Lack of knowledge about dementia mars home care services, says regulator

BMJ 2013; 346 doi: (Published 13 February 2013) Cite this as: BMJ 2013;346:f1027
  1. Adrian O’Dowd
  1. 1London

Some staff who provide home care for older people in England lack important skills and training to enable them to deal with mental health issues such as dementia, finds a new report.

Overall around a quarter of home care providers do not meet all five national standards of quality and safety, concluded the health and social care regulator the Care Quality Commission (CQC) in a report published on 13 February.1

The report gathered findings from inspections of 250 domiciliary care agencies providing at-home support and care to around 26 500 people aged 65 or over in England.

The CQC gathered views from more than 3700 people who used the services. Inspectors visited people in their own homes, carried out telephone interviews, and analysed 1003 responses to questionnaires.

The inspections rated agencies on how they respected and involved people who used their services; the care and welfare of people who used services; safeguarding people who use services from abuse; how providers supported their staff; and how providers assessed and monitored the quality of their services.

Overall the CQC found that three quarters (184) of the providers met all five standards. It said that it found many examples of good care, with people being respected and given choice and staff being supported.

However, a minority of people who used the services were affected by late or missed calls, lack of continuity of care workers, unsupported staff, poor care planning, and failures of providers to listen to service users and their families and carers.

On the issue of providers supporting their staff, the report found that most providers (221 or 88%) were doing so but that 29 (12%) failed to meet the national standard and that staff knowledge was often highly variable.

Some questionnaire respondents said that they did not think that new care workers had received enough training, and examples were given of complaints about a lack of understanding of mental health issues, including dementia.

Most of the providers (212 (85%)) met the standard on the care and welfare of people who used services, but the report found a number of occasions when risks associated with a person’s care or medical condition, such as diabetes or catheter care, had not been assessed, and some care plans had not been updated for several years.

David Behan, chief executive of the CQC, said, “People have a right to expect to be treated as an individual, to be able to exercise choice, and to make sure their carers are aware of their specific care needs. We found plenty of evidence of this; however, we also found elements of poor care which happen too often.”

Jeremy Hughes, chief executive of the charity the Alzheimer’s Society, said, “Half a million people with dementia live in the community, and as the brain gradually shuts down many will need help with everyday tasks such as eating meals, washing, or going to the toilet. However, patchy quality means that some people are being forced to struggle with poor and in some cases undignified care.”


Cite this as: BMJ 2013;346:f1027


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