The need to find the best home care has never been greater.
As we grow older most of us will require additional support to continue to live independently in our own homes.
Home care typically falls to a spouse/partner, another member of the family, or a friend who lives nearby. These informal carers are the unsung heroes who form the backbone of care in our communities. Informal carers are often of advanced years themselves, being a spouse/partner, or they might work and have other commitments drawing on their time.
As an individual’s care requirement grows it becomes both emotionally and physically more challenging and often overwhelming for the informal carer. This is where professional carers can step in to ease that pressure.
What is professional home care?
Professional home care can come in the form of an individual who operates by themselves, what is known in social care as a personal assistant, or a home care agency which employs professional carers to visit and support their clients.
The majority of professional carers are female, but like nursing, a growing number of men also practice in the care profession. At the initial enquiry you should be asked whether you have a preference for male or female carers, particularly in relation to personal care services.
Personal assistants might have long experience of care or they might be relatively new to it. Unlike care agencies, personal assistants are not regulated and as such are not registered and inspected by the Care Quality Commission (CQC) to ensure that they are safe, caring, responsive, effective and well-led, the five key parameters by which the CQC assesses the quality of care. You can find the latest inspection report for each home care agency on the CQC’s website. However, while not regulated as such, a personal assistant does have a legal duty of care towards their clients and their clients do have a duty to their carer, as an employer.
The advantage of a personal assistant is consistency and familiarity, with the possibility of a strong and trusting relationship building over time. An obvious disadvantage of a personal assistant is when they need to take time off, or go off due to sickness or for other reasons, or when care is required seven days a week. And, of course, the initial challenge is how to find a good personal assistant, personal recommendation being a good start-point.
Employing a personal assistant will be cheaper than employing a care agency, but that should be balanced by the level of service that the best home care agency should provide, with a rigorous assessment of the client’s care needs, a written care plan and regular checks and monitoring to ensure that the level of care is to the required standard. A care agency should also be better positioned to provide continuity of cover, ensuring that there is always a carer to visit when required, including sickness and holiday cover.
What kind of care can I get?
Care is a broad term that covers a broad range of requirements from personal care to meal preparation to housework, laundry, ironing to shopping and errands, to accompanied appointments, to companionship, to help with admin. Most local authority funded care will be restricted to what they consider to be the ‘essentials’, such as personal care and preparing and serving meals.
Personal care includes the more intimate requirements: showering/bathing, personal grooming and using the toilet; a care agency has to be registered by the CQC if they are to provide personal care.
Some clients have reduced mobility and will need help to transfer around their home including the use of ‘moving and assisting/handling’ aids and equipment. Health and Safety laws are very prominent in this area and can cause frustration when agencies tell clients that they are “not allowed” to move a client in a certain way, while a spouse has been doing that all along. While frustrating, Health and Safety rules are there to protect the employee from injuring themselves and of course in turn to protect their employer. Some hoists require two carers to operate them to avoid a client swinging in a sling and banging their head while being transferred.
Which is the best home care? Private or local authority?
If you have liquid assets of at least £23,250 you will have to fund your own care needs. The only exception to this would be if you qualify for continuing care following admission and discharge from hospital with a medical condition that requires ongoing support, such as the effects of a stroke. That continuing care is the responsibility of the NHS and it can be difficult to negotiate as the NHS looks to protect its resources. If you are in this position you might need to argue your case and it is advisable to get support from someone who knows these ropes and is used to marshalling the facts and negotiating hard!
Companies that provide local authority funded care, which includes most, will have contracts to provide care in a particular geographic area, providing ‘in and out’ visits of 15-30 minutes, with individual carers perhaps visiting 20+ clients in one day. For this reason, local authority funded care is known for not being the best home care. It’s typically rushed, randomly timed and with cut-short visits.
Companies that offer a minimum of one-hour visits are able to provide a more comfortable, unrushed experience to the client and the carer, with the chance for conversation and companionship. The other advantage of longer visits is that it is much easier to stick to visit times because there are less individual visits in a carer’s schedule or ‘run’ with less potential for delays to build up.
What does the best home care cost?
Many care companies charge variable rates, more for evenings and weekends and double, at least, for national holidays; because of these additions, the actual average hourly rate can work out at 40-50% more than the stated standard hourly rate. Some companies also charge for the initial assessment meeting to create the care plan. What might seem like the cheaper company, based on its standard hourly rate, will often work out to be at least as expensive or more expensive than those with unvarying flat rates.
What is the availability of home care?
As we all know, social care is under significant pressure and the first question is whether the best home agency for you has available carers to provide the care that you need. Home care is managed on the basis of ‘runs’ or schedules for individual carers and the answer will be positive if there is an available gap or where there can be a rearrangement of visits to fit another client in. There may need to be some negotiation over the exact timing of visits and it might take a little time for visits to settle into a regular pattern.
What questions should I ask a home care agency?
If you are going down the private route and looking to engage an agency, these are the basic questions to ask to ascertain what the best home care agency would be for your needs:
- How do you vet your carers? – this should include a detailed application process, a face-to-face interview, a minimum of an Enhanced DBS check (police records) and at least two references (professional or personal)
- How do you train your carers? – induction training should be done face-to-face over 2-3 days, depending on experience, rather than relying on online training. Does this include specific training in the areas that you will require support in, such as use of a particular piece of mobility equipment (Does the agency have their own training room with this equipment in it?), the safe administration of medication, dementia care, catheter care and so forth?
- Is there an ongoing training regime? – what is the agency’s training culture and how is that training delivered, including nationally recognized qualifications? Are the carers encouraged in their professional development?
- Do your carers shadow before they start working? – carers should spend at least two shifts observing an experienced carer supporting a client, followed by at least two shifts being observed themselves. The care agency should have a flexible view on shadowing, allowing additional shifts if the carer is not quite ready to support a client by themselves.
- Are carers regularly monitored? – care agencies should regularly spot check their carers and have regular supervision meetings and annual appraisals.
- How do you pay your carers? – do you pay a decent hourly rate and do you pay full-rate travel time, plus 45p mileage between clients?
- What is the turnover rate of your care staff? – a care company with a low staff turnover will reflect happy staff who in turn will provide a better level of care to their clients.
- What care management and rostering system do you use? – is this electronic and does it give access to the client’s family/supporters so that they can see when the carers visit and be able to read the notes for each visit, given permission of the client?
- How do you communicate with your clients? – and how do you update clients when there are any changes, such as in the timing of visits and who will be visiting?
- How much will a full week’s care cost, rather than just the hourly rate? – this will show how the ‘extras’, weekend, evening and rates add up. What is the rate for national holidays?
The Care Quality Commission (CQC) rating
If you require personal care the agency has by law to be registered with the CQC. You can access the latest inspection report for the best home care agency for you on the CQC website. Unfortunately, the CQC has been going through a period of reorganisation and is behind in its inspection regime which means that the latest reports might be a few years old and potentially now inaccurate.
The CQC very rarely rates an agency as Outstanding and quite a number are rated Requires improvement. If an agency is rated Good overall you will know that at the time of the inspection it was considered Safe, Caring, Responsive, Effective and Well-led, what the CQC calls its Key Lines of Enquiry (KLOEs). Perhaps ironically most agencies tend to be rated Good for being Caring but when they are marked down it is more often in areas of day-to-day management and procedures. Those achieving an Outstanding rating overall tend to do so because of out-reach activities to their local community, or other instances of going above and beyond, rather than for the quality of their actual day-to-day care.
Other home care resources
The Homecare Association is a fantastic organisation that represents the home care sector, supporting research, providing information and support to care agencies and clients alike and lobbying government.
homecare.co.uk is the equivalent of Trip Advisor for the home care sector, listing all care companies and carrying client reviews and ratings. You can search for care companies by postcode.
Age UK is the leading charity supporting the elderly, it is a valuable resource for those with questions about support for the elderly, they also put on activities and organise volunteer visits, although they are typically oversubscribed.
Age Space describes itself as an online community for the caring generation with free expert advice and guides on all matters of ‘elderly care’.
Building a trusting relationship
Once you have appointed the best home care agency or personal assistant for your needs, like all relationships it needs to be worked on from both sides, generating mutual trust as that relationship builds.
It is very important that the client feels able to fairly challenge the agency or personal assistant without generating a defensive response. A client should feel that the agency has their best interests at heart and while not everything may be perfect the whole time, that the agency responds promptly and positively to address and correct any issues that might occur. Central to this is excellent communication and a can-do attitude.
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