Time Critical Homecare Cases

Dementia Care
November 1, 2013

I wrote a couple weeks ago about the huge amount of pressure I have been under recently to offer a service for new packages of care. I have never seen such a spike in demand in October ever before. I have been recruiting for winter pressures since last month in readiness for an increase in demand in November/December/January. I did not expect the level of demand we are currently having and feel grossly underprepared.

Timescales to offer new cases are becoming increasingly tight, and for some cases we have 24 hours in which to plan, coordinate, contact carers, offer, and have a carer ready to attend the property. That’s a lot to do in 24 hours.

The hospitals are under pressure to discharge people who are medically fit. I have written in the past about unsafe hospital discharges, and it is a sad fact that people are being discharged back home and readmitted quite quickly.

As soon as a new referral is submitted to our team from either the hospital or the social work department, a lot of work has to be done.

Carers need to be contacted, which sounds simple enough, but employers working with a dispersed workforce will empathise – contacting employees is not always easy.

What frequently happens to my team is that we will offer cases and a high percentage of those are cancelled. For example last week we coordinated and offered 430 hours of service. In actuality we started a service for 280. 150 hours that had been offered were either no longer required or the service user was a delayed discharge and the offer had been withdrawn.  It is a time consuming process arranging these cases.

What really infuriates me is Time Critical care calls being used incorrectly. When you have a high volume of new referrals you have no other option but to prioritise. Sometimes you have to alter existing clients call times so you can offer a service and when it is required to provide a service at a set time the puzzle becomes even more complex.

I have had a number of bad experiences with ‘Time Critical’ care calls. The main way in which this is misused (or abused) is by social workers.

An example of a recent experience was I offered a service to start with a 10am morning call. This was accepted and we coordinated a service accordingly with a team of regular carers.

Six weeks later the social worker conducted a review meeting and the client was unhappy with the 10am call time. The social worker asked the client what time they would like and the reply was 8.30am. Instead of contacting us and negotiating an earlier start time, the social worker returned to their office, amended the contract for this particular client as “Time Critical for 8.30am” and emailed the contract across to our team. On a Friday afternoon.

My team contacted the social worker (“gone home”) and the service user to discuss further. A meeting was scheduled for Monday to relook at the service and see what could be done, who could be moved later or earlier, what room did we have on other blocks to move someone to or from…. etc etc. On Monday afternoon I had a phone call from the social worker stating that he had rang the service user and he confirmed that over the weekend his carers had arrived at 10am when he had been promised by the social worker the 8.30am call. The social worker told me he was putting this through as a notification of concern!

Social workers have a duty to manage service users expectations. The demand for Homecare is at an all time high. In an ideal world we would love to be able to provide a service at the times that the clients would like them. But in reality this is not always possible and priority has to be given- in certain circumstances- to some service users that require a call at specific times.

Time Critical care calls are required in order to meet a service users specific assessed needs. When assessors/social workers request a Time Critical call they should to evidencing this within the assessment of need and care plan as being essential to the service users support plan to maintain independence.

I believe Time Critical care calls should only be agreed in the following circumstances:

  • There is nobody available in the household at the critical time.
  • The service user would be at high risk if the care was not carried out at the critical time.
  • The service user has a comprehensive care package i.e. 4 calls per day and the visits need to be equally spaced apart in order to meet care needs. In these situations the time critical element may be within time bandings i.e. for a 4 call a day package early morning call could be anywhere between 7.30 – 9.30 and then 11.30 – 1.30 etc.
  • District nurse visits at a specified time for diabetes care / enemas etc.
  • Meals required at set time due to diabetes management.
  • Bladder and bowel regime which requires calls to be within a defined time period e.g. early morning to empty night catheter bag, changing of pad.
  • A service user who has a specific medication regime that they cannot manage themselves and the medication has to be administered at a specific time for therapeutic purposes e.g certain Parkinson’s medication treatments.
  • The service user has to be ready for a specific appointment i.e structured hospital appointments (eg dialysis) attendance at a day centre.

Requests for Time Critical calls should be clearly indicated on the service users contract with both identified time bandings and a covering message detailing why the call is Time Critical.

My team and I are now taking the stance that any new referral that is identified as Time Critical should be checked with the assessor for the reason why. Then we may have a fighting chance of being able to offer the service based on full information of the service users needs and to avoid inappropriate offers of care being made and precious time being wasted.

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Rosie Robinson

Domiciliary Care Specialist


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