HOME CARE

1
HOME CARE

• SETTING STANDARDS
• THE ENGLISH EXPERIENCE

2
HOME CARE IN ENGLAND

• Personal care eg help with washing, getting
  dressed, medication etc
• Social support eg support with daily living and
  maintaining independence
• Practical assistance eg shopping, cleaning
• Health care provided by the NHS eg District
  Nurse or Health Care Assistant is currently
  separate from Personal Care

3
PROFILE OF HOME CARE

• An estimated 3,500 agencies providing personal
  care.
• Only 4 are local authorities, the rest are
  agencies in the private or voluntary sector
• An estimated 250,000 people employed
• Personal care is either commissioned by local
  authorities to meet assessed care needs or
  purchased privately
• LAs commission care for _at_ 382,000 people in
  their own home (Dept of Health stats 2002 a
  decrease of 3 on 2001)
• 3 million hours of care provided per week

4
PROFILE OF HOME CARE

• Average number of contact hours 8.1 per week per
  household (7.5 in 2001, 3.5 in 1993)
• 64 of contact hours provided by the independent
  sector (an increase of 5 on 2001)
• At an average cost of _at_ 70 per person per week
  (nearly 1.4 billion a year)
• Contributions to cost of service vary according
  to income and the complexity/cost of the service
• 22 of households receive intensive home care (5
  increase on 2001 figure)
• Staff turnover 12-15 local authorities but
  higher up to 35 in independent sector

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WHY DO WE NEED REGULATION STANDARDS?

• To protect and safeguard vulnerable people who
  live in their own home.
• To ensure the quality of the service provided
• To respond to and recognise the increasing
  complexity and changing requirements of the task
• To provide a coherent framework for the service
  as a whole, across all sectors
• To protect staff providing the service, working
  primarily on their own, with no direct
  supervision, on premises over which their
  employer has only limited control.

6
REGULATION OF DOMICILIARY CARE

• CARE STANDARDS ACT 2000 introduced national
  requirement
• REGULATIONS legal basis for the standards
• STANDARDS detail of what is required
• Implementation by the National Care Standards
  Commission (NCSC) to become the Commission for
  Social Care and Inspection (CSCI) in April 2004

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WHO IS REGULATED?

• ALL organisations which provide PERSONAL care
  services to people living in their own home.
• Organisations which only provide PRACTICAL
  CARE eg cleaning or shopping services etc are NOT
  to be regulated

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PERSONAL CARE

• For the purposes of regulation Personal Care
  is defined as
• Undertaking any activity which requires a
  degree of close personal and physical contact
  with a person, regardless of age, who for reasons
  associated with disability, frailty, illness or
  personal physical capacity, needs care.
• It will be illegal for agencies providing
  only practical care to undertake personal care
  activities unless they are registered and
  regulated

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PERSONAL CARE ACTIVITIES

• Examples include
• Assisting a person get up/go to bed, get
  dressed/undressed
• Helping a person wash, shower, bath, wash hair,
  shave, oral hygiene
• Assisting a person with their toilet requirements
• Assisting a person with their medication or other
  health related tasks
• Personal support of a confidential, sensitive or
  specialist nature

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NATIONAL CARE STANDARDS COMMISSION

• Agencies providing personal home care registered
  with the Commission
• Regulation came into effect 1 April 2003
• All agencies including each branch of an agency
  will receive an annual Inspection and be
  monitored against the standards
• Within each agency there must be a Fit Person
  who is registered with the NCSC as being the
  overall person responsible for the service.
• Within each office or branch there must be a
  Registered manager who has overall responsibility
  for the day to day management of the service.

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CRITERIA FOR STANDARDS

• They are MINIMUM standards ie they indicate a
  level below which no provider should fall
• They must be realistic and achievable
• They must be focussed on outcomes for service
  users
• They must be meaningful to all
• They should facilitate development and growth of
  the service not provide a straitjacket
• They should be raised and changed to meet the
  changing nature of the service in the longer term
  not become tablets of stone

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NATIONAL STANDARDS TO REGULATE DOMICILIARY CARE
NATIONAL STANDARDS will apply to-

• SERVICE PROVIDERS
• Private sector -
• large national companies
• small local businesses
• Voluntary organisations
• Housing
• Associations
• Local authorities
• Health trusts PCTs

• SERVICE USERS
• Older people
• People with -
• Physical disabilities
• Learning disabilities
• Mental Health problems
• Sensory loss
• Cultural religious needs
• Children families
• Carers advocates

• WITH
• IMPLICATIONS
• FOR-
• Inspection
• Care Commissioning
• Contracting

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PROCESS OF DEVELOPING THE STANDARDS

• Analysis of 90 LA voluntary schemes
  identification of best practice
• Core working group of 20 people representing all
  perspectives and sectors
• Broad reference group
• Group of representatives of service users
• Wide consultation on draft

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USER FOCUSSED SERVICES

• INFORMATION Service User Guide with a Statement
  of Purpose Aims Objectives
• NEEDS ASSESSMENT and care plan
• MEETING NEEDS
• CONTRACT terms and conditions under which the
  care is provided
• CONFIDENTIALITY
• RESPONSIVE SERVICES flexibility to respond to
  the day to day needs of people receiving care

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PERSONAL CARE

• SERVICE USER PLAN detail of how the care is to
  be provided
• PRIVACY AND DIGNITY
• AUTONOMY AND INDEPENDENCE enabling people to
  make decisions about their own lives doing
  tasks with the person rather than for them
• MEDICATION AND HEALTH RELATED TASKS assisting
  with medication

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STANDARD 10 MEDICATION AND OTHER HEALTH RELATED
ACTIVITIES

• Interface with health becoming increasingly
  blurred Intermediate Care agenda, promoting
  independence, Rapid Response, hospital discharge
• Needs of people living in their own home becoming
  more complex
• Move towards Domiciliary Care Staff taking on the
  role of Health Care Assistants
• With the agreement of all parties written into
  the Care Plan and the Service User Plan and
  following the necessary training

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PROTECTION

• SAFE WORKING PRACTICES Health and safety
  legislation
• RISK ASSESSMENT - manual handling risk
  assessment plan for managing the risks
• FINANCIAL PROTECTION safeguarding the money and
  property of the person
• PROTECTION OF THE PERSON from abuse
  (intentional or unintentional,) neglect and
  self-harm
• SECURITY OF THE HOME when entering or leaving
  the home
• RECORDS KEPT IN THE HOME to record care
  activity, financial transactions, medication
  taken etc.

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MANAGERS AND STAFF

• RECRUITMENT AND SELECTION clearance through
  Criminal Records Bureau,
• REQUIREMENTS OF THE JOB Job description Code
  of Conduct
• DEVELOPMENT AND TRAINING induction process and
  specialist training
• QUALIFICATIONS for all newly appointed care
  staff and for managers
• SUPERVISION one to one meetings with line
  manager every 3 months annual performance
  appraisal

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QUALIFICATIONS

• Induction training including TOPSS
• National Vocational Qualification (NVQ) in Care
  level 2/3
• Specialist training
• Training in undertaking risk assessment manual
  handling risk assessments
• Supervisor training - NVQ in Management level 3
• 1st line management training NVQ in Management
  Level 4
• Becoming a Registered Manager

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STANDARD 20 QUALIFICATIONSWHY ALL STAFF NEED
TO BE COMPETENT

• Front line staff work predominantly on their own,
  with no day to day management or supervision, on
  premises over which their employer has very
  limited control
• The nature of personal care is increasingly more
  complex, demanding and stressful
• The interface with health care is more and more
  blurred
• Managers need to know that their staff are
  competent and able to make the right decisions in
  difficult situations
• Service users, with complex personal care needs
  deserve and need to have their needs met by
  competent and trained staff

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ORGANISATION AND RUNNING OF THE BUSINESS

• BUSINESS PREMISES, MANAGEMENT AND PLANNING
  Business and financial plan
• FINANCIAL PROCEDURES
• RECORD KEEPING importance of keeping records up
  to date.
• POLICIES PROCEDURES to support practice
• COMPLAINTS COMPLIMENTS from people receiving
  care their relatives etc
• QUALITY ASSURANCE monitoring of standards,
  annual survey of views of users

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THE ABILITY OF PROVIDERS TO IMPLEMENT STANDARDS
CAN BE AFFECTED BY A NUMBER OF FACTORS INCLUDING-

• The approach adopted to the commissioning and
  contracting of the service
• Payment of a realistic rate for the provision of
  personal care
• Recruitment and retainment of staff
• The ability of staff to deliver on the standards
  in the frontline

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A VISION FOR THE FUTURESOME OPTIONS

• Clearly separating domestic work from the
  provision of personal care working at the
  interface with health
• Amalgamate the role of Health Care Assistants
  (NHS) and people providing personal home care
• Pay staff a realistic rate for the work
• Place staff on annual salaries full/part
  time/job share
• Ensure staff are competent and trained for the
  work they are employed to undertake
• Develop more sophisticated processes for
  commissioning and contracting home care based on
  achieving outcomes and allocating blocks of time.
• Develop a more collaborative partnership with
  commissioners and contractors
• Make the work more interesting. Make it a career
  not just a job

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A VISION FOR THE FUTUREKEY WORDS

• Collaboration and co-operation
• Partnership
• Person-centred care
• Trust
• Quality provision
• Realistic pricing

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• STANDARDS AND REGULATION IS NEVER AN END IN
  ITSELF, BUT THE MEANS TO AN END-
• ENSURING THE QUALITY OF PERSONAL CARE SERVICES
  PROVIDED TO PEOPLE WITH CARE NEEDS LIVING IN
  THEIR OWN HOME

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THE FUTURE LIES IN DOMICILIARY CARE

• TAKING CARE TO THE PEOPLE
• NOT MOVING PEOPLE TO THE CARE

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NOT THE END BUT

• THE BEGINNING!