.

When assessing risk, balance the risk of a particular behaviour or activity with how it is likely to benefit the person's wellbeing and help improve their quality of life. The named care coordinator, or other practitioners planning home care, should:

• complete a risk plan with the person as part of the home care planning process and include this in the home care plan

• ensure the risk plan includes strategies to minimise risk, for example specialist equipment, use of verbal prompts, use of support from others

• ensure the risk plan includes the implications of taking the risk for the person and the care worker

• carry out risk assessments as part of home care planning and at relevant intervals, such as when significant factors change.

Social care practitioners should liaise with healthcare practitioners and other people involved in the person's care and support to ensure the home care plan promotes wellbeing, particularly in relation to:

• medicines management

• pain management

• overall skin integrity and preventive care.

Write any medicines management requirements into the home care plan including:

• the purpose of, and information on, medicines

• the importance of dosage and timing, and implications of non‑adherence

• details of who to contact in the case of any concerns.

Always discuss with the person and their carer whether telecare could complement their home care package (and any other services they are using).

Discuss the potential benefits of telecare, such as how it can provide reassurance to the person and their carer, while bearing in mind the rights of a person, particularly in relation to privacy, choice and control.

Consider addressing the potential negative effect of social isolation on people's health and wellbeing. Consider involving voluntary sector and community organisations to maintain family and local community links, working with the carer as appropriate.

Ask people:

• which elements of their home care service are a priority for them, and

• whether they want some home care time to be used flexibly (that is, used for a variety of jobs according to what is needed).

Give people and their carers (with the person's permission) a copy of their home care plan in a format that meets their needs.

Ensure a 'care diary' (or 'care record') is kept in the person's home. This is a detailed day‑to‑day log of all the care and support provided, which also highlights the person's needs, preferences and experiences. Offer the person a copy of it.

Home care workers should ensure the care diary completed routinely on each visit is detailed enough to keep people, their carers and practitioners fully informed about what has been provided. Record any incidents or changes. Read new entries if you have not seen the person recently.

Ensure all people involved in providing care and support have access to the home care plan and to the care diary. Encourage them to read and contribute to both documents, as appropriate.

Undertake an initial review of the home care plan within 6 weeks, then review regularly, at least annually.

If the person wishes to use telecare, work with them to identify their preferred telecare options that maximise dignity and help them live in the way that they choose.

Ensure telecare does not replace personal contact, unless the person using services wants it to.

Record in the home care plan how the telecare equipment meets the person's needs and will help them achieve their desired outcomes.

Offer people using home care services information about options for telecare that could help them. Include information on potential risks and benefits, so they can make an informed decision.

Ensure service contracts allow home care workers enough time to provide a good quality service, including having enough time to talk to the person and their carer, and to have sufficient travel time between appointments. (This is aligned with the Care Act 2014, which requires commissioners to pay due regard to all costs associated with delivering care and support.) They should ensure that workers have time to do their job without being rushed or compromising the dignity or wellbeing of the person who uses services.

Home care visits shorter than half an hour should be made only if:

• the home care worker is known to the person, and

• the visit is part of a wider package of support, and

• it allows enough time to complete specific, time limited tasks or to check if someone is safe and well.

Consider contracting and monitoring in a way that allows services to be delivered flexibly to ensure the person can identify what is a priority for them. This might include, for example, allowing provider organisations (with the person's agreement or at their request) to use time flexibly.

Ensure home care visits are long enough for home care workers to complete their work without compromising the quality of their work or the dignity of the person, including scheduling sufficient travel time between visits. Take into account that people with cognitive impairments, communication difficulties or sensory loss may need workers to spend more time with them to give them the support they need. Some may need workers to spend more time helping them eat and drink.

Ensure there is a complaints procedure in place. Tell people about how they can make a complaint either in writing or in person.

Make the complaints procedure available on your website and in other ways appropriate to people using the service and their carers. Give information about escalating complaints (to the commissioning body and Ombudsman) or ensure this information is readily available.

Ensure continuity of care so that the person knows the home care workers and the workers are familiar with how that person likes support to be given, and can readily identify and respond to risks or concerns, by:

• introducing people to new home care workers, and

• building teams of workers around a person and their carer, and

• informing people in advance if staff will be changed and explaining why, and

• working with people to negotiate any changes to their care, for example when visits will be made, and

• recognising that major changes (for example moving from home care to use of personal assistants) can make people feel unsafe.

Ensure home care workers are able to deliver home care in a way that respects the person's cultural, religious and communication needs and reflects all 'protected characteristics' in the Equality Act 2010.

Consider the need for independent advocacy if a person lives alone, has difficulty expressing their views and aspirations or lacks capacity.

Home care workers should avoid missing visits. They should be aware that missing visits can have serious implications for people's health or wellbeing.

Closely monitor risks associated with missed or late visits and take prompt remedial action. Recognise that people living alone or those who lack capacity may be particularly vulnerable if visits are missed or late.

Ensure plans are in place for missed visits. These plans could include:

• making arrangements for a family member, carer or neighbour to visit

• giving home care workers contact details for this person

• setting out clearly in the person's risk assessment what should happen if a visit is missed.

Put contingency plans into action when visits are missed or late.

Ensure monitoring of missed and late visits is embedded in your quality assurance system and discussed at contract monitoring meetings.

Ensure home care workers contact the person who uses services (or their carer) if they will be late or unable to visit, as well as informing their manager, if appropriate.

Ensure that the telecare provider gives the person and their carer information about how to use the equipment, and confirm that the person can confidently use it.

Regularly review a person's use of telecare to ensure they find it useful. Involve the person in the review and seek feedback from others, such as carers or call centres. Keep the person informed about any new telecare options available.

Provide telecare call centres with all relevant information about a person's circumstances (if the person agrees).

If providing alarm‑based telecare, ensure response systems are in place. For example, the alarm can be linked to a warden, live‑in care worker, family member or contact centre.

If the alarm is set to alert a carer who does not live near the person, ensure there is a 24‑hour, 7‑days‑a‑week contact close by who is able to provide assistance.

Have a transparent and fair recruitment and selection process that:

• uses values‑based interviews and approaches to identify the personal attributes and attitudes essential for a caring and compassionate workforce, and

• ensures workers have the necessary language, literacy and numeracy skills to do the job.

Consider involving people who use home care and their carers in recruiting and training home care workers.

Ensure that new home care workers are observed at work more than once during their induction period.

Ensure home care workers are able to recognise and respond to:

• common conditions, such as dementia, diabetes, mental health and neurological conditions, physical and learning disabilities and sensory loss (see also recommendation 1.3.8 in the section on planning home care)

• common care needs, such as nutrition, hydration and issues related to overall skin integrity, and

• common support needs, such as dealing with bereavement and end‑of‑life, and

• deterioration in someone's health or circumstances.

Make provision for more specialist support to be available to people who need it (for example, in response to complex health conditions) either by training your own home care workers or by working with specialist organisations.

Ensure home care workers have the knowledge and skills needed to perform their duties safely by providing, as part of the full induction and ongoing training package, specific training on:

• what constitutes 'safe' care

• identifying and responding to possible or actual abuse or neglect

• identifying and responding to environmental risks

• safe care policies and procedures.

Use feedback from people using the service and their carers to assess training needs for the workforce.

Ensure home care workers have opportunities to refresh and develop their knowledge and skills.

Develop workforce plans for the home care sector, in collaboration with provider organisations, identifying current and future workforce needs. Include training and how such needs might be met by prioritising available local authority resources in the plans.

Respond promptly to workers when they request support to deal with difficult situations.

Supervise workers in a timely, accessible and flexible way, at least every 3 months and ensure an agreed written record of supervision is given to the worker.

Observe workers' practice regularly, at least every 3 months, and identify their strengths and development needs.

Appraise workers' performance regularly and at least annually. The annual appraisal should include a review of workers' learning and development needs, and feedback from people who use the service and their carers.

Consider making training available for health and social care practitioners to ensure they collaborate to provide integrated planning and delivery of home care and support.