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Home care visits should last 30 minutes and be personalised – NICE

Home care visits must last at least 30 minutes and be tailored the individual rather than following a one-size-fits-all approach, NICE’s first guideline for the social care sector has recommended.

The guidance states that home care visits to elderly patients should only last less than half an hour if the worker is known to the person, the visit is part of a wider package of support or only specific and brief tasks or check-ups must be completed.

The recommendation states that service contracts must allow home care workers enough time to provide good quality services, including having enough time to talk to the individual and to travel between appointments. Carers should not be “rushed” during their job or compromise the dignity or wellbeing of the person using services.

NICE also suggested that contracting and monitoring should made in a way that allows for more flexible service delivery, including by letting provider organisations use their time based on the person’s priorities.

Miranda Okon, a home care worker in London who helped develop the guideline, said visits shorter than half an hour are not allowed in the area where she works, which ensures she delivers everything the person needs.

“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,” she added.

However, the LGA, representing that councils that fund social care visits, blamed the rise in short visits as another symptom of the financial pressures facing the sector.

A spokesman said: “The funding gap in adult social care services is growing by just over £700m each year and it is vital for our elderly and disabled population that government urgently addresses this. 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.”

The guidance also laid out a need for the social care sector to tailor its services to each individual. Services should support the aspirations, goals and priorities of its users, and their carers must also be treated with respect and empathy.

Part of this includes moulding support services to what people can or would like to do rather than following a cookie-cutter structure. If a person can still feed themselves, for example, they should be supported to do this rather than be spoon-fed.

The importance of prioritising continuity of care is also emphasised in the guidance, which recommends that service users should have the same home care worker so they can become familiar with them and build a relationship.

Bridget Warr, chief executive of the United Kingdom Homecare Association (UKHCA) and chair of the guideline group, said: “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 their right coordinated 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.”

Overall, the guidance spelled out seven priority areas of recommendations that should be adopted in the sector. These included ensuring a transparent process for matching care workers to people, taking into account specific skills and needs.

It also suggested identifying a care coordinator amongst providers to lead home care planning and coordinate care by making sure everyone knows that they should be doing and when.

There must also be greater integration between home care workers and the NHS, with healthcare practitioners and carers “liaising regularly” about the person’s medication.

The home care workforce must also undergo specialist training so they can understand conditions affecting those with dementia, diabetes, mental health conditions and learning disabilities. This includes knowing about local and national organisations that provide specialist support.

Alistair Burt, community and social care minister, welcomed the guideline and said it will provide reassurance for “countless families who rely on this care”, as well as for the thousands of workers who “want the time and support to be able to give people the care they deserve”.

NICE is also collecting feedback on the development of a quality standard for home care that will focus on around six to eight key areas of care that most need to improve. The anticipated publication date for this document is June 2016.