Scottish Care, the umbrella group for independent care providers in Scotland, has reported on how Care at Home services (and associated housing support services) need to be re-evaluated, and their importance recognised in improving social care nationwide.
The report covers three areas: the importance of relationships in care at home; time flexibility; and its important role in prevention.
Relationships in care
The previous National Care Standards for Care at Home (under review) state that people using care at home services should know, on each occasion, who will be providing their care. Their personal plan should include:
‘The name or names of any home care workers who will work with you.’ – Standard 3
This makes sense: close personal care cannot be anonymous: the care is best delivered by people known, and in a mutual relationship of trust and reliability. That is part of the very definition of care.
But sadly, it is not always the case. My personal and professional experience has been that larger providers often find it difficult to coordinate home visits over large areas to ensure consistent visits by the same carer to the same person being cared for. One effect of this is that the personal plan may not be known in advance to the carers, with the potential for mistakes in care. Another is the frustration such visits can cause to the person concerned, which in return affects their quality of life and care.
However, in other services I found good examples of personal relationships in care being a positive influence, where the carer was welcomed as a trusted and reliable supporter of the lifestyle of the person concerned.
This too is very important. We all have events in our life which may require rearranging our schedule and receiving care is not exempt from this. So we should expect providers to be amenable to re-schedule visits on request. This again is supported by the National Care Standards.
Just as important, and relevant here, is that the time and length of visits should be reliable. For example, if a person is being supported to go to bed, or to rise in the morning. their personal preferences should be adhered to, rather than some vague schedule of calling sometime in a two-hour interval. This has sometimes been complained about in Care at Home provision.
A preventive role
Perhaps this is the most important feature of care at home. In the current crisis of increasing pressure on acute services, care at home has the capacity to recognise and treat people’s health and social care needs on the spot, as they arise. Preventing a problem getting worse can reduce the burden on our emergency services. It can also prolong people’s independence, promoting their welfare and indeed lengthening life in many cases. Loneliness and solitude are now widely recognised community problems for older people: reliable and good quality care at home can be a lifeline for people, enabling more responsive attention to their needs and bringing a measure of helpful human contact where this is perhaps lacking.
The Scottish Care report was developed with wide participation by services, and recommends fundamental changes to meet the above principles. These changes include better leadership, improved commissioning support, and better integration and collaboration with the range of other health and social care services which can be provided.
It is advisable for our policy makers, commissioners and providers themselves to work to ensure that these improvements and developments are acted upon. This is in the interests of people receiving services, and in our overall interests in a society where all of us can expect to receive care at some stage in our lives.