Whistle-stop home care visits should be avoided and named care coordinators appointed to plan support for service users, according to guidance on domiciliary care from the National Institute for Health and Care Excellence (Nice).
Nice’s guideline for councils and home care providers said visits should last at least 30 minutes and only be shorter if the care worker is known to the person receiving care, the visit is part of a wider support package, and it allows enough time to complete specific tasks such as checking someone is safe and well.
No compromise on dignity
The guidance, which is advisory rather than mandatory, said visits should be long enough “for home care workers to complete their work without compromising the quality of their work or the dignity of the person”.
This meant potentially scheduling more time for people who had cognitive impairments, communication difficulties or sensory loss. Service contracts should also give home care workers sufficient time to travel between appointments, while those being supported should also be seen by the same worker or workers to ensure continuity in their care.
15-minute visit concerns
The advice follows longstanding concerns about the practice of councils commissioning appointments of 15 minutes or less. Three-quarters of English councils commissioned visits of 15 minutes last year, according to research by Unison published in December 2014, up from 69% in 2013. Overall, 15-minute visits made up 14% of all home care visits, though the Association of Directors of Adult Social Services has said these were mostly not for personal care, but to check on people’s wellbeing or prompt them to take medication.
Responding to the Nice guideline, Adass president Ray James said: “Anyone receiving Council funded social care has a right to a personal budget: wherever possible people receiving care and their families should be the ones who choose when and for how long people visit them in their own home.”
The Nice guideline goes further than the statutory guidance under the Care Act 2014, which says 15-minute visits are not appropriate for the delivery of intimate care but may be for safety or medication checks, or if they are chosen by the person.
Councils must follow the statutory guidance unless they can demonstrate legally sound reasons for not doing so.
‘Aspirational but achievable’
Nice said its guideline set out recommendations that were “aspirational but achievable”, with many requiring a change of attitude rather than more money.
However, responding to the recommendations, the Local Government Association (LGA) said a lack of money was to blame for the shortness of home visits. Sector leaders are calling on the government to ensure adult social care is protected from further cuts in the forthcoming spending review, which will set government spending limits up to 2020.
Enormous financial pressures
“Sadly, the rise in short visits is just one of the symptoms of a social care and support system that is under enormous financial pressure,” said a LGA spokesperson. “Councils are doing all they can to work with providers to make sure older people have access to the services they rely on to keep them independent and well and will continue to work to improve care. However, the government must adequately fund the system and commit to a long-term strategy to ensure people get the care they need.”
While it cannot enforce the Nice guideline through its regulatory role, the Care Quality Commission said complying with it would help providers achieve a ‘good’ or ‘outstanding’ rating following an inspection. Currently, 32% of home care services are not rated as good or outstanding.
Nice’s guidance also called for the appointment of named care coordinators for each individual receiving care. These coordinators would be drawn from the professionals who are providing that person’s care and support and could include their social worker or lead nurse. The coordinators would be tasked with taking the lead on home care planning and coordination of care as well as ensuring good communication between professionals.
Value of relationships
Bridget Warr, chief executive of provider body the United Kingdom Homecare Association and chair of the expert group that helped develop the guideline, said it was “vital” that its recommendations were implemented, “particularly in relation to the time available to provide dignified care”.
“We know that people who use home based care value the relationships that they build with those who support them, but can be frustrated if their care is not properly coordinated between different professionals. Therefore we are particularly pleased to see the recommendation of a ‘named care coordinator’ principle in the guideline.”
Further recommendations
Further recommendations made in the NICE guideline include:
- Holding initial reviews of home care plans within six weeks and holding further reviews at least once a year.
- Closely monitoring of the risk of missed or late home visits and taking prompt action where this is an issue.
- Providing service users and their carers with information on their rights, what to expect from home care services and how to make complaints.
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I refer readers to ‘Time to Care’ a CSCI publication in 2008 which said exactly the same thing but better and in more detail. We are very good at ignoring the obvious when it doesn’t suit the agenda – in this case, the cost of supporting people in older age!
My understanding of the legislation is that medication checks are seen as a health need. Medication only visits should therefore be NHS funded, and not provided as a chargeable service?
Neil Clarke
I have had no problem proposing 15 minute visits for people to undertake specific tasks during the day, for example;
To help someone use the toilet
To make a hot drink and sandwich
To prompt medication and fluids
There are many needs that can be met well within a 15 minute visit. Anyone who says that is too short to do something, should sit in a quiet room without speaking and watch the clock while 15 minutes passes.
Ironically, many times a 30 minute visit is arranged as part of a care plan and the carers rush to do the task and leave in under 15 minutes anyway!
I think anyone who suggests 15 minutes is an acceptable length of time for a personal care visit, instead of sitting in a room quietly watching a clock, should have to be the recipient of one of these calls themselves. I wonder how important their dignity would become during a very rushed toilet visit with someone they don’t know well.
Health are once again showing their hand by trying to say the councils are at fault for 15 minute medication checks when it is Health responsibility to provide this care as it is a health need. This lack of understanding across Central Government is typical, blaming the Councils for everything when their facts are wrong.
This seems to contain a presumption of vulnerability. The visits can be only be shorter ‘if the care worker is known to the person receiving care, the visit is part of a wider support package, and it allows enough time to complete specific tasks.’ What if getting brief specific tasks done is the only help I need? Where is choice in this? If I have capacity and I am properly supported to plan my care, I may not want to use an agency but if I have to, I will want to decide for myself.
Steve Hall….how very naive. To many people clock watching in an empty room will indeed seem a long time. But at the end of it, you can go back to what you were doing. Imagine this; sitting alone in your house willing someone/anyone to speak to you just to break the profound loneliness and when that person does come along, they only have 15 minutes. And 5 minutes of that slot includes the clocking in and writing up the notes. 10 minutes to prepare my delicous soup and sandwich all the while thinking about the next person on the round.
Soul destroying for the recipient and deliverer of such “care”.