Home care visits should be 30 minutes or longer, says industry watchdog

Home care workers should spend at least thirty minutes with each client during home visits, focusing on what they can do during this time, not what they can’t, according to the National Institute for Care and Excellence (NICE).

The demand for home care is anticipated to increase in England due to an increase in life expectancy. Nearly half a million people received home care in England during 2013-2014, while 80 percent of them were aged 65 or older.

Current predictions estimate that 25 per cent of people living in England will be aged 65 or over by 2035, a prediction that comes during a time when the future of adult social care is uncertain.

NICE guidelines suggest a change of attitude to care, opposed to needing extra funding

The NICE guidelines offer recommendations that are described as ‘aspirational and achievable’ with many recommendations suggesting a change of attitude to care, opposed to needing extra funding and support. The guidelines recognise the work local authorities are doing, highlighting that many are already providing and supporting high-quality services.

Deputy chief executive and director for health and social care at NICE, Professor Gillian Leng, said: “The need for support at home is something that is likely to affect many of us. As we age, most of us will want to continue living in our own homes, surrounded by a lifetime of memories, for as long as we can.

“Helping a person remain as independent as possible is an important component to maintaining their wellbeing. Without good support, older people can suffer from social isolation, malnutrition or neglect. They may also be at risk of injuring themselves, perhaps from a fall or other accident, if they do not receive adequate help and could end up in hospital.”

The guidelines which are also aimed at Clinical Commissioning Groups and other commissioners of home care services, recommend that services support people's aspirations goals and priorities and also that care workers are treated with courtesy, empathy and respect.

Welcoming the guidelines, minister for community and social care, Alistair Burt, said: “Most of us envisage spending our old age in our own home and we want to provide the great care that can make that a reality. We asked NICE to develop this guideline so that everyone involved in providing home care has clear standards that we will expect them to follow. This will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve.”

Home care workers are advised to make sure the support they can offer focuses on what clients can do and what they would like do, as opposed to offering a ‘one size fits all’ approach to care, so if a person can feed themselves, then they should be supported to do so and not be spoon-fed.

Commissioners must ensure home care workers have enough time for each visit

Chief executive of the United Kingdom Homecare Association (UKHCA), and chair of the guideline group, Bridget Warr, said: "The help each person needs will differ and it is important that the home care delivered is tailored specifically to the individual; his or her needs, wishes and aspirations.

“The guideline emphasises the importance of people receiving support from trained and competent staff with whom they are familiar. For this to happen, those commissioning and delivering home care must work together with the person wanting support to plan the right co-ordinated care in the way the person wants. They should be sure that there is adequate time allowed for the home care worker to provide good, sensitive support in a way that protects and enhances the person's dignity, wellbeing and independence.

“The guideline spells out how this can be achieved and will, I hope, help to provide focus for those many providers and commissioners who want to ensure high quality, responsive, sustainable support at home is available to those who want it."

The NICE recommendations urge commissioners to ensure that home care workers have enough time for each visit without being rushed or compromising the care and dignity of the service users. The time should include enough time to talk to the person requiring care and for the care worker to travel between appointments.

A spokesperson for the Local Government Association, said: "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. The funding gap in adult social care services is growing by just over £700 million each year and it is vital for our elderly and disabled population that Government urgently addresses this. This funding gap is combined with other pressures such as the cost of introducing the National Living Wage, which the LGA estimates will cost councils more than £830 million a year by the end of the decade.

"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 that people get the care they need."

Regular training and development is vital

Home care worker, Miranda Okon works in London and helped to develop the new guidelines. She said: “The role of a home care worker is a valuable one to many older people and their families. I see three or four people a day and help them with things such as doing their laundry or shopping, cooking meals, or helping them to wash. I also make sure I have time to chat to them as I might be the only person they see that day.

“Visits of less than half an hour are not allowed in the area where I work and this makes sure I am able to do everything I need to for each person without rushing. But this isn’t happening everywhere and if workers are in a situation where they have to choose which task to do before they have to rush out of the door this isn’t acceptable. Home care workers deserve proper recognition and support to do their jobs well and giving them enough time is vital to this.

"Regular training and development is also important: not only will it lead to a more skilled workforce, but may even help to retain staff by giving them a better defined career path.”

The guidelines states that home care visits shorter than half an hour should only be made if the home care worker is known to the person and the visit is part of a wider care package, ensuring that the purpose of the visit can be fully and properly undertaken during the allocated time.

In addition, the guidelines stress the importance of prioritising the continuity of care by ensuring people have the same care worker or workers so they are familiar and build a relationship with them during each visit.

Director of homecare.co.uk, the online guide to home care, Davina Ludlow commented on the guidance, saying: "Cuts to council budgets are hitting social care hard.

"Fifteen minutes of care isn't enough - but home care workers are often left with no other option.

"Commissioners are under pressure to drive down costs, which inevitably impacts on quality.

"The Government needs to step up and allocate further funding, before we see this ticking time bomb blow up."

Responding to the new guidelines, director of corporate affairs for Leonard Cheshire Disability, Andy Cole added: “Leonard Cheshire Disability welcomes this new guidance from Nice, which supports our view that high quality homecare should be built around people’s individual needs, aspirations and priorities.

“In particular, we welcome the clear guidance that homecare visits lasting less than 30 minutes should not be commissioned, unless they are for specific time-limited tasks such as checking if someone is safe and well. Care workers need time to care; to talk to people, to deliver compassionate, personalised support, and to maintain safety and quality.

“We are also pleased to see a clear focus on investing in the right support for people at the earliest possible stage. This is vital to enable everyone to continue living independently and would result in a cut in hospital admissions and reduce the need for care and support over the longer term.”

Welcoming the new NICE guidelines, chief inspector of adult social care at the Care Quality Commission (CQC), Andrea Sutcliffe, said: “CQC inspections have found a wide variation in the delivery of home care services – we have seen some great care, but also care that does not meet the standards people who use these services have every right to expect. I hope that staff and providers will use the NICE guideline to improve the quality of care they provide which should help them to achieve a rating of Good or Outstanding.

"I am pleased that the NICE guideline has emphasised the importance of person-centred care and the need to recruit, support and train home care workers appropriately. These are key areas we focus on in our inspections."

NICE has invited stakeholders to comment on areas for quality improvement within home care services. For more information, visit: http://www.nice.org.uk/guidance/indevelopment/GID-QSD135/consultation/home-care-topic-engagement