Very brief (just a few minutes) Homecare Visits
One of yesterday's media stories, was that some homecare visits take 5 minutes or less.
Rochelle Monte, in yesterday's Daily Mail, commented that some homecare workers are told by their employer 'not to start conversations in case you are 'held up'', and Rochelle pointed out "People just want to chat, you might be the only person they see that day, that week".
Since I became entangled in 'some NHS stuff', and probably also because I'm now getting on a bit, I have come to realise that 'I missed a lot when I was younger'. I still 'miss a lot' - but I'm now much more aware of the problem. When an elderly relative of mine was living alone at home about 25 years ago, we (my parents and/or I) would visit him a couple of times a week. We tended to concentrate on 'feeding and tidying' - and clearly people do need to eat. But 'tidying' ?
Making sure his bed linen was clean, etc, wasn't - with the benefit of hindsight - of as much interest to him, as 'social interaction'. Because he was losing his sight, and lived alone after his wife had died, he had much less opportunity to meet and talk to people: in fact, I'm sure with hindsight, that he wanted us to sit and talk to him, and he wasn't bothered by the 'clean and tidy house' issues.
I sort of wrote about this type of thing, recently in my piece 'Autonomy and Safety':
That was a longish piece, but it included this section:
'It is clear, from many media reports and also various court cases, that when faced with a conflict between patient autonomy and 'safeguarding', most professionals naturally go for 'safety' - at its simplest, most professionals go for the easier-to-'measure' 'keeping people alive' position. But it could be argued, that those children should not be looking at a care home for their parents, and thinking 'does this look 'safe' - it could be argued, that they should be thinking "If my mum comes here, will she look forward to waking up in the mornings". The correct question might be, not 'are you [mum] safe here', but 'are you enjoying being here'. 'Autonomy for me, but 'safety' for you', isn't exactly consistent, is it ?'
One of the problems here, is that these 'soft but valued by the person' things - such as 'I like you to sit and talk to me for a while' - are nothing like as easy to 'measure' as 'harder' things [was a meal prepared ? were medications given ? etc]. And perspectives about what 'matters' can be very different in a young person, and in an old person: or in a person's friend and a council manager.
But it is too facile to say that 'only the hard things matter - social interaction isn't what homecare should be providing anyway': because, 'a life without purpose and enjoyment, probably isn't worth living'. Despite the difficulty of achieving this, somehow we (society) need to get more of 'what the individual being cared for values' into the system. I don't know how we achieve that - but 'care should promote lives worth living', and not just the easily measurable tick-box things.
I think I started to ramble, in there.
I work for a care company that prides itself on person centred care, we do not accept calls less than 30minutes.Tasks do have to be completed but the individual is at the centre of the care plan. I can never understand how some care companies are in bussiness.There must be more good companies out there. We learn about personal history before we even meet a new service user.An individuals well being is a primary care,but it is always bad press you read about.
Hi Rosann, its nice to hear there are other good providers out there, but I am sure you will agree that they are few and far between. There is alot of bad press but it has to be,to ensure people are aware of the issues facing the sector and essentially promote good practice. Our vulnerable deserve better. I'm lucky enough to now work for a very good provider our minimum call time is 1 hour. I have been involved in alot of negative press but am now able to talk about the valuable role when carried out with dignity and respect that filters down through an organisation who truly do care. To us its personal.
Hi Rosann and Rochelle,
As Rochelle says 'it is all personal' and as Rosann says 'the individual is at the centre'.
Losing 'the personal' inside 'a system' is a really problematic thing in both social care and health care - when you stop asking 'am I doing what the person wants or not' the care tends to become 'mechanical and 'production-line''.
Keep up the good work !
It looks as if the campaigning by Rochelle and others has paid off - the momentum has now built, on this one.
There is a report on the first page of today's Times about an intervention by NICE - this seems to be draft guidance published for consultation (I have not yet found the relevant links, but I'll put them here if I find them), but extracting from The Times:
'Whirlwind care visits to sick and elderly must end, the health watchdog has ordered.
...
New guidance, issued today by the National Institute for Heath and Care Excellence (NICE), says that home-help calls should last a tleast half an hour.
...
Gillian Leng, the director for health and social care at NICE, said: "Carers should have enough time - generally not less than half an hour - to carry out the tasks properly without compromising the quality of care. Without adequate support at home, older people can suffer from social isolation, malnutrition, neglect or may even end up in hospital, perhaps from a fall or other accident."'
Yes the campaign is definitely growing and I have high hopes that the Care Act implementation process will give us added impetus with the refocus on well-being and the fact that is not always task based, but also depends strongly on the meeting of social and psychological needs, and not just about physical issues. Sometimes the fifteen minute chat does far more for the individual that any amount of cleaning and tidying. My own Mum who has always been very house-proud said to be yesterday, its taken me 90 years but I now realise that house work isn't that important, its the interaction with others that is. And yes I totally agree with her, yes we have to keep the environment safe, but its interaction that matters.
Keep up the good work everyone.
Hi Liz and anyone else reading - I'm puzzled, because I've looked at the NICE website several times, and I can't find the guidelines/consultation The Times was describing.
I'm going to send an e-mail to NICE asking about this, but if anybody has found the relevant link perhaps they could post it here ?
There were 2 things discussed in The Times in the same article: most of it was about this length-of-care-visits thing, and a small piece at the end was about the [separate] 'identifying cold homes' one - I can find the cold homes one on NICE, but I can't find the care visits one.
I'm somewhat baffled by this - NICE has just sent me this answer to my 'where is the guidance The Times mentioned ?':
'Regarding your query on our guidance, I believe it is the recently published guidance on excess winter deaths and morbidity and the health risks associated with cold homes which you are referring to. You can access the guidance from the previous link. The guideline is for commissioners, managers and health, social care and voluntary sector practitioners who deal with vulnerable people who may have health problems caused, or exacerbated, by living in a cold home. This guideline makes recommendations on how to reduce the risk of death and ill health associated with living in a cold home.'
I've just asked again - although I [think I] was clear enough in my original e-mail - and I've pointed out that the article in The Times ended with:
''The guidance is the first of its kind issued by Nice, and is published today for consultation. The final guidelines are expected later this year.
In separate guidelines also published today, Nice said plumbers and heating engineers should be recruited to prevent deaths because of cold. They would be urged to raise the alarm if homes they visited were not warm enough'.
I'll report on what NICE comes back with, when I get a reply.
After NICE initially pointed me at the 'cold homes' guidance/consultation, I've just received information on the 'care visit times' one - this is the e-mail:
Dear Mike,
Thank you for your email.
Apologies, to clarify, we are consulting on draft guidelines for the topic of home care. The consultation documents can be found from the following link:
http://www.nice.org.uk/guidance/indevelopment/gid-scwave0713/consultation
We encourage people with an interest in our guidance to get involved in the development of our guidance by registering as a stakeholder.
Organisations can register from the start of the development process and contribute by submitting responses to consultations on draft
documents.
For practical reasons, only national organisations can register as stakeholders.
If you are an individual who wishes to comment we strongly recommend that you contact a registered stakeholder organisation that most closely represents your interests and pass your comments to them. If you are unable or do not wish to do this, you can still comment using the proforma. Unfortunately, NICE does not have the resources to respond
to comments from a large number of individuals or local organisations.
We encourage people with an interest in our guidance to:
•
regularly check the list of guidance in development, and consultations
currently open
•
subscribe to our monthly newsletter which provides information on forthcoming guidance, consultations and other news.
I hope the above information is useful. Please let me know if there's anything else I can help you with regarding NICE guidance.
Kind regards,