As we work toward services that enable people to remain in their home of choice, it is important that the barriers to providing people with the support they need are identified and addressed. To that end NICE has produced a new set of quality standards focussed on home care of older people.
Statement 1. Older people using home care services have a home care plan that identifies how their personal priorities and outcomes will be met.
Older people using home care services have a care plan that reflects what support they need, what is important to them, what they feel they can do, and what they want to be able to do. It should also take into account their specific health problems or disabilities.
For someone living at home with dementia, it is important to assess at regular intervals that the care plan is fit for purpose, as per the NICE guidelines Dementia: Independence and wellbeing “People with dementia are involved in making choices and decisions about their care and support.” And “People with dementia take part in a review of their needs and preferences when their circumstances change”.
Statement 2. Older people using home care services have a home care plan that identifies how their home care provider will respond to missed or late visits.
Older people who use home care services have a plan for what their home care provider will do if a visit is late or missed to ensure that they stay safe. The plan will include details of who will come if a home care worker misses a visit (for example a family member, carer or neighbour).
When the person receiving homecare lives with dementia a missed visit can cause additional stress, it is really important that the wider support network is aware and can step in as important aspects of the routine can be missed and it can lead to the person losing confidence to remain in their own home.
Statement 3. Older people using home care services receive care from a consistent team of home care workers who are familiar with their needs.
Older people who use home care services have the same home care workers who are familiar with their needs. Older people and their family members or carers are notified in advance if new staff will be visiting.
This is extremely important when delivering care to a person living with dementia, whether or not they live alone or with a primary carer, the home care worker get to know what is important to the person, any communication problems and cultural or other special features which can make a difference to the continuation and quality of care. A home care worker who knows a person can also better detect any changes in the condition and assess if an early review of current arrangements are necessary.
Statement 4. Older people using home care services have visits of at least 30 minutes except when short visits for specific tasks or checks have been agreed as part of a wider package of support.
Older people who use home care services have home care visits of at least 30 minutes unless they, and their family members or carers, have agreed in advance that some shorter visits for specific tasks or checks can meet their needs.
Shorter visits have been recognised by the CQC as confusing for someone with dementia, and home care staff find it difficult to carry out meaningful activities with less time.
Statement 5. Older people using home care services have a review of the outcomes of their home care plan within 6 weeks of starting to use the service and then at least annually.
Older people who use home care services have a discussion with a member of their care team about whether they are happy with their care and if it is helping them in the way that they want. This should happen within 6 weeks of starting to use the service and then at least once a year. Older people can involve a family member or carer in the review of their care if they wish. The home care provider should agree how often a review is needed but the older person and their family member or carer should know who to contact in case they want to arrange a review at a different time.
To involve the person living with dementia these reviews should take place with a care team worker who is familiar to the person living with dementia, who understands their background and needs and is able to communicate with the person.
Statement 6. Home care providers have practice-based supervision discussions with home care workers at least every 3 months
Older people who use home care services can be confident that they are receiving care from home care workers who are well supported and have regular discussions with their manager. The care workers work with their manager on improving their skills and approach if they need to so that the service they provide meets the needs of older people.
Home care workers supporting a person living with dementia should understand how dementia impacts day to day life and have the knowledge of best practice when caring and assisting a person to remain in their house with a good quality of life.
DSDC have developed a specific version of our training program Best Practice in dementia care aimed at care workers caring for people at home.
Read the full guidelines Home care for older people