Domiciliary, residential and nursing care in Staffordshire

Healthwatch Staffordshire undertook research into domiciliary and care home services in Staffordshire to understand the experiences of service users and providers of the current system and the needs of potential future users. The research included:

- surveys of 115 service users

- semi-structured interviews with 15 service users and 8 providers

- focus groups with 26 potential future users, 15 users with learning disabilities, and 7 service users with physical disabilities.

The purpose of the research was to find out the views and ideas of individuals (service users, families, carers, providers) on domiciliary care and care home services and provide this information to the Council to help them shape the services in the future.

The key findings of the report are as follows:

Choice: Support from social workers was variable and the involvement of service users in making an active choice was limited as social workers and/or families appear to be the key decision makers.

Cost: Cost impacts the choice for those who were funded by local authorities and self-funders. There is a gap between the funding available and the actual cost of providing care which can impact on the quality of care.

Staff attitudes: Staff attitudes, particularly being friendly, impact the quality of care. They also impact on the perception of dignity and respect – examples were given of users feeling that carers and service providers lacked respect for them.

Quality of care: Future potential users/families have a poor perception of care homes due to media stories and previous experience/contact with care homes – leading to a preference for domiciliary care.

Continuity of care: Continuity of care is important to users and relatives, especially in terms of domiciliary care. High staff turnover impacts on continuity – providers need to address recruitment and retention issues to minimise the impact.

Time and length of calls: There was a perceived lack of flexibility in the timing of calls made by domiciliary care workers – seeming to suit the provider rather then the service user. A need was identified for domiciliary care to be provided out of hours at an affordable cost. The shorter calls (fifteen minutes) were seen as inadequate to meet the needs of users especially those with complex needs.

Companionship: Loneliness was a factor for many participants especially for those living alone with domiciliary care or those in residential care for older people.

Activities: Users with learning disabilities appear more likely to take part in activities than older users as there appears to be a more specific effort to support these service users to take part in activities and develop life skills.

Family involvement: Families have a significant influence over the choice of care providers. Providers said that they made sure to involve the families in care plans and activity however this was not always the case. Domiciliary care services can be a source of support that allows families to continue caring for their relatives at home.

The report made 16 recommendations:

1) Activities: Wider activities should be developed for older users in care home settings including outings to enable socialisation with the wider community. Users receiving domiciliary care should be supported to take part in activities both inside and outside their home.

2) Choice: A further piece of work should be considered around the issues of capacity and choice in care provision.

3) Length of calls: Providers should be allowed to reach a realistic assessment on the time needed to provide adequate care during domiciliary care visits with input from users, relatives and carers.

4) Assessments by providers: Assessments should be undertaken by service providers before they enter an agreement with service users. Six week assessment periods should be avoided as the only assessment mechanism.

5) Information for families: Wider information should be made available to families about the types of care available and how the care system works – this should include information from the local authority as a trusted source.

6) Reliability: Domiciliary care providers should ensure that their scheduling of visits is realistic in order to increase reliability. Providers should ensure that service users know when their carers are expected and who to expect in advance – and any change in plans should be communicated in a timely and appropriate manner.

7) Continuity of care: Providers of domiciliary care in particular should try to use the same carers for the same service user where possible.

8) Staff retention: Providers should consider how to increase staff retention e.g. reviewing pay and conditions and providing regular, paid, training to enhance skills and improve job satisfaction.

9) Companionship: Providers should review ways to support service users to maintain relationships with friends and family, including outings. Domiciliary care providers should consider how service users can be assisted to develop and maintain relationships outside their home. Consideration should be given to commissioning voluntary sector organisations alongside care providers to provide support for good neighbour schemes and befriending services in order to reduce loneliness and social isolation.

10) Access to community services: Providers and the local authority should look at how access to community services can be maintained for people entering care homes to enable them to remain participants in wider society.

11) Review payment levels for care: The local authority should review its allowances for care to ensure they are in line with neighbouring authorities and reflective of the costs of delivering quality care.

12) Support for self-funders: The local authority should ensure equivalent support is given to self-funders choosing care providers as that given to local authority funded individuals.

13) Quality of care: Providers should provide regular feedback mechanisms for users and demonstrate learning and service improvement from feedback. This should include a robust complaints system.

14) Staffing levels: Providers should ensure that staffing levels are sufficient to deliver care services that meet the needs of service users including the pursuit of activities.

15) Flexibility: There should be an investigation into the provision of ‘out of hours’ care where required and this should be funded where possible to ensure that there is availability.

16) Training: Providers should ensure that there is regular paid training for their staff including training designed to foster dignity and respect for users.