Care Home or Home Care?

There are two main choices available to those who require care: going into a residential care home or receiving care at home. Care at home is possible so long as the person needing support is in a condition whereby they are able to manage in their own home with a helping hand – to a greater or lesser extent – from friends, family and/or a care at home service. Of course, staying in your own home means you retain independence and have autonomy in deciding what you do and when you do it, and those who value both these will do far better receiving care at home. For some, however, care at home is simply not possible due to the amount of physical support they require or their level of cognitive function. We can help you to decide which type of care is suitable and will be open and honest in letting you know if we are able to provide support at home in the particular circumstances.

Choosing the right type of care – regulated vs non-regulated care?

We understand that when you are new to choosing care, it may be easy to overlook the key differences between regulated and unregulated care. Some organisations might claim to be a care company but may not offer the full, regulated service you should receive.  Some organisations simply act as introduction agencies for individuals (personal assistants) and neither the organisation nor the individual in this case will be regulated.

What is meant by regulated? It means care services in England that are registered with and monitored by the Care Quality Commission (CQC), the independent regulatory body for health and social care.  The CQC carries out regular inspections, measuring standards of service against certain fundamental standards of quality and safety put in place by legislation, which are there to make sure people receive the care they need. Companies registered with the CQC also need to adhere to strict guidelines and procedures in order to provide good quality care.  The CQC can take what is known as ‘regulatory action’ for breaches of some standards, and can directly prosecute in the case of failures to meet other standards.  Clients who feel they are not receiving care to the standards expected or required can ultimately make a complaint to the CQC (equally, they can give feedback where they feel the care is of a high standard).  Engaging a provider that is registered with and regulated by the CQC gives clients and their families peace of mind.

To make sure an organisation you are speaking to is regulated, you can ask them to send you a copy of their CQC report (or you can search for them directly on the CQC website). If they cannot provide a report then they may well be an introductory agency where their responsibilities as a provider are likely to be very different.

Why a care organisation might not be regulated

In the case of domiciliary care (home care), the CQC regulates and monitors care organisations providing support with personal care – meaning person-centred care such as washing, bathing, showering, continence care, dressing and so on. The CQC does not regulate organisations offering services such as:

• Shopping

• Household tasks

• Cleaning

Non-regulated care organisations often act as introductory agents, providing personal assistants to carry out light tasks around the house.  These organisations are not required by law to be regulated by the CQC unless the duties involve hands-on, personal care.

The dangers of a non-regulated care service

Non-regulated providers do not have a regulatory body to answer to, they do not have the checks and balances in place to ensure that the people they care for are kept safe from harm, abuse and neglect. They also have no legal obligation to employ their carers, which means that you as the customer will be responsible for their wages, insurance, pension, holiday pay, sick pay and other paperwork or compliance, as well as finding an alternative carer if the carer is sick or if they do not meet the standards expected, and issuing contracts and other necessary employment-related documentation.

The Health & Social Care Act 2008 also states that “providers must provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times” as part of regulated provider requirements.  A non-regulated service may not carry out the background pre-employment checks that a regulated provider is obliged to (checking with the ‘Disclosure and Barring Service (DBS)’ that there is nothing in the carer’s background that could impact on the safety of the service), may not provide training to the standard they should, and may not assess competence and skill levels through ongoing training and quality assurance checks.  Although the CQC cannot directly prosecute a provider for breaching this regulation, it can take what is known as ‘regulatory action’, in other words, sanctions can be applied to a regulated care provider that does not comply with the regulations.

1st Homecare is a regulated, fully-managed service, meaning that the CQC monitor our practices and from the moment we take an enquiry through to delivering care to you or your loved one at home, the process is managed and monitored by our management team to ensure that you receive a dignified safe service that meets your or your loved one’s needs and preferences.

Conversely with a non-regulated service, once an enquiry has been placed and a carer allocated, this is where the partnership usually concludes – it’s a very transactional purchase and the management of the carer then falls onto the person needing care and/or their family.

A regulated care service provides peace of mind

Regulated providers go through regular inspections to make sure the support they are providing is always person-centred and focussed on the wellbeing of the people in their care.

These inspections are carried out on a regular basis and the provider, by law, must display their most recent rating on their website and office premises.

Every provider must have a registered manager, according to The Health and Social Care Act 2008, and these managers themselves go through a ‘fit and proper persons’ assessment before they can take sole responsibility of the service.

As noted in a previous question, registered providers have to ensure they employ sufficient numbers of suitably qualified, skilled, competent and experienced staff to meet the needs of the people they are caring for, and providers must carry out careful background vetting (in the form of a check under the Disclosure and Barring Service, as well as obtaining references) on job applicants.

Quality-assured training and best practices

Many regulated providers offer in-house training to their carers before they are sent out to work in their local communities. This means that you can be assured that they have the knowledge required to support you or a loved one in the manner which meets the person’s needs.  The CQC will expect providers as a minimum to train staff in the Care Certificate, which is a nationwide training standard applying to both the health and social care workforce; additionally, due to the requirement on providers to ensure there are both suitably experienced and competent, regulated providers would be expected to have new staff shadow experienced staff before setting out on their own, and to carry out ongoing checks on staff performance – we do this in the form of “spot checks” while care is being provided, and “after care” checks where we visit the client immediately after a visit to assess how it has been carried out.

Each company is likely to have its own set code of conduct, however the CQC also has its own fundamentals standards of quality care, including:

• Person-centred care. Is the care tailored to your needs and preferences?

• Dignity and respect. Making sure you have your personal space and privacy when you want them

• Safety. You should never be made to feel unsafe in your own home

• Staffing. Does the provider have the right staff for your needs?

Your next steps when looking for care

There’s nothing stopping you from using a non-regulated service but for peace of mind, a regulated provider with a fully-managed service will allow you to call upon an experienced team to help out in an unexpected emergency, such as a carer falling ill, and ensure you or a loved one are always safe and well-cared for.

The CQC publishes reports on all registered home care providers and care homes – these can be found online and you can always ask the provider what their rating is.

It’s important to remember that there is no one-size-fits-all approach when it comes to care, so please speak to us to learn more about our regulated service and the support we can provide.

How is care paid for?

Funding is provided by local authorities and the rules determining the type of care that an individual may receive varies from one local authority to another. Funding will be provided according to the value of the individual’s assets and according to the care needs of the individual, with funding provided to those who have greater needs.

If funding is not provided by the local authority, then care must either be provided by the family and friends of the individual or, privately, by an organisation such as 1st Homecare, or by a mix. Care is usually charged for each hour attended and travel costs may be charged too.  Please speak to us to find out about how we charge for our service.

For those with long term medical conditions funding may also be provided by the NHS through its Continuing Healthcare programme.

How much care is required?

If you are unsure as to how much care is required, we will visit the premises of the person requiring care and produce a care plan which will set out the tasks that are required on the basis of a daily or weekly cycle. This is then used as the basis to calculate the timing and number of visits required.

Can you choose a different care worker?

We recognise that everyone is different and that some people get on better with some carers than others. If, for some reason, you would prefer to change care worker after you have started receiving care from us, please feel free to call our office and we will talk through the qualities of the person you would prefer instead and we will do our best to find a more suitable alternative carer.

Client or Service user?

Many companies refer to their clients as service users. We don’t. We call them clients because we build up a rapport with every one of them and treat them as individuals. We listen to them and do things differently according to their wishes. We give them the respect they deserve and we treat them with dignity.