Let’s not lose the potential of technology in homecare

In August this year Scottish Care published ‘TechRights: Human Rights, Technology and Social Care’. It was launched at our event called ‘Tech Care, Care Tech.’ which was the first event of its type held by Scottish Care.

Since the publication of the report a great deal of debate has ensued both in Scotland and further afield not least about the role of robotics and the Internet of Things.

In the months that lie ahead Scottish Care will continue to work with partners on a range of projects relating to technology and its use in social care. One area we are investigating with a wide range of colleagues and academics is the potential to develop inter-operability which would enable providers to use the best software offers for their service delivery and enable them to ‘speak’ to one another in an integrated way. We will keep you up to date on this and related work.

However we have to state that the positive use of technological interventions in order to maximise rather than replace human encounter is facing some real challenges.

The first is the way in which some technologies are being used to restrict rather than to promote human relationship. Scottish Care has long argued that the use of call monitoring hardware and software within the care at home sector needs serious review. There are real benefits to organisations and individual workers not least in terms of safe lone working practices. However, what we have at the moment is the use of systems like CM2000 by Scottish local authorities which serves to effectively treat the frontline workforce in an unacceptable manner. Effectively workers are being electronically tagged and we have clear evidence that workers are leaving organisations who are forced to use this technology – a valuable resource the homecare sector can ill afford to lose.

This needs to be challenged as a matter of urgency or we will witness a whole generation of frontline homecare workers who will be resistant if not hostile to the benefits of technology for frontline care. Call monitoring models need to be person-centred and human rights based in use and implementation and not act like some sort of ‘Big Brother’ device to instil suspicion and mistrust.

A second challenge relates to the data that we are already gathering. Hundreds of homes are increasingly utilising the benefits of smart technology. There is an astonishing breadth of smart technology that is already and very shortly will be taken for granted in most homes. There is as some have commented a danger of ‘tech clutter’ in some of our homes, especially the living room from smart devices like the now commonplace Echo Dot, to music speakers like Sonos, smart televisions in abundance through to heating controls like Nest and Hive.  But less rare but growing are smart lighting devices, alarm clocks, radios, vacuum cleaners, microwaves, kettles washing machines and doors.

The volume of data that is being collected is astonishing but it is not utilised. We could do much better than we are already in using this data to move from a reactive model of homecare to one that is truly preventative and builds the support and care service around the distinctive needs of the individual. Such an emphasis requires resourcing and trust between commissioner and provider. It also requires those creating national data platforms to speak to homecare organisations and providers in order to maximise benefit.

A third challenge is something we alluded to in the TechRights report and that is the extent to which we need to re-envision the role of homecare to enable it to attract people who are technologically confident and competent. But for the tens of thousands of staff who are working already in homecare we need to do more than we are at present to invest in training and development for them, so that they overcome fear and cynicism and see technology as an asset to care. Such training and learning is the first to be cut in contracts during austerity and this is a fatal flaw for the development of a responsive, prevention focussed future model of care in the home.

Lastly the way in which care technology is introduced must bring the wider general public with it, especially as we move to an age of greater use of home robotics and artificial intelligence. At the moment there is a real lack of knowledge on the one hand, and a fear on the other. Such an articulation has to be based on an assertion of what should always remain the essence of homecare. This must surely be the sense that in ultimate terms , not least palliative and end of life care, that contact has to be human and that whilst technology can assist and add value it should do so in order to support and enhance human presence rather than replace it.

We live, as has been numerously said, in very interesting times. As innovation and technological discovery accelerate into areas and abilities we can only imagine, we have to be clear that a rights-based, person led, citizen controlled technology for homecare needs to be a priority in all the design and debate.

Dr Donald Macaskill

 

Yesterday I was having a discussion with a colleague about the various bits of research we are currently undertaking within the social care sector and the privilege we’ve had of leading various focus groups with front line staff working in services across Scotland.

“Have you ever done it?”, she asked.

“Done what?” I enquired.

“Worked in a social care service?”

My answer was no, and I explained that this means you can feel like a bit of a fraud spending your days researching and advocating for a sector you’ve not worked in, never mind forged a career in doing so.

But we both went on to reflect that it was a job we didn’t actually think we would be able to do, recognising that it requires a particular set of skills and personal attributes in order to be able to deliver the high quality, personalised and complex care we’ve come to expect, not least of home care provision.  We shared our mutual sense of admiration for the thousands of individuals who do undertake these roles and make a huge difference to people’s lives on a daily basis.

At the same time, I’ve been thinking about an exercise we have been conducting with home care providers and workers in recent weeks, asking them to reflect on something that stands out to them about the year they entered the home care sector, as well as something that comes to mind about the reality of home care provision in 2018.  Whilst we’ll be publishing this data more fully in Spring 2019, initial findings are already showing the huge changes that have been experienced within the home care sector, not just over the past few decades but even in very recent years – something we’d already begun to explore through Bringing Home Care.  With the pace of change, it means that those not directly connected to this sector (but who are reliant on its existence and success) may have no real idea what working in home care looks like or entails in 2018.

In terms of policy around home care, we’ve seen a real drive towards supporting people in their own homes for as long as possible, including those who would traditionally have accessed medical and residential care, based on the knowledge that most people would want to remain in their own familiar environment if at all possible.  Policy changes relating to Health & Social Care Integration, Self-Directed Support and changes to service regulation through the new Health and Social Care Standards have also emphasised the importance of individual choice and control, independent living, self-management and prevention.

Hopefully, these reforms will progress us towards a new age for home care – where services are planned for and commissioned in a sustainable way which reflects their criticality to our communities and infrastructure, and where services are empowered to be flexible enough to deliver the support that individuals want in order to achieve their personal outcomes.  Those are the ambitions, I think, that make a policy drive towards supporting people in their own homes for longer truly worthwhile.

However, these positive drivers don’t necessarily mitigate the reality of extremely limited resource – financial, human and sometimes, imagination around the commissioning, planning and delivery of home care which, in effect, makes it the Cinderella service of health and social care.  And given the exercise we’ve been conducting alongside Scottish Care’s previous research, we know that that challenging reality is biting.  But is the speed of reform sufficient to alleviate the very serious pressures on the sector now?  We know that home care services are concerned about being here in a year’s time, we know that recruitment and retention is more difficult than ever, we know that hospitals and care homes don’t have the capacity to deal with additional demand and we know that care packages and associated home care hours are increasingly hard to get and maintain at required levels.

My concern, therefore, is that the consequences of positive ambitions yet slow reform coupled with an already overstretched sector creates a reality where the policy becomes skewed.  With a drive towards more care in the home but without the pace needed to protect, sustain and develop this sector and its workforce, it means that not enough home care can be delivered to meet demand.  It puts the responsibility on relatives and informal carers to step into the gaps to provide often intimate and complex care at what can already be a distressing, emotional and exhausting time for them. 

It also undermines the truly professional and highly skilled role of home care workers who do their utmost to deliver care without the access to the wider support that they should have.  Even if you have a care package to support you in your own home, it’s regularly commissioned around task and time for the lowest cost – almost saying ‘this is an unvalued job that anyone can do’.  This is an unhelpful message to reach people considering working in home care who, in reality, need formal qualifications, require to be registered with the SSSC and will be delivering complex care to people living and dying with co-morbidities.

We need to turn this on its head quickly and loudly.  We need to be emphasising that radical reform needs to take place in this sector because its sustainability is absolutely vital to the lifeblood of our communities, the NHS and all services involved in integrated health and social care delivery in Scotland.  We need to be ensuring that people can positively choose to stay at home safe in the knowledge they will have holistic support that’s predicated on their needs and ambitions rather than minimum cost.  We need everyone to know that the image they may have of home care in years gone by – mopping, shopping, cups of tea – is not the home care of 2018.   It’s not even recognisable to that delivered 5 years ago.

And we need to be celebrating the fact that not everyone can be a home carer (including me) because they are truly special individuals who we need to admire, reward appropriately, and value.

We simply cannot afford to be without them, or to shy away from brave thinking and radical changes in the home care sector.

@BGatherum

 

 

 

 

 

 

 

 

 

 

 

 

 

The My Home Life team has had the pleasure of working with Care at Home Managers in Scotland in the last few years. Although the MHL programme was originally designed for care home managers to improve the experience of people living, working, visiting and dying in care homes, in many local authorities the programme has also been offered to Care at Home managers with success.

Within West Dunbartonshire health and social care partnership, care at home teams have been included in the programme. On the current cohort we have a senior manager and three team leads from the Care at Home team as participants.

The model of care within care at home teams means that the managers face to face contact with their large number of colleagues, particularly those who are providing the care, can be limited.

MHL encourages the participants to do things differently, not necessarily do different things and so Care at Home managers have been creative in how they can demonstrate the difference, and co-create solutions with their colleagues.

Using an appreciative approach and the Caring Conversations Framework, communication with colleagues internal and external to the main office has been transformed. Meetings of every kind are conducted differently, ensuring every voice is heard, using creative approaches such as the use of images to help colleagues explain to each other how they feeling. Supervision has been transformed from what used to be a tick box approach to a genuine interest in what is going on for each other and how colleagues can continue to give of their best. Care at home staff tend to be in touch with their managers when things are not going well and telephone calls with colleagues used to be stressful. Now time is given to listening and working with the colleague to come up with a solution which works for everybody, and when things are going well, managers are taking the time to call or text their colleagues to thank them specifically for their work. How manages recruit and support new colleagues into the workforce has also been considered with a view to enhancing the experience for them all and thus improving retention of colleagues.

Managers are also beginning to spend more time with the users of the service, particularly at the assessment stage, where they can find out more about what the expectations and needs of the user are in order to provide the most suitable package of care. Some of them are using emotional touch points to explore how clients are feeling about allowing carers to come into their homes to provide personal care which is giving them further insights. Should a complaint be received, managers will now visit the person who has made the complaint and use one of the creative tools to understand how the person is feeling, how they would like to feel and work with them to come up with a solution together.

 

Below are a couple of quotes from Care at Home participants:-

‘A client I find difficult and challenging contacted me. I spoke to him about MHL and he invited me out to discuss his care.  I realised no one had asked him how he felt or what could be done… I used the positive inquiry tool and what he said was valid and we had caring conversation. I managed to go get to core of his complaint and we discussed other options. I was able to give feedback to his carers. MHL and the 7 Cs stopped me taking it personally and it…was amazing ,  he gave me feedback about me and my influence.  I agreed to talk with my line manager and have done similar with carers.’

‘I’ve been taking time to speak to families and relatives who can tell me what is working well with the service. I have become more proactive and not so much reactive. This is the first Christmas I have not been looking for a new job, the shift is in me. I can’t change other people. But I’ve changed.’

 

Care at home teams offer such an amazing service to enable people to stay in their own homes, it is wonderful to see how managers using the MHL approach are transforming personally and professionally, modelling and appreciating different ways of working which are achieving different outcomes for colleagues at all levels.

 

Below are a couple of poems created by Care at Home Team Leads

 

M.H.L. and ME

 

I have the ability
live with me forever
deal with difficult situations
fellowship and support of others

 

Live with me forever
sharing the challenges
fellowship and support of others
different directions

 

Sharing the challenges
deal with difficult situations
different directions
I have the ability

 

My ‘Yes!’ Moment

 

I do think I am of value

I felt an instant shift, my ‘yes!’ moment

Fiona’s words of wisdom struck a chord within me

I own my insecurities now

 

I felt an instant shift, my ‘yes!’ moment

My journey has been slow and steady

I own my insecurities now

I can, and I will, keep on growing

 

My journey has been slow and steady

Fiona’s words of wisdom struck a chord within me

I can, and I will, keep on growing

I do think I am of value

 

Written by Fiona Cook – external My Home Life facilitator