While the industry and Government encourage continuity of care for home care clients through the provision of regular carers, the actual practice is becoming difficult for home care providers to upkeep.
When an older person accepts a carer into their home, they are inviting them into a deeply personal space. A great deal of trust is required on both sides. The carer must be empathetic towards their client and knowledgeable about the tasks they will be asked to perform, while the care recipient must be respectful of the carer too.
Over time, as the care recipient and carer work together and get to know each other. The carer comes to understand the client, their likes and dislikes and their needs, and will be alert to changes if they occur.
Deep bonds of trust and respect can evolve. Here at HelloCare, we often hear of friendships forming.
We also hear about home care providers sending different carers every day. This constant change can have a destabilising and upsetting effect on the care recipient and it means those intimate bonds of trust and respect have no opportunity to form.
The March quarter Sector Performance Report from the Aged Care Quality and Safety Commission lists ‘consistent client care’ as the fourth most complained about matter in home care.
As the Final Report of the Royal Commission into Aged Care Quality and Safety noted, “Older people get the best care from regular workers they know, who respect them and offer continuity of care as well as insights into their changing care needs and health requirements.”
With that in mind, the Commissioners recommended aged care providers be required to give consideration to continuity of care when using contractors or subcontractors (Recommendation 90).
Mark McBriarty, Executive Director of My Care Solution, said some home care providers rotate carers between clients.
“I have heard of rotations after six months, but strongly disagree with the practice”, he told HelloCare.
Many providers “outsource” home care work, thereby losing the ability to provide continuity of care.
“Once trust is established we find clients will share concerns that they may not even share with their General Practitioner (GP) such as about continence issues. Once we know the issue, we can provide a range of discreet solutions.”
The use of contract staff for home care “most definitely” contributes to a lack of continuity of care for care recipients, said Mr McBriarty.
“If you or the client does not know the caregiver (or their capability) how can you possibly manage a positive service experience,” he explained.
Having inconsistent staff “defeats the purpose” of consumer-directed care, McBriarty added.
Consumer-directed care, or person-centered care as it is also known, is the cornerstone for aged care services in Australia. It means care revolves around understanding the person, knowing their life story, their interests, their values, community and family linkages.
Care should revolve around the person as a person, not simply as another consumer. This level of service is nigh impossible when staff are rotated too often.
Jacki Attridge, Uniting NSW.ACT’s Head of Home and Community Care Operations told HelloCare they aim to have “small care teams” for each of their clients.
“A small care team means there are multiple people who can support, monitor and ensure continuity of care.
“With multiple people aware of a client’s routines and preferences, ad hoc requests can be better responded to and clients are less likely to become dependent on one carer.
“The number in the team will vary based on the complexity of the client’s care and how many services they receive each week,” Ms Attridge explained.
However, staff shortages and the pandemic have made continuity of care challenging.
It seems it is a delicate balance ensuring the consumer can build a sense of trust and familiarity with their carer, while also ensuring they can always receive the care they need.
“All is done to keep this as consistent as possible, however, this has become more challenging with COVID disruptions to service provision and the current workforce shortage the industry is facing,” said Ms Attridge.
Home care workers in Australia have shared their experiences with HelloCare about what is occurring on the front line. It seems most of the time home care providers attempt to ensure consistency of staff as much as is practical.
One home care worker shared the home care experiences of her mother, who appreciates the familiarity of having the same carer every week.
“They have a great rapport with each other and are more like friends than carer and client. I believe those connections are important,” she said.
However, home care workers outlined new client management systems as an issue that is changing how staff are rostered.
A home care worker of 12 years said, “We have worked with the concept of same staff, same clients as much as possible, nurturing trust and familiarity. Some wonderful long-term friendships have developed.
“The new rostering system is aimed at streamlining hours on the road and kilometres travelled per day, but on the human side is very upsetting for many of our clients who depend and thrive on routine, especially the many who are still living independently with dementia in our community.
“The disruption with different staff coming is setting off a lot of behaviours and it is hard on staff.”
One home care worker said that she is discouraged from forming close bonds with her clients.
“They say we aren’t allowed to get too close and that’s a bit of a joke as we became so familiar with each other after years of caring.”
A Sydney-based home care recipient in her 70s told HelloCare she is “lucky” to have only one or two workers visit from week to week. However, she said she would prefer to have the same person coming every week.
“You don’t want them chopping and changing all the time,” she told HelloCare.
Each cleaner “does things differently” and it makes it more “difficult” to manage what they do when there are two.
She finds there is also less opportunity to build trust when the cleaner changes every week. If the same person came every week “they would get to know me, and I would get to know them”.
“I’d prefer to have the same person all the time.”
Share your thoughts with us. Do you find your home care provider is rotating the staff more regularly between clients or are they trying to ensure continuity of care?
Relationships are the foundation of good lives. When we have to rely on a service system that is struggling to both access the right staff and deliver consumer directed care, who are unable to hold our needs within a small team of carers, our risks significantly increase . Community Circles Australia recognise the risks to this system and intentionally connects (and builds connections) between everyone, formal and informal, paid and unpaid supports – family, friends, community and providers, gp’s etc to best understand and meet the needs of an older person. It shares the information, understanding and it takes all of us to live a good, integrated life.