A few years ago, I was asked by my boss, who was new to homecare, to write about what he called, Random Acts of Kindness. This was nothing to do with Random Acts of Kindness Day which is celebrated on February 17th but more about capturing what is sometimes called in homecare ‘going the extra mile’. The manager had been visiting homecare branches and had been blown away by the kindness care staff were showing towards their service users. Their kindness was not receiving great fanfares, staff were just quietly giving up their time to enhance the lives of service users, who, in the majority of cases had no other family. His request however triggered alarm bells and made me consider why my view of these ‘random acts of kindness’ differed from the manager.
Homecare providers are used to thinking about how services can be ‘person-centred’ and we often talk about care plans reflecting the needs, wishes and expectations of people who use those services. But what if those wishes involve spending Christmas Day having dinner in a family home with people they know and that home belongs to the care worker who is usually paid to provide care and support for them?
My initial reaction to the request triggered a very risk-averse response and is the kind of thing that runs through my head in the middle of the night;
- What if the turkey wasn’t cooked properly and the service user became ill?
- The husband of the care worker picked the service user up and drove her to their house – was this a breach of confidentiality – was there a safeguarding issue?
- Had there been a risk assessment – what if they fell?
- What if the service user gave the children a gift – was this a breach of the gifts policy?
- The usual care was commissioned by the local authority – what would they say: Safeguarding and breach of professional boundaries or just an act of genuine human kindness for a lonely lady on Christmas Day?
If the service user has the capacity to make a decision when she accepted the invitation she probably did what we all do every day – we weigh up the risks, we sometimes make decisions and do something because we want to do it, even if that decision involves a risk or is a bad decision. So why just because someone is receiving care and they have the mental capacity to make a decision, should the care worker who they have known for 10 years, not be able to ask a service user to have Christmas lunch with their family?
When I stopped and challenged my initial response, the answer, I believe, to this thorny issue is that it is about balance. It’s about being safe and proportionate. The Care Act refers to engaging people in conversation about how to respond to their safeguarding situation. Random Acts of Kindness or going the extra mile shouldn’t be driven out of home care, we aren’t using robots yet to provide services. But what these acts of kindness do need are checks and balances in place to make sure both staff and service users are safe. Staff should talk first to their manager and make sure their manager understands what they are doing and document the discussions. Engage with the Local Authority, if they are commissioning the services to make sure they are aware and finally but most importantly, engage the service user in conversation -there should be no feeling of pressure or obligation from either side. If there are any concerns that there may be a safeguarding issue, the correct procedures should be followed.
Poor homecare makes headlines, but everywhere care workers are performing random acts of kindness that don’t make headlines and these “kind words and actions can seem so small, but their effects are truly endless.” (Author Unknown).
Isn’t this what compassionate care should be about?
