Inadequate homecare training putting elderly and disabled at risk

The safety of elderly and disabled people who rely on homecare is being put at risk because staff are receiving inadequate training, according to a UNISON study published today.

The survey of more than 1,000 care workers employed by councils and private firms across the UK, found that staff are increasingly being asked to perform intimate procedures that would previously have only been carried out by registered nurses.

Changing catheter bags, peg feeding, stoma care*, administering medication and looking after patients with dementia are just some of the difficult tasks that homecare workers carry out, even though many receive little or no training.

Inadequate training can leave care users in significant discomfort and vulnerable to infections. And, worse still, insufficient training on how to administer medication could lead to fatal overdoses, says UNISON. 

Meanwhile, homecare workers are being denied access to vital knowledge, new skills and career opportunities, the survey finds. 

Of the homecare workers surveyed who regularly carry out the following tasks:

•    Almost six in ten (59 per cent) had received no training in how to attach or change a convene catheter. 

•    More than half (52 per cent) had not been shown how to perform stoma care. 

•    More than four in ten (45 per cent) had not received training in how to change a catheter bag.

•    More than a third (38 per cent) hadn’t been showed how to carry out peg feeding. 

Almost a quarter of staff (24 per cent) administering medication had received no training, despite some of them distributing drugs such as liquid morphine and insulin. 

More than two thirds (69 per cent) said they cared for people who suffer from dementia. Despite this, more than a quarter (27 per cent) had received no training in how to work with people with this illness.   

More than three-quarters (78 per cent) of respondents had asked for extra training to help them carry out their increasingly demanding roles, but less than half (49 per cent) had received any. 

UNISON General Secretary Dave Prentis said: “If homecare workers aren’t receiving adequate training to carry out complicated tasks, there could be fatal consequences for the people they care for.

“The funding the government gives to councils for social care has been slashed since 2010, forcing many local authorities and private companies to skimp on training. It is a stark illustration of the lack of dignity that is being afforded to both care workers and the people who rely on homecare.

“Plans to integrate NHS and social care services are doomed to failure while we have a social care system that treats homecare workers with such contempt, and the people they care for with such disregard.”

UNISON says that the survey suggests that homecare workers are feeling increasingly uncomfortable with a system that is sending them into the homes of people with complicated needs, with the bare minimum of training, or in some cases, no guidance at all.

Those staff who report some form of training expressed their dissatisfaction with its quality:

•    Less than half (46 per cent) said that their peg feeding training had been good enough to help them do the task properly.

•    Only four in ten (39 per cent) stated that the stoma care training had been sufficient for them to do their job properly.

•    Less than half (47 per cent) said that the training on how to change a catheter bag had been good enough.

•    Just over a third (34%) reported that the training to show them how to attach or change a convene catheter had been good enough.

•    More than a third (36 per cent) said the training they’d received in administering medicine had been inadequate.

UNISON believes that the government’s new care certificate – which came into force this month – does little to address the increasing lack of training for care workers. It is also only aimed at new employees. The certificate merely provides a basic induction to care, is not mandatory, and the training provided by the employer is neither monitored nor assessed.

This lack of training is compounded by the fact that homecare workers are increasingly being forced to carry out their roles within shorter periods of time, as a growing number of councils use 15-minute visits. Many employees are not being allocated the same care users, preventing them from building relationships with any of the people they care for. 

Despite being expected to carry out increasingly difficult tasks with more responsibility, many homecare workers are being paid below the national minimum wage. This is because non-payment of travel time and care workers having to pay for their petrol, uniforms and mobile phones. 

Notes to editors

The online survey was carried out over a six-week period between February and March 2015 and received 1,020 responses. The respondents worked for a variety of employers – local councils, private and charitable, or voluntary homecare providers. The report is available here

* Catheter bags collect urine.

A peg tube is a feeding tube that passes through the abdominal wall into the stomach.

A stoma is a bud-like structure that is formed when a surgeon stitches the opening of a patient’s bowel or ureter (the tube that carries urine from the kidneys to the bladder) to the skin on the abdomen. A pouch is placed over the stoma to collect waste products that would usually pass through the colon and out of the body.

A convene catheter is a tube through which urine passes through into a bag attached to the leg.   

The report and press release have been made available to the social care regulators across the UK (the Care Quality Commission; Care Inspectorate; Care and Social Services Inspectorate Wales; Regulation and Quality Improvement Authority)

Three care workers responding to the survey said:

“I have just completed the manual handling course. This is not something you can do without practical training. It is awful to think that this course means that someone is legally able to use a hoist without ever having seen a sling or been shown how to use one. The course says you must not do any task if you don’t think you have received adequate training, which is typical of the culture of “covering your back”, now so common in care.”

The worst thing was trying to help a lady with a catheter have a shower. Neither she nor I could work out a way to do it that did not leave her with a soaking wet catheter bag chafing against her leg. I also didn’t have a clue how the catheter was supposed to be strapped to her leg when I started. Neither did the colleague who was supposed to be mentoring me, and it was several weeks before a district nurse showed me how the elastic bandage was supposed to be threaded through the catheter bag.”

The number of dementia and mental health cases has increased dramatically. Whilst I have had basic training in dementia care, I have not had any in mental health. I have requested this many times but nothing happens. I have been to paranoid schizophrenics, been threatened with a knife twice, had no back up from management and felt totally frightened, let down, alone and vulnerable.  My colleagues and I frequently ask to work in pairs for these clients, especially at night, and when working in rough areas but this is ignored. Today I was hit by a dementia client again. Who cares about us care workers?”