Providers and the care system

Meeting the carer before the care begins

When home care starts, NICE guidance in England says new care workers should be introduced to the person before they visit on their own. Why guidance there treats familiar faces as part of good care.

By the WeHomeCare Omnibus editorsPublished 19 October 20264 min readGetting helpProviders and the systemInformation, not medical advice

On a white cottage doorstep after rain, an older woman points out her garden to a laughing young woman as a terrier jumps up to greet her.

From WeHomeCare

We think your parent should decide what their family sees, and you can ask any care provider how it makes that possible.

Visit updates

wehme.careVisit Updates2 todayTodayAFAna has checked outMorning visit · 10:48 · 46 minCompletedBreakfast and a slow start. We did the crossword together and she was in good spirits.AFAna has checked inMorning visit · 10:02In progressYesterdayMRMarco has checked outAfternoon visit · 15:16 · 46 minCompletedShort walk to the shops, all well. Picked up milk and the paper.MRMarco has checked inAfternoon visit · 14:30CompletedOct 24PNPriya has checked outMorning visit · 10:32 · 58 minCompletedHair washed, lunch prepared for later. She asked after the grandchildren.PNVisit note sharedPriya · Saturday morning visitSat 10:35Lovely morning. We sat in the garden for a while and she named every plant.

Soon, somebody your parent has never met will knock on their front door, wipe their feet on the mat and step into a hallway that has been private for decades. It is a strange thing to picture from the outside, and stranger, perhaps, from the inside. This is information, not medical advice. It does not grade providers or say what a first visit ought to look like, and no page could. Home care services work differently from place to place, and the same worker may not always be the one who comes. What this piece offers is why guidance in England puts weight on people meeting first.

In England's guidance on care at home, a carer who is not a stranger is treated as part of good care, not as a courtesy on top of it.

Introductions come first

In England, NICE's public information on home care for older people says new care workers should be introduced to the person before they visit on their own. NICE's public information in England also asks for the same workers to visit, so that the person is familiar with the people coming into their home.

NICE's guideline for home care services in England (NG21) makes the same point from the side of the services. It recommends continuity of care, so that the person knows their home care workers and the workers know how that person likes support to be given, and it names introducing people to new workers as part of that. In that guideline, familiarity is the aim and an introduction is where it begins.

What we don’t claim here

We don’t tell you whether a change is serious, or where ordinary ends and concerning begins. No authority sets that threshold, so we don’t imply one.

Who can weigh it: your parent’s doctor or other health professionals, who know the person and the situation. Where to take it →

In England's guidance, the person stays in charge

NICE's guidance from England is clear about who leads. Its public information in England says the care a person gets is meant to reflect what matters to them, what they feel able to do and what they want to be able to do. It says the person should be in charge of deciding what support they get, though they can ask a family member or carer to help, and that they are to feel in control at all times, with their privacy and dignity respected.

Time is part of that picture. In England, NICE guideline NG21 recommends that home care contracts allow workers enough time to provide a good service, including time to talk to the person and their carer. As we read it, getting to know someone is written into the time that guidance in England asks for.

In England, NICE's public information says home care providers should regularly check that the person is happy with their care, and make sure they know who to contact if they have a complaint. Concerns about the arrangement itself can go to the provider first. How home care is set up and overseen differs by where your parent lives. Questions about your parent's health that come up along the way belong with their doctor or other health professionals rather than the agency. The steps themselves are set out in Bringing a carer into your parent's home and Questions to ask when choosing a carer or agency.

For a person with dementia, a little more

Some guidance is written for a particular situation, and it is worth keeping it there. The Alzheimer Society of Prince Edward Island, a provincial chapter in Canada, suggests introducing a care provider to a person with dementia before care begins, so the provider is not a stranger. The same chapter suggests that the first few visits to someone with dementia might take place while a family member or someone they trust is at home. It says staff knowing the individual likes and dislikes of a person with dementia helps them care more easily. The same chapter describes in-home help as an adjustment for the person with dementia and for their family, and notes that the first attempt may not work.

Meeting first, in England's guidance, is the start of your parent and the people who help them coming to know each other, on your parent's terms.

When to ask a professional

This piece stops where a professional’s judgment starts. Bring what you’ve noticed, plainly, to your parent’s doctor or other health professionals.

Sources

The outside sources this article draws on.

Primary: Taken from the official source itself, and cited directly.

PrimaryNICE (England), Home care for older people: what you should expect, 2015
PrimaryNICE (England), Home care: delivering personal care and practical support to older people living in their own homes (NG21), 2015
PrimaryAlzheimer Society of Prince Edward Island (Canada), Preparing for in-home help and support, 2012

How we source

Carefulness, made visible.

Named, not counted

Each piece names its sources and tags each one Primary or Secondary. It never counts sources at you.

Holding back

Where a part isn’t confirmed, a piece runs shorter and says what is missing.

Naming the limit

Every piece names where its authority ends, and who to ask instead.