In the world of home care, balancing the dual priorities of liability management and quality care is no easy feat. For many providers, managing risk can often lead to strict policies that inadvertently limit the services carers are allowed to provide.
The founder and CEO of Prestige Inhome Care, Nick McDonald, offers valuable insights into how this delicate balance can be achieved without compromising the quality of care clients receive.
McDonald explains that the root of many restrictive policies lies in risk management. “Some organisations’ response to risk management is simply to avoid the activity altogether,” he says.
This can manifest in various ways, from prohibiting carers from dusting shelves above shoulder height to banning the movement of even lightweight furniture. While these policies are often well-intentioned, designed to protect staff and minimise insurance claims, they can leave clients dissatisfied and carers feeling disempowered.
“At its extreme, it’s like saying, ‘We’re so concerned about falls that we won’t let a client walk,’” McDonald remarks. “That’s a make-believe scenario, but it illustrates how risk-averse some organisations can become. Instead of finding ways to mitigate risks, they eliminate the task altogether.”
This overly cautious approach can create friction between carers and clients. Carers are often the ones left to explain these policies to clients, sometimes facing frustration or disappointment.
As McDonald puts it, “The poor carer is the one saying, ‘I’m sorry, I can’t move that chair,’ even though it’s a lightweight office chair on wheels. Both the carer and the client know it’s absurd, but the rules leave little room for flexibility.”
McDonald acknowledges that financial considerations often play a role in shaping these policies. Workplace injuries and public liability claims can significantly impact a provider’s bottom line. “Work cover claims are enormous in our industry,” he notes.
“The premiums alone can make you question if it’s even worth running the business.” However, he stresses that avoiding all risk isn’t the answer. Instead, providers must find a way to manage risk responsibly while still delivering the services clients need.
At Prestige Inhome Care, McDonald has implemented a more balanced approach to risk management. The organisation invests in comprehensive training, robust risk analysis, and appropriate equipment to ensure that staff can safely perform a wide range of tasks.
“We’ve had workplace injuries, and we’ve learned from them,” McDonald says. “But we don’t let that stop us from doing what our clients need. We just work hard to mitigate the risks.”
This philosophy extends to involving clients in decisions about their care. “To the extent that they’re able, we take almost full direction from our clients or their families,” McDonald explains.
“On a superficial level, we tell them we’ll do anything that is safe and appropriate. If a client asks us to microwave a meal or open a can of dog food, we’ll do it. It’s common sense. We’re there to make their lives better.”
Common sense, McDonald argues, is a crucial element often missing in risk management policies. While formal risk assessments are important, they should not replace practical judgment. “We use tools to rate the likelihood and impact of risks and apply controls, but then we take a step back and ask, ‘Does this sit comfortably with us? Is this practical?’” he says.
“You can’t have a shopping list of services you will and won’t do because every client is different. There’s always something you didn’t think of, like changing the paper in a birdcage. That’s where our case managers come in – they’re well-trained to balance clinical risk analysis with common sense.”
This approach requires significant back-office support, including robust insurance coverage. McDonald admits that the costs can be high, but he views them as part of doing business.
“We’ve had claims for things like rocks flicking up from lawnmowers and breaking windows,” he says. “It’s not ideal, but it’s manageable, and it allows us to provide the services our clients need.”
Ultimately, McDonald believes that a client-centred approach is the key to achieving a balance between risk and care.
“It’s about weighing the cost of managing those risks against the benefits to the client,” he explains. “Our goal is to make their lives better, and that means sometimes accepting a level of risk.”
This pragmatic approach contrasts sharply with the rigid policies of some providers, which McDonald views as counterproductive. “The irony is that strict rules don’t always work,” he notes.
“If carers don’t agree with a policy, they might find a workaround. So, you’re still exposed to risk, but you’ve also created a disconnect between carers and management.”
By fostering a culture of trust and common sense, Prestige Inhome Care aims to bridge that gap. “We want our staff to feel empowered to make decisions that benefit their clients,” McDonald says. “That’s why we invest in their training and support them with clear procedures and the right tools.”
The result is a model that balances safety, quality, and practicality. While no system is perfect, McDonald is confident that this approach serves clients and carers alike.
“At the end of the day, we’re in this business to help people,” he says. “And that means finding a way to meet their needs without letting fear of risk hold us back.”
That’s all well and sounds good.
Another issue I have found is that many cleaners don’t know how to clean! They vacuum so fast that only the obvious bits are picked up; the rest are scattered far and wide.
Also, time spent showing in a new cleaner each fortnight because the one allocated is off sick or incapacitated is exhausting. I would have been lucky to have the same person two times in a row.
I know too, that the agencies are stretched to the limit meeting their obligations to clients. It is frustrating for everyone.
I only had one cleaner who was thorough. I asked her if she could come each time but she couldn’t fit me in because she was super busy.
When we talked about how happy I was with her work and how dissatisfied I was with others, she agreed that not many knew how to clean properly.
FYI – I only required short-term help while recuperating from surgery.
Maybe it’s because home care staff have been complete exploited by the providers in the past? Families of some clients treat carers as maids as do some clients. I don’t blame carers one bit if they refuse to clean an oven or use antiquated cleaning g equipment.
The reason why we want support in our homes, is that we cannot do it ourselves and therefore do not want dirty homes. My house was dirtier getting support workers than before. The policies are ridiculous. They are making everyone want to discontinue with Homecare packages. The new act will be coming in July and many people have to pay, I ask pay for what? Substandard “ care” with no continuity of “ care”
.. I don’t need someone to come into my home to open a can of pet food which in fact could be more dangerous than moving an office chair on wheels because they could cut their hand on the lid. Isn’t it more dangerous driving to a premises? I have said before it would’ve been far easier for the government to give us a monthly amount so that we could hire cleaning companies or a Provider of our choice.
The turnover of staff is a nightmare for people with dementia. How are they expected to retrain people every two weeks?. yes there is a disconnect between providers and the support worker and I will not call them “carers” We don’t call the lawnmower man a “carer “ and yet he’s coming to help.. the aged have become conned by government, pretending to care and it’s just gaslighting us. I have only been happy with my Package since I left regular provider and self managed it.. now we’re all concerned about the new act and how many rules they’re going to put in our way to prevent us from self managing. Many now site if they have to pay they’re giving up the Package I would rather get people from outside.. that will mean more people will end up in hospitals from accidents.
Due to this policy, Someone who I am close to who has Home Care was frustrated with how very little cleaning gets done. She decided to reach up and dust near Her light to get rid of cobwebs and lost Her balance and fell, breaking Her hip! She has been in Hospital for 2 months! I asked if She had climbed on a chair! No, after using a duster to get rid of the cobweb She had turned and tripped. One so called Home Care Helper used to do 15 mins cleaning then sit and read My Friends newspaper stating, “I have finished early so I need to relax.”
Once the new changes come in as of July 1st, Self funded retirees would be far better off to employ a cleaning company and their own gardener. As they will be paying most of the cost of a cleaner from an Aged Care Company, they might as well pay a professional cleaner and get a good job. A package for them is only worthwhile to receive clinical services at no cost. Same with their choice of gardener who will maintain the whole garden, tree trimming included. For showering etc, it is still cheaper to employ your own person, even offering them free board and a small wage. They can still use the up to $15,000 for home modifications and supports.