What are the Risks in Home Care Services?

Introduction

We know that all healthcare can be regarded as high risk care. However, home care presents additional challenges as there is a potential risk to human rights when care is delivered in the home, behind closed doors. In many ways this type of care can be more of a risk than that provided in an institutional setting. The reason for that is that there are basic and advanced healthcare needs which are being provided in a setting that has not been designed for the delivery of healthcare. When home care staff are heading out to a service user they really don’t know the settings they are going to have to deliver care in. This has fundamental risks for the service that is being provided.

Research Findings on Risks Home Care

In 2013 The Canadian Patient Safety Institute completed a review of a vast number of care records for home care. They identified the following risks in the home care setting:

1. Inconsistencies in the way care is planned and delivered in Homecare.
2. Lack of integration of Home Care teams, lack of care coordination across healthcare sectors and failures in communication.
3. Poor standardization of processes, documentation, equipment and packaging of medication.
4. Clients and caregivers sometimes make decisions that put their health at risk.

We expect these risks will be foremost to HIQA’s considerations as they look forward to the regulation of the area.

Some of the comments from the Equality and Human Rights Commission (2011) in relation to risks in home care were around the fact that a lone worker is responsible for providing care in the service user’s home. This posses potential risks of neglect or physical abuse. The Equality and Human Rights Commission also note lack of autonomy and choice and the potential lack of respect for privacy and dignity as home care risks.

Privacy and dignity continues to be a focus of HIQA’s regulation in residential care sector services. They continue to find weaknesses in this area in relation to putting the resident / service user at the centre of care and demanding that they are given autonomy and that their rights are respected.

The key clinical aspects of homecare risks identified by the British Medical Journal (2013) are:

1. Falls
2. Medication errors
3. Psychosocial
4. Behavioural or mental health problems
5. Wound infections

Home care organisations need to look at how they are going to address these risks from an evidence-based perspective and put the protocols and care plans in place to be able to identify preventative measures.

In addition to the above there are key challenges to home care staff. The Equality and Human Rights Commission (2011) quote that:

“The least satisfying element is not having enough time, you try not to hurry them [older people] (or to let them know you haven’t enough time) but you are aware that your next client is watching the clock and waiting for you to arrive.”

Conclusion

In order to better manage risk and prepare for upcoming licensing, home care organisations should look to the development, implementation, continuous review and improvement of an effective Quality and Safety Management System. Home care organisations should use the National Standards for Safer Better Healthcare as a guide to build this framework.

If you require any assistance with Risk Management or developing a quality and safety framework, please contact HCI at 093 36126 or info@hci.care.