National Care Standards: Care at Home

Annex C The context of the standards for care at home

Recent research into users' and carers' views of quality identified two main features of home care which influence feelings of satisfaction or dissatisfaction with the service:

• the relationship with the home care staff; and
• the way in which care is delivered.

The most important aspects of the service were:

• staff reliability;
• continuity of care and of staff;
• kindness, understanding, cheerfulness and the general manner of care workers;
• competence in undertaking specific tasks;
• flexibility of response to changing needs;
• knowledge and experience of the needs and wishes of the user or carer (or both); and
• information about the services that will be provided.

The main sources of dissatisfaction included:

• incompetence and lack of initiative;
• unreliability;
• frequent changes of care worker;
• unsuitability of care workers;
• service not being flexible or responding to people's needs;
• lack of appropriate training;
• workers in too much of a hurry;
• failure to provide help with specific tasks;
• services not being able to provide help 'out of hours';
• disruption to services through change of contracts; and
• poor value for money.

In another study, people using services criticised the following:

• visits at inappropriate times, with the result that, for example, people using the service had to get up too late or go to bed too early;
• staff failing to turn up at all;
• an apparent lack of training for home care assistants; and
• difficulties in meeting some people's needs for help in using the toilet.

Scottish research with older people using home care services revealed what was especially important to them:

• notification in advance (or as soon as possible) if a care worker could not attend or was delayed;
• always being given the name of the care workers and what time they will visit, and to be told of changes;
• an up to date personal plan that is held in the house and used to monitor visits, tasks completed (including meals and medication) and length of visits;
• appropriate training for all care workers and advance information about individual needs; and
• sharing information between the care workers in different agencies and between people from the same agency visiting at different times of day.

Similar needs were expressed in a final study. People using the services wanted:

• all-round care;
• a routine that is adapted to the user's routine;
• flexibility;
• time and thoroughness; and
• sensitivity.

Sinclair et al conclude with recommendations for an option for 'professional, integrated' home care. This would aim to:

• fit the user's routine;
• be based on familiarity;
• be reliable;
• be flexible;
• involve different disciplines, for example health and social work;
• be all-inclusive; and
• be cost-effective.