UKHCA Briefing
Homecare Innovation Challenge
Case Studies from UKHCA members
February 2014
Edited by UKHCA Policy and Campaigns Team
United Kingdom Homecare Association Ltd
Sutton Business Centre
Restmor Way
Wallington
SM6 7AH
Telephone: 020 8661 8188
E-mail: policy@ukhca.co.uk
Website: www.ukhca.co.uk
Twitter: @ukhca
Registered in England. No 3083104
Table of Contents
Homecare Innovation Challenge – case studies from UKHCA members .... 3
Meeting the homecare challenge ...................................................... 3
Case Studies ................................................................................. 4
Fred - a reason for living, the social approach to healthcare ............. 4
Mrs K – leave me alone, I can manage, the reluctant client .............. 7
Jack – the case for excellent homecare, re-ablement in the home ..... 9
Mr X – coming home after amputation, with integrated care ............11
Mrs S and Mrs C - re-enablement, another word for support............14
Theresa – making a success of a personal health budget ................15
Sonia and Bob – essential support from personal assistants ............17
Arthur – a successful outcome with live-in care .............................19
Joyce – sleep-in assistance solution for sleep apnoea .....................20
Bluebird Care Tameside – a community approach to homecare ........21
Conclusion ...................................................................................24
Further Information ......................................................................24
Disclaimer
Whilst every effort has been made to ensure the accuracy of this briefing, it is a
summary, rather than a definitive statement of the law; advice should be taken
before action is implemented or refrained from in specific cases. No responsibility
can be accepted for action taken or refrained from solely by reference to the
contents of this briefing.
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©United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
Homecare Innovation Challenge – case
studies from UKHCA members
Sometimes illness, disability or frailties caused by older age mean that we
need help to live at home. The family is often the first port of call, but
they may not always be available to assist, and individuals may prefer not
to trouble them. So what other support is available?
Nowadays professional homecare enables people to live independently at
home, supplied by well-trained careworkers and carefully supervised by
their employer, which is usually a regulated independent or voluntary
sector organisation.
Meeting the homecare challenge
In 2013, the Care and Support Minister Norman Lamb launched the
Homecare Innovation Challenge, to generate ideas for developing
integrated and sustainable homecare for the future.
In response to the Challenge, The Guardian newspaper hosted the
Homecare Hub – an online forum for the exchange of ideas - and the
Department of Health sought case studies on homecare’s current
successes, with a focus on integrated care and re-ablement.
UKHCA members stepped up to the plate, and we received many
interesting and inspiring case studies which demonstrate the vital work
that homecare providers do, in supporting individuals to live at home.
Some also highlighted the prominent role of homecare organisations in
the local communities.
Here is a selection of the case studies we received.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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Case Studies
Fred - a reason for living, the social approach to healthcare
When we are young, we believe we are invincible: we take our health and
our well-being for granted. Ill health and life-limiting conditions are things
that happen to others – never ourselves. Serious car accidents are things
we read about in newspapers – not in which we participate. The careless
step from the kerb, mobile phone to ear, into the path of a van would
never happen to us.
Would it? And then, in an unthinking, unfortunate flash...
So you’ve survived the crash. The lungs work and the heart beats – but
the brain no longer functions as it used to. You’re alive but things you
took for granted – eating your favourite meal, washing and dressing – are
now impossible to do alone.
The fact is accidents do happen. Disease does strike. The stark reality is
that for many people in the UK, whilst they benefit from excellent
healthcare, their every-day human needs – their social care – can be
sadly lacking.
Take Fred for example. Fred is an elderly but strong gentleman who
suffered a traumatic, life-threatening injury to the frontal lobe of his brain.
It has left him with limited movement from the waist down and affected
his general understanding, emotions and behaviour.
Fred’s care was originally provided in a specialist brain injury unit – which
succeeded in ensuring Fred was healthy and clean. In truth though, there
weren’t too many signs of rehabilitation.
Despite being physically capable, Fred had a tendency for aggressive
behaviour which provided a barrier to his care. It became a regular
occurrence that up to four different people would be responsible for
washing and dressing Fred each morning. His nutritional needs were met
by the fitting of a feed tube through the stomach known as a PEG. Fred’s
disruptive behaviour – such as shouting at the television in the communal
area – meant that he was isolated from other residents.
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Case Studies on Homecare
Despite the understandable stress, Fred’s family did not want to see him
continue in this state and so they enabled him to come home, with NHS
continuing healthcare funding paying for support.
And that’s where we became involved.
Our role at Your Care Services is to do everything possible to ensure those
in our care lead a life worth living, using a social approach to healthcare.
The team decided the best way forward was to get to know Fred as a
person – to develop a relationship with him and involve him in his care.
We noticed that most of his aggressive behaviour occurred during washing
and dressing. This is not surprising. Many of us would feel vulnerable in
such an intimate situation but helping somebody wash is obviously an
important part of care.
Our care workers overcame these difficulties by taking a step back and by
allowing Fred to take the lead. They would provide him with the flannel –
and give him directions and encouragement. When he became distressed
or aggressive they would calm him down by talking to him about his
hobbies, interests and memories.
It was a long and challenging journey for Fred and his care workers but
the outcome has been rewarding for both – and an inspiration to others.
Fred has come from being washed in bed to showering himself almost
unaided. There is still the odd flannel launched in frustration – but his
care workers are there to provide verbal direction and remind him of the
task in hand.
This may be a small step in one part of Fred’s daily routine, but the
approach of his care workers simply seeing him as a person behind the
behaviour and allowing him to take an active role in his own care, has had
a positive impact on other parts of his life.
Fred for instance, now enjoys eating a meal independently at the table
with his family. It was a slow process, but the key to achieving this goal
was for his care workers to take a step back and allow Fred to explore his
abilities in an environment he trusted and in which he felt safe.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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After a year of achieving re-ablement in day-to-day activities such as
washing and eating, Fred is now at a stage where he is able to attend a
day centre and socially interact with others.
Fred’s life has changed – for the better. He is not a lone example – many
others have to adapt to disabling conditions, and it can be a long road
back into society.
Sometimes in hospitals time-pressured professionals have little
opportunity to get to know a person. So is it really a surprise that these
once fit and healthy people, victims of accident or disease, can struggle to
come to terms with the dependent person they have become?
While meeting an individual’s healthcare needs will aid recovery in the
short term, it is an integrated health and social care approach that leads
to a new level of recovery – a quality of life and a reason for living.
Broadly, healthcare can be defined as helping someone attain and
maintain good physical health. Social care, however, looks at increasing a
person’s ability to achieve re-integration into society.
For many people this is a huge step to take and requires solid foundations
based on trust, confidence and empowerment.
Fred's case shows how much can be achieved by simply seeing the person
behind the condition or behaviour and giving that person a role within
their care.
This is the true meaning of ‘social’ in social care.
In comparison, the healthcare approach alone can lead to dependency and
act as a barrier in itself to long term recovery. Although the combination
of health and social care can take longer to see any effects, the outcome
is definitely far greater.
The ultimate goal of health and social care is providing a quality of life.
For Fred – and others – with support and the right kind of care, there is
now also a reason for living.
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©United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
Contributed by Your Care Services
www.yourcareservices.org.uk
This case study appeared on The Guardian’s Homecare Hub.
Mrs K – leave me alone, I can manage, the reluctant client
“Leave me alone. I don’t want any help. I can manage by myself and I
definitely don’t want anyone in my home” said Mrs K, lying frail yet
adamant in her East of England hospital bed. A friend had been trying to
persuade her to accept help so she could go home. Mrs K was lucky to
have this kind neighbour, as her remaining relatives did not keep in touch.
Mrs K had mild dementia and leg ulcers but was otherwise quite fit.
However, she had caused alarm on a number of occasions, by leaving milk
on the electric stove or putting bread with jam in the toaster, and once
needed the fire brigade to come and stop a serious fire.
As a domiciliary care provider, we - Home Instead Senior Care - wanted to
work with Mrs K to help her live as independently and happily as possible
towards the end of her life. This required a great deal of patience,
flexibility and coordination of services across health and social care. Key
to our care workers' approach was the continued consideration of what
gave the client most pleasure, ensuring that quality of life was a central
focus of care delivery, in addition to practical requirements such as
washing and personal care.
Mrs K’s protests were kicked into touch by the council social worker. She
was given two options - either accept a large care package in her own
home, around eight hours a day, or enter residential care. Mrs K chose
what she personally felt was the lesser of two evils, meaning Home
Instead entered her life. We were asked to cover the ‘critical’ times of day
when she would be most at risk, including activities such as getting up,
washing, dressing and especially meal preparation - Mrs K could be highly
dangerous at meal times, unless closely supervised!
© United Kingdom Homecare Association Ltd, 2014
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Our Care Manager gathered information from Mrs K, her neighbour and
the social worker. It was difficult to talk to Mrs K as answering even a few
questions made her tired and irritated, so our care manager had to be
patient. But involving Mrs K in decisions about her care was an essential
step in the care planning process.
The care package put into place consisted of homecare from 9am to 1pm
and from 5pm till 9pm. It was planned this way to cover key active times
in Mrs K’s day and also to give her time alone in the afternoon when she
typically had an afternoon nap. Mrs K lived in her own very pleasant
bungalow and her main pleasures in life were looking out from her
conservatory at her garden and reading, pastimes she far preferred to
conversation.
Before care workers started caring for Mrs K, they were given a detailed
briefing on her background and care needs. This included what to do if
Mrs K refused entry to them or evicted them from her house whilst
delivering care. Initially Mrs K was very hostile to hosting care workers,
something which posed a challenge to the care team, who had to use their
tact to allay Mrs K’s fears and ultimately win her confidence.
Mrs K’s household and personal affairs were managed by her solicitor but
gradually we were able to take over many of the day to day home
management tasks and ensure they were integrated to the care that was
already in place. We arranged a gardener to lick her garden into shape
and place special attention to the area nearest her conservatory window,
so Mrs K could enjoy the view. The TV switchover was sorted out and a
mobile hairdresser found who could cope with an unpredictable welcome.
Meal times remained a challenge. Mrs K did not want meals specially
prepared for her, so we tried ready heated meals instead. The key issue
was to avoid Mrs K having any access to tin foil containers - she saw no
problem with popping them into the microwave and letting the sparks fly.
Therefore we worked with the food company who made it part of their
routine to put the hot food on a plate and remove the foil containers
straight away.
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Case Studies on Homecare
Mrs K was a challenge to look after for a long while. She was very
resistant to the care workers doing any task for her, or with her, yet they
were required to be there eight hours a day. Most care workers get a
great deal of satisfaction from helping their clients and so seeing unmet
needs or tasks proved very frustrating for them. But the care workers
gradually built up a relationship with Mrs K. They learnt there were some
days when more could be done than others, and if they discreetly did
small jobs in the background she would accept it.
The Care Manager also respected that Mrs K wanted more time alone and
work was done to see if the care package could be safely reduced.
Interestingly when the contact time was cut a little, Mrs K used delaying
tactics to get the care workers to stay longer, so perhaps she did enjoy
their company after all!
The Home Instead team kept in close contact with both the social worker
and district nurse team and over time took over full responsibility for the
running of the house. Any visits by a health professional or someone such
as the hairdresser were timed for when a care worker was present,
otherwise they may well have been sent away or unwittingly exacerbated
Mrs K’s confusion.
As a result of the cooperation between domiciliary care, social services
and the NHS Mrs K was able to remain in her home till the last month of
her life, despite her dementia.
Contributed by Jean Allen, Director, Jean Allen Care Services Ltd
www.homeinstead.co.uk
This case study appeared on The Guardian’s Homecare Hub.
Jack – the case for excellent homecare, re-ablement in the home
“Jack’s daughter first contacted us just over a year ago, when we had
been trading for just a few months, after getting one of our leaflets
through her door. At the age of 91, Jack had been living quite
independently in a sheltered flat until six weeks prior to his daughter’s call
to us. Despite a few health problems, including poor eyesight, arthritis
and a heart problem, he managed pretty well with day to day living.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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Jack had to spend a few weeks in hospital and, unfortunately, during that
time things started to fall apart. His mobility all but disappeared; he
became confused, incontinent and quite depressed. He then went into a
care home to ‘recuperate’ for a couple of weeks, but there things went
from bad to worse. He became very depressed and withdrawn and his
family felt like they had all but lost him.
Joe, our care manager went to the care home to see Jack and his
daughter to do an assessment to see if, with our help, Jack could come
home as soon as possible. Joe started chatting to Jack about his life, his
experiences during the war, and Jack’s passion for, amongst other things,
football and tap dancing. The two of them really clicked, and for the first
time in weeks Jack began communicating. It was an emotional moment
for his daughter as she began to see light at the end of the tunnel.
As luck would have it, we had recently taken on two very experienced
care workers who were ideal to introduce to Jack and to put him back on
the road to recovery and independence. For the past year our care
workers have been visiting him 3-4 times per day to assist him with all
aspects of personal care and meal preparation.
Jack has four regular care workers and a fantastic relationship has been
established with all of them. He also enjoys meeting new care worker, as
long as one of the ‘old faithfuls’ is there, and is a popular choice for
shadow visits for practical inductions.
Although Jack relies heavily on the care he receives, he has made
amazing progress in the past year. He has recovered his appetite (he has
a particular penchant for crisps!), loves to watch Glenn Miller films and
talk about the past. He also has a great sense of humour that has really
come to the fore over the past year.
All of us at the office take a keen interest in Jack’s progress. Joe pops
over to see him occasionally, which causes great amusement among the
care workers as Jack always reports that ‘the boy from the office’ has
been to see him.
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When we found out that the lunch club Jack used to go to would not let
him back because he has difficulty using a knife and fork, we arranged for
one of his care workers to go with him every Monday, free of charge, to
help him. Not only has this given Jack back an important part of his social
life, but it has helped promote Caremark in the community too.
Jack’s family have been hugely appreciative of the care that he has
received and of the difference this has made not only to his life but to
theirs too. Jack’s daughter said: “Your help to Dad and myself this year
has been amazing. I watched Dad come 'back from the brink' and settle
into his home again. He obviously has many limitations but your team
(and your thoughtfulness) have made all the difference to us both”.
Jack’s grandson recently made a short film about his grandfather, which
Jack’s daughter sent to us and gave us permission to link to on our
website. It brought a tear to many of us and can be viewed at
http://www.openideo.com/open/mayo-clinic/inspiration/jack-s-story/
Jack’s story has shown what high-quality, consistent care can do to
change people’s lives. Jack has touched our lives too; he is a wonderful
character, and is a daily reminder of why we are in this business.”
Contributed by Anna Wilson, Director Caremark (Enfield), edited by Mary
Wardell, PR & Marketing Executive, Caremark Limited.
www.caremark.co.uk/
Mr X – coming home after amputation, with integrated care
Integrated homecare from our perspective is a person centred approach of
dealing with the needs of an individual while aiming to meet all outcomes
required including but not restricted to nutrition; mobility; personal care;
work, learning and leisure; medication; running and maintaining own
home; complex needs and risks. This would include an open channel of
communication between parties involved in the person’s care and a onepoint assessment that would avail the parties involved a snapshot of the
individual’s needs – eliminate several assessments and reduce cost and
time lapsed while arranging service provision.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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I remember Mr X who recently came home after a double amputation and
setting up his care package is a testimony of integrated health care.
It started with a referral from social services that detailed medical history,
next of kin contact details, extended history of events over the last 12
months and care needs; it also included information about how to transfer
Mr X. We, as care providers, simply met Mr X on discharge and risk
assessed him for service provision. During this, it came to light he would
need some tweaking done to the equipment provided. Since we had the
contact details of community occupational therapists we simply rang them
and gave them all information we had – saving time. They went out very
quickly, I must add, and resolved this which ensured no disruption to Mr
X’s care service.
Furthermore, we contacted the Consultant who had been dealing with Mr
X at the hospital to ascertain his potential with regards to mobility. We
were thinking of the long-term care needs and how to help Mr X to do
what he could for himself (with and without prosthetic legs - he had none
at this stage). The occupational therapist team were also given the same
information. This led to the appointment of a specialist to deal with Mr X’s
case - a quick resolution that probably wouldn’t have been possible a few
years ago!
Obviously, the sharing of information was with the consent of Mr X and in
accordance with data protection rules. With a responsible person as the
central point of information – social services (the social worker) - and
homecare workers implementing carefully laid down plans in a safe and
dignified manner, Mr X’s wishes and preferences could be respected and
observed.
Mr X was so excited to be back at home, as he could smoke to his heart’s
content, but we had to advise him to use electric cigarettes at night while
in bed to reduce the risk of fire.
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©United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
Mr X’s case is a good example of the integration of health and social care
because outcomes are achieved and time is used more effectively, in turn
leading to reduced cost. Prior to integrated care it took a long while to set
up care packages and, even when this was done, a long time to sort out
problems relating to the care package because third party providers didn’t
have the information they required or it took a while for them to set up
meetings to get such information. Also, when they then had the
information, it took more time to get hold of all parties that would
potentially be required to have an input in service provision, a frustrating
process.
When we deliver care we ensure that re-ablement is built into all aspects
of tasks provided. For example:

Encouraging the service user to wash areas of their body that they
can and helping wash the rest that they can’t (with time and
repetitive action some individuals do a bit more);

Offering a choice of meal and drinks, with the service user
preparing the food they can while we do the rest;

Assisting them with medication from pharmacy-prepared aids (we
can get it out and put it in a dose cup which they take themselves.
In some instances they improve and can manage medication
themselves from such prepared aids);

Supporting them to walk with aids and exercise routine (as set out
by physiotherapist).
The last example is an excellent example of integration because it
demonstrates how the physiotherapist can work together with
careworkers, ensuring that the exercise routines are carried out at the
correct frequency, for example, daily, and ultimately reducing cost. One
might argue that specialist attention may be preferred but the same
outcome can be achieved (for low and medium risk cases) as long as
there is regular feedback from the careworkers to the physiotherapist in
charge.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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The above case study refers to a service user with a physical disability,
but we have also worked effectively to help with the re-ablement of
people with mental health issues.
Contributed by Femi Adams, Training Manager, C and S Care Services Ltd.
www.candscareservices.co.uk/
Mrs S and Mrs C - re-enablement, another word for support
For many years Alpha Care Specialists has been providing enablement
care to their customers. This was before there was a name for it or before
it became fashionable.
A re-enablement service is what we provide, but what does it mean? To us
it means to support people to achieve their goals in life rather than do it
for them. That sounds easy, I hear you say. Let me tell you it’s not easy.
It is far easier and quicker to do things for people rather than supporting
people to do it themselves.
Why bother, if it’s easier and quicker? Supporting people to do things
themselves helps them with their life style, it maintains their
independence, it builds their confidence and they feel they can live and
participate in their community longer. Enablement gives that extra
support to people to make their own decisions and choices and it assists
them to maintain their skills and knowledge.
For example, Mrs X suffers from dementia, loves to bake and was getting
very confused and frustrated when she was baking, as the recipes were
difficult to follow. She could remember bits and pieces but her baking was
a disaster (Paul and Mary of television’s Great British Bake-Off would not
have been impressed).
But with the support of her personal care assistant, who reminded Mrs X
about the recipe she was following, she was able to reach her goal. Not
quite the finals of the Bake-Off, but a considerable achievement none the
less!
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©United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
Mrs C used to be housebound, was unable to go out on her own. She was
not able to manage her money when out shopping or even go to the
laundrette. The personal care assistant supported her by taking Mrs C to
the post office to collect her pension. Our staff member also helped her to
use the laundrette, took her shopping and accompanied her to doctor’s
appointments. Mrs C feels really confident now and is able to go out on
her own, but only because she had the support in place to do this.
Taking part in the community is very important to people. They want to
go out and see friends or go shopping and some want to go to church.
Having a personal care assistant enables people to achieve these goals
and can help to stop their frustration being left at home or not being able
to go out.
Alpha Care Specialists also provide a Home from Hospital service. This
service is to re-enable people back into their everyday life having been
discharged from hospital. We provide a short five to six week service that
helps to support people after their stay in hospital to become stronger in
their bodies and minds to enable them to feel confident to go out on their
own again.
Contributed by Litsa Worrall, Chief Executive Officer of the GGCCE
www.alphacarespecalists.org.uk
Theresa – making a success of a personal health budget
Theresa and her family live in Norfolk and have been using
HomeCareDirect (HCD) to help them manage their personal health budget
since January 2013. By using a personal health budget, Theresa has been
able to have a service designed specifically for her, choosing her mum and
dad to be employed by HCD to provide the complex care she needs –
whilst remaining at home and out of a residential setting.
Theresa’s father, Tim O’Sullivan says “it really works for us; we’ve been
involved in taking care of Theresa for a long time whilst she was under the
care of the local authority, then the PCT and then the CCG. We’re finding
it very good”.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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Theresa is a sociable 24 year old lady. Her parents have been her full
time carers since birth. She also lives with her brother and sister in a
specifically adapted property and enjoys a happy life at home with her
family. Theresa’s care needs are complex and include quadriplegic
cerebral palsy and microcephalism.
Theresa uses a tracheostomy tube to breathe and has a PEG through
which she feeds and has her medication administered.
Theresa’s care at home is funded through continuing healthcare funding
provided by Norfolk and Waveney PCT via a personal health budget. Due
to this, the family were able to take control over Theresa’s care at home.
Asked whether he felt a personal budget had improved Theresa’s health
and well-being, Tim said “Absolutely”.
Asked if there were any downsides to personal health budgets, Tim said
“The red tape involved in setting it up can leave you a little non-plussed at
times’. Tim went on further to say that ‘red tape could put some people
off, and that’s when you need help from the professionals”.
This is where HCD come in. For 10 years HCD have been helping people
take control over their care at home by removing some of the hassles that
have traditionally been a barrier to people who want to choose their own
personal assistants and organise their own support. Namely, the
responsibilities involved with being an employer, keeping up-to-date with
training, insurance, payroll, funding management and recruitment/
interview support – HCD provide all of this as part of the service. HCD also
provides a dedicated care support officer and a 24/7 support line to help
people make a success of their personal health budget.
What this meant for the family was that they had all the choice and
control offered by a personal health budget, but were left free to
concentrate fully on organising and providing Theresa’s care.
“We’re able to concentrate strongly on Theresa’s care without having to
do all the admin - it stops you doing two jobs” said Tim. “It works much
better now”.
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Training has been provided or sourced by HCD qualified nurses who work
in partnership with the local district nursing team. The training has been
to full Care Quality Commission standard, taking place both in the home
and in a hospital setting using the latest up-to-date techniques.
The family also has the reassurance that HCD will ensure they are kept
up-to-date with best practice guidance on an on-going basis – securing
the best possible care for Theresa.
Due to Theresa’s complex care needs, traditionally she may have been
placed in a residential nursing setting. However, by using her personal
health budget funding and with HCD employing her parents to be personal
assistants, Theresa can remain at home with her family and be well cared
for.
A true success story with great outcomes for all involved.
Finally, when asked whether he would encourage other people to move to
a personal health budget, Tim said “Yes, I would definitely recommend
them”.
Contributed by Bruce Adams, Business Development Manager,
HomeCareDirect
www.homecaredirect.co.uk
Sonia and Bob – essential support from personal assistants
Since 2003 the Independent Living @ Home Service, part of Services for
Independent Living (SIL), has provided home care and support to disabled
and older people via teams of support workers individually selected and
approved by the individuals.
The very consistent person-centred teams get to know the person really
well and understand their precise, often complex needs. Specific training
to meet the person’s needs and detailed support plans enable the person
to live the life of their choice and achieve their identified outcomes.
© United Kingdom Homecare Association Ltd, 2014
Case Studies on Homecare
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Over the years, numbers of individuals, employing their own personal
assistants through direct payments, have come to Services for
Independent Living for help when their direct payments has been
withdrawn as a result of continuing health care funding taking over. Just
at the point in their lives when their health is deteriorating and, now,
more than ever, they need the least disruption to their lives, they fear
losing their trusted personal assistants. SIL has been able to employ the
personal assistants, provide them with additional training and support and
manage the support plan for the individual.
Sonia had multiple sclerosis. She lived in a village location with her
primary school age daughter Anna. She received intensive support from a
team of 5 personal assistant who had developed good relationships with
both Sonia and Anna.
When Sonia was 35, health took over her funding and she was told she
must have an agency to support her. Sonia wanted to keep her personal
assistants. SIL employed and managed them all. With training and
assistance they supported Sonia at home to be a parent to Anna until
Sonia died aged 40 (at home).
Bob had motor neurone disease. He had lived in a static caravan in a field
for many years. He did not want to leave it. He became agitated and
verbally abusive to people he did not know well. He had one trusted
personal assistant. When health took over funding due to significant
health deterioration, SIL employed the personal assistant and she
supported two carefully chosen support workers who Bob eventually
approved to provide a rota of consistent help. Bob’s ambition was to go to
Spain in a camper van before he died and one of those support workers
made it happen for him – just in time. Bob spent less than a day in
hospital at the end.
Contributed by Ginnie Jaques, Services for Independent Living
www.s4il.co.uk/home
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Arthur – a successful outcome with live-in care
Arthur is 76 years old and lives in North London with his wife Maisie.
Arthur has Parkinson’s and needs quite a bit of help with daily activities
like getting up and dressed, eating meals, taking medications and getting
out and about. His mobility has been affected and he uses a wheelchair
which he needs someone to push. He also has difficulty in swallowing
which makes eating and taking medications difficult. Arthur has trouble in
speaking clearly and getting his views across. It is very important that he
gets his medications at the right time.
Arthur has been using an hourly care agency to support him, but
increasingly needs more help during the day, and Maisie is struggling to
meet all his needs on her own. He also finds that the time of the care
workers’ visits can vary greatly from one day to the next, making his
medication regime hard to maintain. Arthur has struggled with making
himself understood to the numerous new faces that come to tend to him
each day, and finds the constant change of care workers hard to keep up
with. Arthur’s son Bill engaged the services of The Good Care Group.
The Good Care Group provides Arthur with 24 hour live in care. Arthur felt
he would be more comfortable with a male care worker, and so was
introduced to Henry and Bob – both specialist care workers employed by
us and trained by Parkinson’s UK. In addition to having the right skills for
the job; both Henry and Bob have a keen interest in motor sport – an
industry Arthur spent most of his working life in.
Arthur’s care is flexible – he has support on hand whenever he needs it,
which suits the fluctuating nature of his condition. Daily routines are built
around his needs and preferences – not the other way round. Medications
regimes are closely adhered to. Arthur has found that because his care
worker are there for him around the clock, they have been able to help
him with his physiotherapy programme, working on exercises which have
improved his mobility and level of independence. They have also
organised days out for Arthur and Maisie – something Maisie had
struggled to achieve on her own. Recently they enjoyed a picnic in
Regents Park – Maisie organised the food whilst Henry sorted out a
wheelchair taxi and other practicalities.
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Henry and Bob have cared for him for over a year now, and the continuity
of care has been really beneficial. Henry and Bob have got to know
Arthur; they understand his speech despite his difficulties, they can read
his body language, and they know exactly how he likes things done.
“Having Henry and Bob to care for Arthur has taken away the burden from
me and allowed me to be his wife again. Having his condition managed so
effectively by both care workers has meant that Arthur has felt more
himself and enjoys life once again.”
– Maisie, Arthur’s wife.
Contributed by Dominique Kent, Director of Operations, The Good Care
Group London Ltd
www.thegoodcaregroup.com
Joyce – sleep-in assistance solution for sleep apnoea
Joyce has lived independently for a number of years, supported by
FitzRoy’s Support at Home team.
Waking abruptly with difficulty breathing is quite frightening for most
people. Many people with sleep apnoea are able to self-calm after waking
from an interruption in breathing, recognising when emergency assistance
might be necessary as the bout is unusual, and what might be more
natural rhythms associated with the condition.
For Joyce, a diagnosis of sleep apnoea caused additional anxiety. Already
lonely at night, and tired from frequent night-time waking, Joyce
increasingly relied on emergency services to help come and calm her at
night, even though she was using breathing apparatus (CPAP – continuous
positive airway pressure) to help her.
While the emergency response was superb with paramedics and the local
GP providing excellent support, concern grew about how best to assist
Joyce and manage the strain repeated call-outs were placing on an overstretched emergency response system.
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With discussion from health and social care professionals, FitzRoy built a
case for additional support for Joyce from a sleep-in assistant. Since
Joyce was living in a one bedroomed flat, this necessitated a move to a
new property.
The new ground-floor flat has had a huge impact on Joyce. She is able to
sit at her large picture window and watch the comings and goings in her
street and build relationships with her neighbours. This has enabled her
to feel part of her community as the previous flat was situated at the end
of the road and faced into a back garden - which meant the only time she
could socialise was when she was walking to and from her car.
While sleep apnoea is still an issue for Joyce, her sleep-in assistance
makes her reaction calmer and the quality of her sleep has improved – an
in turn, she is less tired, and as a result of being friendlier with her
neighbours, is also less lonely too.
From a worried and anxious individual a few months ago, Joyce is a new
woman. A life transformed.
Contributed by FitzRoy Support at Home, Norfolk
www.fitzroy.org/
Bluebird Care Tameside – a community approach to homecare
As we walk through the door into a person’s home we should be aware
that we are entering a place that contains very personal items and
memories for that person. To return to that personal space again and
again, to provide care that is viewed as helpful and supportive, by the
person, has to be earned through the development of a relationship
underpinned by respect and trust.
Bluebird Care Tameside provides a full range of home care services from
shopping and companionship to full personal care including live-in care.
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Integration into the community underpins the provision and delivery of all
our services and is central to getting to know people and building
relationships built on respect and trust. It does not matter whether we
are working with a community group, a customer or a member of staff,
the same principles apply. All our care workers have their own customer
case load and pride themselves in working with customers and their
families in a flexible and responsive way to ensure people feel safe,
comfortable and independent in their own homes.
Building relationships with and within the local community is often stated
but the level to which this is done and maintained, as well as the
associated outcomes, are not necessarily always articulated for others to
adopt as a possible way forward. Our framework for integration was
introduced at a very early stage in the development of the business and
has gone from strength to strength since then. It is a simple but effective
approach that requires planning and a consistent input from everyone in
the team.
For us, the concept of people doing business with people has been the
underlying principle for all our integration work. The use of our
framework is therefore underpinned by the formation of relationships built
on respect and trust. Getting to know individuals and groups, within our
local community, particularly our local charity community, has not only
been about meeting and talking but also about contributing to their local
community work agendas.
For example, the whole Bluebird Care Tameside team have been involved
in charity bag packs and charity bike rides within Tameside. All the team
are encouraged to undertake two hours of voluntary work a month and for
all of us this has fostered a sense of connecting with the local community
and all team members have reported just how much they have enjoyed
these events. Recently, the care manager, along with the care workers,
created a Volunteers Wall and all members of staff are encouraged to plot
the number of voluntary hours they have done with the knowledge that
the one with the most hours, at the end of the year, will be awarded the
Volunteer of the Year prize.
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Contributing to the local charity work agenda has become a significant
part of what the Bluebird Care Tameside team are about and all team
members view this work as being fundamental to their role. Having this
team identity has also led to some creative ideas, on the part of the team,
as to what we can do. One of our current projects is undertake a charity
bike ride, with our local friends and colleagues, around the whole of the
Tameside boundary to raise money to keep local elderly people warm this
winter.
An important part of our framework is talking and sharing what we do
with others. Everyone who works for and with us has learnt that photos
are taken of everything we do. We now have a photo album of every
event we have been involved in as well as a growing pile of press cuttings
which we proudly show to all who visit our office. Stories and photos can
also be found on our webpage as well as in our Twitter and Facebook
conversations.
An important factor underpinning our framework of integration is the care
of staff who are very much the ambassadors of the services we provide.
We have a very clear policy for recruitment and look for people to join our
team who reflect our core values. Our core values are based on putting
the customer at the centre of their care by respecting their decisions, their
privacy, independence and dignity. Each care worker is matched to a
customer, by the care manager, in partnership with the customer and
family and all our care workers build up their own customer case load. To
help care staff deliver their values based care, the care manager ensures
they receive regular training and supervision. All of this is reflected in
customer feedback:
‘It’s the little things she does that make all the difference’
‘I can’t find any fault at all they know exactly what needs to be done’
‘My parents are very happy we are getting exactly what we want’
Use of our integration framework as has led to local people choosing to
use our services. We continue to believe that people do business with
people whether that is a local group, a member of staff or an individual
and their family who choose to take our services.
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We have given to the community and the local community have given
back to us. We have been recognised as a Living Wage Employer and
invited to have a stall in the Pride of Tameside Market Place but the public
recognition that we are most proud of is that one of our care workers is
now a finalist in the North West Great British Care Awards.
We know we have got lots more to do because working with local people
takes on-going commitment but I know the Bluebird Care team has a big
heart and we go the extra mile for people because that is what matters to
us.
Contributed by Dr Lynn Sbaih, Director, Bluebird Care (Tameside)
www.bluebirdcare.co.uk/uk_office/about/tameside
Conclusion
The variety of support provided by our members, and styles of
management evident in the above case studies, shows the flexibility and
versatility of homecare in supporting people at home.
The case studies also demonstrate how far homecare has come in
becoming the service of choice for those who wish to remain living at
home, rather than move to residential or nursing home care.
Our thanks to everyone who contributed to this publication and the
service users who agreed to their individual stories told. They are an
inspiration to us all, as are the efforts of the many homecare workers who
support them.
The names of the people receiving homecare services and their relatives
have been changed to protect their anonymity.
UKHCA Policy and Campaigns Team
Further Information
Finding care
For further information about UKHCA members, if you are seeking care for
yourself or a relative, see: www.ukhca.co.uk/findcare/
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Media enquiries
UKHCA also produces an overview of the UK domiciliary care sector for
researchers and journalists at:
http://www.ukhca.co.uk/pdfs/domiciliarycaresectoroverview.pdf
We receive many requests from the media for case studies to demonstrate
the value of homecare. If you are a journalist and wish to use any of the
above case studies, please could you contact media@ukhca.co.uk with
details of the information you need, your publication and deadline or call
07920 788993.
Joining UKHCA
United Kingdom Homecare Association (UKHCA) is the national
professional association and representative association for organisations
who provide care, including nursing care, to people in their own homes.
You can read more about how to become a member of UKHCA and access
a range of good practice publications, advice lines and training resources
for homecare at: www.ukhca.co.uk/joining.aspx
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