Everyone wants it and for very good reasons, as it helps:
Build relationships between staff and service usersImproves the quality of support providedStaff to recognise changes in wellbeingReduce the stress of meeting new peopleImprove communication and confidencePeople to better plan their lives
So why is it so hard to achieve?
First you need to understand how support is delivered. Care at home is made up of a small number of people with support needs linked to a small staff team. Support is usually provided between 07:00 and 22:00, covering Breakfast, Lunch, Dinner and Bedtime.
This is called a run and in the perfect world you would only have to create a run once and never change it. Unfortunately, there are many factors which impact cause plans to change, here are some of the ones which have the greatest impact.
1. Delayed Discharges
Commonly known as “Bed Blocking”, delayed discharges are a priority for NHS teams across the UK. This results in people being discharged from hospital with the basic minimum package. Often people’s needs have been poorly assessed or equipment and adaptations have not been put in place. Medication records and basic information such as how to access the address and when the person will be discharged may be missing. This leaves well-meaning care providers trying their best to support a vulnerable person as well as the existing service users. This type of pressurised discharge leads to service users’ times and staff being changed to accommodate emergencies.
2. Changes in Health
We all have periods in our life where our health changes without warning. This may be something as simple a cold or upset stomach or more serious such as a fall or stroke. To prevent a hospital admission people are supported in their own homes for as long as possible.
Many people are supported by their partner or family, and any ill health of a loved one may also impact their support needs. This may mean a change in visit times, moving to a double run or having additional visits. This impacts the visit times and staff team for both them and other service users on the same run.
3. Death, Admissions and Transfers
Should a person die, be admitted to hospital, go into respite or transfer to a care home then the run will be impacted as new service users are added or existing runs are combined to ensure they can be staffed fully.
If we are to give people an opportunity to work in social care then often this will be on a part time basis, allowing them to work around family commitments. The impact to runs is that you need twice the number staff to deliver the same support. For service users and families this means double the number staff visiting.
All staff need days off, training, holidays and supervision. Additional staff used to cover absences ads to the pool of new faces.
Despite our best efforts, staff leave jobs for better opportunities, to have a family, retire or go into full time education. Any loss from the staff team means changes for everyone.
Refusing staff, means either they cannot work on a run, or the service user will need to move to an alternative run.
5. Everything else
The list goes on but here are some of the issues care providers deal with:
- A person has died
- Someone is found on the floor
- A person is ill and requires an ambulance
- Waiting for hours until an ambulance arrives
- No response when we visit
- Calling the police break into the premises
- Service users cancelling visits without notice
- Asking for the visit to be reinstated without notice
- Emergency discharges without notification
- Broken or missing equipment
- No heating, electricity, food or medication
- The protection of service users from other people
- Staff sickness or personal emergencies
- Changes to bus timetables, cancelled busses
- Poor weather
- The need for double staffing due to illness
- Refusal of support due to gender or ethnicity or visit time
What can we all do about it?
Every single day we work to give the best consistency possible considering all these external factors. Where things are within our control then we work tirelessly to make improvements. Where matters are outside our control then we work to influence others to make changes in their policies and procedures.
Only together with understanding from service users, families, staff, providers and commissioners will we truly achieve more consistent service for all.
What we have done
Novacare have participated in working groups, contributed to external consultations, submitted feedback to the Scottish Government and met with contracts teams and the Chief Officers amongst many others.