The National Institute for Social Care (NICE) has developed guidelines for best practice in commissioning and delivering home care for older people in England. The guidelines ‘Home care: delivering personal care and practical support to older people living in their own homes’ were developed through literature research of studies published, and subsequent consultation with stakeholders, including people who receive and provide home care.
NICE intends, after further work, to issue standards for home care covering the areas where this kind of support is seen as most in need of improvement. Organisations and groups are already being consulted on which key areas should be covered, and NICE plans to have these standards released next year.
Stakeholders, providers and other interest groups including carers have welcomed the guidelines. Providers are advised that the inspection of home care will include these guidelines in looking for evidence of good practice: they are therefore well advised to implement the recommendations which are made in the report covering the guidelines.
The guidelines provide very good advice, with many areas which point to, and advocate, substantial improvement in practice.
One significant area is that some people felt that support visits were too short. This is very important, and care and support are not simply mechanical tasks to be carried out – they involve human interaction, discussion and perhaps a bit of banter and gossip. So services are recommended to ensure that the views of supported people are listened to and that support workers have at least half an hour to carry out most kinds of support visits.
A further area is the issue of continuity of staff and of support. The care task is a personal one, where both carer and cared for need to know each other well, and have trust and confidence in each other. This could be very difficult to maintain if a different person arrives at different times each day, with little or no chance for working relationships to develop.
Attention to these two points are crucial for effective support. Care standards are already applied in home care inspections in Scotland, and they state that the service must show consistency of who is giving the care, how it is provided, and the reliable timing of support visits.
The guidelines issued by NICE are a very welcome pointer to best practice, and the forthcoming standards should reinforce and further increase the quality of this expanding area of care and support.
