Practical guides #7: How to decide on a care package for a patient.

This blog post will cover

  • What is a package of care
  • What is included in packages of care
  • How to decide what package of care a patient needs
  • Common misconceptions about carers
  • Blister packed medications and Dosette boxes
  • When a reablement POC is appropriate
  • When to recommend a key safe

 

I’m coming to the end of my community rotation.  During this rotation I have provided care calls to patients while waiting for packages of care to start. This means that the patient isn’t sat in hospital just waiting for care to be put in place. It’s given me quite an insight to what carers do for patients.  So today I’m going to write about how to decide what package of care (POC) a patient needs. On the ward, medical social workers will be looking to you to tell them what support a patient will need on discharge.  This will be based on your assessment of the patient on the ward.

What is a POC?

“A care package is a combination of services put together to meet a person’s assessed needs as part of the care plan arising from an assessment or a review. It defines exactly what that person needs in the way of care…to live their life in a dignified and comfortable manner” Taken from Social Care Services http://socialcareservices.co.uk/care-package

In other words, it’s putting in place professional carers to assist with tasks that the person isn’t able to do so they can live at home.

What is included in a package of care?

Let me tell you the types of things that a package of care can include so you know what you can put in place.  The maximum number of calls a person can have a day is 4. A full package of care is 2 carers, 4 calls a day. If someone is struggling with a full POC the next step up is 24 hour care.

Of course, carers will only do these things if they are needed.

Morning call:

  • Getting person out of bed
  • Personal care: washing, dressing and changing pads
  • Supervision on the stairs
  • Medication
  • Breakfast and hot drink
  • Emptying commode
  • making a flask of tea that the person can help themselves to throughout the day if they can’t make a cup of tea for themselves.

Lunch call:

  • Preparing meal and drink (it will always be a simple meal to prepare based on the food that the patient has got in the house)
  • Medication
  • emptying commode
  • changing pad
  • refilling flask of tea

 

Tea call

  • As above

 

Bed call

  • Undressing and getting into nightwear
  • Medication
  • Commode
  • Changing pad
  • Supervision on stairs
  • Getting into bed

 

Of course depending on the patients ability there may also be assistance with transfers (getting on and off chair/bed/toilet) at every care call. If a person transfers with a hoist, a Re-turn or Sam Hall Turner then they will need two carers at every call. Carers may also apply creams to body areas if needed.

Common misconceptions about carers

Carers are only meant to do personal care and don’t really do domestic chores such as shopping, cleaning and laundry although this can depend on the locality and the carer.  This is seen more as a home help service. People must pay privately for these services. I recommend getting someone who is DBS checked (this used to be called CRB check-it’s when someone has undergone police checks). Age UK can recommend people to you in your area.

Also carers won’t just ‘just pop in to see if someone’s alright’ which families have asked me for. There needs to be a point to them calling.

So how do you decide what people need?

To start, you may want to find out what help family or significant others can provide and work out where the gaps are. If the patient is volunteering their family for all sorts of tasks, it’s important to get that person’s confirmation that they will be able to do this. To identify what help that person will need, it’s helpful to write yourself a list like this:

 

e.g.

Patient X

 

  • Mobility: independent with WZF on ward
  • Chair: Independent
  • Bed: independent
  • Toilet: independent with FSTF
  • Stairs: 2x rails independent
  • Washing: requiring assistance of one for lower body on ward
  • Dressing: ?
  • Breakfast: ?
  • Lunch: ?
  • tea-family will do evening meal
  • medications –can self medicate with blister packs
  • housework-has private cleaner
  • laundry-family
  • shopping-neighbour
  • commode-doesn’t need a commode.

So in this example I need to establish if they can dress themselves and make breakfast and lunch as this is where the gaps are.

Washing and dressing

So the obvious way of finding this out whether a person needs a carer to assist with washing and dressing is doing a washing and dressing assessment. Simply put, if they can do it themselves, then they don’t need carers. If they haven’t got anyone to assist, can’t do it at all or can only do it partially, then you’ll need carers.

Washing and dressing assessments can be time consuming and often, if you’ve got busy wards to cover, you can’t do this for everyone on your caseload. A quick way of finding out is asking the nurse or HCA on the bay if that person has required assistance on the ward with this. If they need help with it on the ward, they’ll need help with it at home.

Consider the patients condition, Sometimes it can be really obvious that they will require help, like if they’ve broken their shoulder or  less obvious e.g. a patient may be able to wash and dress themselves but may get very fatigued or breathless especially bending to do their lower body.

If it’s not really obvious or it’s more complex, you may want to do a washing and dressing assessment (or asking your therapy assistant to do it for you).

 

Meals

Again, the obvious choice of finding out whether someone will need carers for meals is doing a kitchen assessment. Read my blog post on how to do a kitchen assessment. After your baseline assessment, it may be very easy to tell on the ward that someone will struggle with this, like if they have poor mobility, they are very frail, or they’ve fractured their wrist, haven’t got the cognitive skilks, they are very breathless or fatigue easily. Although when you are newly qualified, it can be very hard, this comes with experience so don’t be hard on yourself.

Care calls don’t need to be provided for every meal. Instead of having a morning and lunch call, a carer may leave that person with a sandwich and a flask of tea at breakfast thus not requiring a lunch time call. Sometimes, people don’t want carers popping in all the time, so this can be a good compromise.

Medications

You need to find out whether the person can self medicate. You’ll need to ask a few questions to find out.

  • Can they read the instructions on the medication box? How many to take and at what time? You could ask them to tell you what pills did they take before they came into hospital and at what times do they take them. They may say something like “ I take x tablet every morning and night, I take y tablet before I go to bed. Although their prescription may change on discharge at least you know they can read the box and remember to take tablets and get into a routine.
  • How often do they forget to take their pills?
  • Do they have the cognitive skills to remember when to take them?
  • Can they physically get the pill out of a child safety bottle or a pack?
  • Do they usually use blister packs at home?
  • Do family help with their pills?
  • Can they administer the medication themselves? E.g swallowing, rubbing in creams.

 

If they require assistance, you’ll need to find out how many times a day they need to take their medications as they’ll need that many calls. Carers can only assist with medication from blister packs. Local pharmacists can do blister packs for people where all the pills in the morning will be labelled morning and all in one blister that they pop out in the morning. Then the same for lunch, tea and night. Note that certain medications cannot be blister packed like Warfarin as the dose can change daily.

Blister-pack-web

Blister pack

 

Dosette boxes.

‘Dosette’ boxes are boxes that the patient or their family may fill with medications. They have separate compartments for days of the week and / or times of day such as morning, afternoon and evening. Carers are not allowed to fill dosette boxes, this must be done by the family/patients support network.

 

 

dosette-pill-box-medication-medicine-2

Dossette box

 

Bed call

The patient will need a bed call if they require help undressing and getting into nightwear. Or help getting into bed if they have difficulty with their bed transfers. However if that person needs to get up and use the loo during the night, they need to be independent with their bed transfers, unless they are willing to wear a pad. Your stair assessment would help you decide that they also may need supervising on the stairs.

Care agency assessment

On discharge home, a manager from the care agency put in place by the social worker will visit the patient’s house to do their own assessment. A couple of times I have been fortunate to have visited a patient’s home the same time that the care agency have visited to do their assessment.  They will ask the patient what they feel that they need help with, look at what medications they are taking and look at the patient’s transfers.

Reablement POC

If your patient has the potential to return to being independent, you can recommend a ‘reablement POC’. This is where specially trained carers assist the patient for up to 6 weeks with the aim of getting that person independent again or reducing the care calls. As the weeks go on the patient does more and more for themselves. So a basic example would be, if someone was previously independent with their activities of daily living and then had a hip replacement. They would probably return to being independent as time went on. If someone had a deteriorating condition like Parkinson’s, dementia or were palliative you wouldn’t  be looking at a reablement POC as it is not likely that this person will return to independence.

Keysafes

You’ll need to find out whether the patient is able to let the carers in. If they can’t then they will need a key safe.   A key safe is a small box installed by the front door where a code must be entered to access they key where the carer can then let themselves in.

KeySafe original slimline

key safe

Consider a keysafe when the person:

  • Needs help getting out of bed in the morning
  • Needs supervision on the stairs.
  • Has limited or no mobility
  • has no one else to answer the door

 

Be aware some people do not want key safes outside their property (or grab rails for that matter) as they feel that this makes them look like a target for people that prey on vulnerable people. If this is the case, explore whether this can be installed in a more discreet location like at the side of the house. Key safes can be arranged and fitted through social services for a cost or can be purchased from DIY stores. Although I would advise a sturdy one that looks like it can resist tampering. There are key safes that are Police approved like the Supra C500.

That’s all for now, next time I write I’ll probably have rotated again so I’m sure that I’ll have some new challenges to work through and tell you about.

See you then

Helen

 

Related articles:

Working with unpaid carers to support our patients

How to do a kitchen assessment

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3 thoughts on “Practical guides #7: How to decide on a care package for a patient.

  1. Pingback: Practical guides #8: How to do a washing and dressing assessment and introduction to dressing aids | The OT process

  2. This post (and indeed your whole blog) is very helpful thank you! Am I correct in thinking that a 4x a day POC is needed if a person is incontinent? Otherwise the time in between care calls may be too long and sitting in a wet/soiled pad could put the patient’s skin at risk – particularly if they are elderly and have a high Waterlow score. Thanks again.

    • Hi, thanks for your comments and for taking time to read the blog. That would depends whether the person can mobilise to the toilet independently and are able to change a pad themselves. If they are unable to do either of those things then they would need 4x POC.

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