Are home care visits long enough?

Last week NICE published new guidance on “Home Care: delivering personal care and practical support to older people living in their own homes”. The media has focussed on a key point about home care visits needing to be longer. Sky quoted recent figures that showed eight councils in the UK had provided 593,000 care visits lasting five minutes or less over a three year period.

I agree with the NICE guidelines which call on care providers to “ensure service contracts allow home care workers enough time to provide good quality service” But is it possible that some tasks and hence visits can be done in a different way.

Take for example someone who may receive a 5 minute check 3 times a day to remind about taking medication. In Hull they are taking a different approach. They are using medication dispensers to reduce the number of home care visits required, avoid admissions to residential care and reduce the pressure on primary and secondary care, generating financial efficiencies.

To illustrate the point, Anne (name has been changed) had been regularly missing her tablets because of loss of short term memory. She was prescribed eight tablets a day but becoming depressed because she was regularly missing her antidepressant tablet, and was getting confused with her blister-pack tablets as the days on the pack did not match with the day she thought it was. She lives alone and so was at risk of hospitalisation due to missed doses, depression or overdosing. It was therefore decided to trial a medication dispenser with Anne to see if this could remove the immediate risk and give Anne the confidence needed to self-medicate on a continuous basis.

Results
Anne has been using the pill dispenser for four weeks now and it has made a big difference. She takes seven tablets in the morning and one in the evening. Of 112 tablets due in the first
two weeks, she only missed two. Although initially she was wary of the audible alarm when she started using the dispenser, it took a big burden from her; she no longer needed to worry about what day it was but simply took the tablets when the machine sounded and dispensed the tablets. Her family refill the pill dispenser as required (fortnightly).

The dispenser has prevented Anne needing a homecare service to help her with her medicines and averted the need for residential care which may have resulted as a consequence of poor health due to not taking her medications as prescribed.

The dispenser alarm system has also given Anne a regular routine (getting up at 8am and getting ready for bed at 10pm), improved her sleep pattern, given her extra confidence and increased independence and reduced her confusion. Her family are reassured that she is taking her tablets as she should and no longer need to ring to check.

Just to be clear – technological solutions are not about replacing human contact or restricting independence and it can only be effective when combined with good care. But let’s open our mind to the options now available to us via technology. Digital care, Remote video consultations, apps and online services are gradually creeping their way into our lives in so many ways.

Telecare guidance is covered by NICE and quite rightly states – If the person wishes to use telecare, work with them to identify their preferred telecare options that maximise dignity and help them live in the way that they choose (1.3.26).

Let’s open our mind to the possibilities, but have our minds firmly fixed on the needs of the individual and really test if the package of care truly achieves the desired outcome.