Delegated healthcare activities – have your say!

The last few years have seen more and more people being cared for in their own home instead of going into hospitals. And the people are staying at home have more complex conditions they need support with, so the kinds of things their carers are being asked to do is changing to become more complex too. We know homecare providers are already carrying out activities which would previously have been done by healthcare professionals. We know homecare providers are already carrying out activities which would previously have been done by healthcare professionals. Activities like medication administration, wound care, and catheter care are just some examples of the additional work that homecare staff are now doing. We have heard too of staff supporting with complex feeding needs (e.g., using a PEG tube) and even some ventilation support.This change has been happening for some time, but what has not been seen is consistent support, guidance, training and recognition for the carers to feel confident and competent when carrying out this additional work. 

 

Speaking to carers, we know that these kinds of healthcare activities are often handed over without dedicated training and with little or no ongoing support. We hear that there are a lot of concerns about the risks both to those receiving care and to the carers doing it, if healthcare activities aren’t delegated safely. We have heard of homecare providers often carrying out this extra work at a financial loss given the time and complexity of the activities, which is not accounted for in the standard rates they are paid for packages of care. Homecare agencies have also told us that without clear guidance on what care staff can and can’t do, it can be challenging to get insurance for delegated healthcare activities which are not covered by the usual policies.

 

But there are, of course, lots of benefits to carers taking on healthcare activities – many people have built great relationships with their carers and having this carer help them rather than waiting in for a District Nurse or other healthcare professional to arrange a visit can really help to improve person-centred care, especially for people with dementia who may have more trust with their carer than with a healthcare professional they don’t know. There can also be benefits for homecare staff too – if done properly, taking on more complex activities can build their skillset, give them more variety in their work, and give them more options for career development.

 

This work is already happening, and some have called it “health by stealth” in reference to the lack of proper planning and training that has accompanied this change. A research study at King’s College London is now looking to find out more about what is happening when healthcare activities are or aren’t delegated in homecare settings, and how acceptable it might be for and appropriate homecare providers and staff to take on more activities like this. We want to show what is needed to help support homecare workers and their employers to care for their most complex client’s needs safely for everyone involved.