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Working in Domiciliary Care

For some adults who have age-related impairments, or physical, mental or sensory disabilities, it may be difficult to live independently. Domiciliary care organisations provide these adults a sense of self-reliance by offering them specialised treatment in their own homes. Personal assistants or care agency staff members are able to visit patients in their own homes and help them with any daily activities that they would be otherwise unable to safely complete as well as administer any necessary medical treatment.

As domiciliary care is provided within a private residence instead of an assisted living or medical facility, there are unique risks to both the care provider and the patient. Therefore, as a domiciliary care provider, you must become knowledgeable about proper assistance and treatment procedures as well as insurance considerations so that you can minimise the potential risks to staff and patients.

Domiciliary Care Responsibilities

Your domiciliary care organisation has an obligation to ensure that patients receive the comprehensive assistance and care that they need. In order to accomplish this, there are several general responsibilities that your organisation and staff must meet (this is not a comprehensive list):

Domiciliary care organisation responsibilities:

  • Conduct a risk assessment for patients and their private residences. In addition, develop a specific care plan that outlines how often care providers need to visit a patient, how long each visit should be, what assistance or treatment a patient requires, and what medication or equipment is necessary. If there is a task that cannot be safely done with one care provider, the task should be altered or arrangements should be made to have two care providers assist.
  • Record all assessment and safety measures that have been implemented to alleviate risk, and regularly evaluate the systems to ensure their continued effectiveness.
  • Provide thorough and comprehensive staff training for first aid, medical and general care treatment, and for required devices or equipment.

Domiciliary care provider responsibilities:

  • Ensure their own safety as well as the safety of their patient.
  • Assess potential risks related to the treatment and care of patients, and develop safety procedures to mitigate identified risks. Safety procedures should be approved by the organisation.
  • Report previously unidentified risks, accidents or incidents through the proper procedures as established by the organisation.

Relevant Legislation Often, domiciliary care providers work by themselves—just them and their patient. Such lone working scenarios present unique risks to staff and patients. Because there is no one specific law dealing with lone working, your legal duties for ensuring the safety of your employees—those working alone and with others—fall under the following pieces of legislation (this is not a comprehensive list):

  • Health and Safety at Work Act 1974: You are obligated to provide and maintain a safe work environment for your staff.
  • Management of Health and Safety at Work Regulations 1999: You are obligated to assess all the potential risks to your staff’s health and safety, and implement strategies to mitigate those risks.
  • Health and Safety (First Aid) Regulations 1981: You are obligated to provide your staff with first aid equipment and training.
  • Provision and Use of Work Equipment Regulations 1998: If a care provider is required to use equipment to effectively meet a patient’s needs, the risks associated with using the equipment must be properly assessed. In addition, all equipment must be regularly and properly maintained.
  • Lifting Operations and Lifting Equipment Regulations 1998: If a care provider is required to use any lifting equipment—such as a hoist—they must be properly trained to use it and the equipment must be properly maintained.
  • Control of Substances Hazardous to Health Regulations 2002 (COSHH): Any substances that are hazardous—including hazardous waste and cleaning materials—must be identified, and the potential risks to the health of the care providers and patients adequately assessed. Procedures to address the risks must then be implemented.
  • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR): Accidents or incidents that happen during work operations that result in deaths, major injuries or dangerous occurrences must be properly reported.
  • Corporate Manslaughter and Homicide Act 2007: Your organisation could be convicted when the death of someone to whom it owes a duty of care—such as a member of your staff or a patient—has occurred due to the negligence of your organisation. This could involve a failure to adequately implement risk management systems.

Domiciliary Care Risks

Your staff of care providers will be required to administer treatment and assistance to patients with a range of impairments and disabilities within their own homes. For that reason, there are inherent risks that both your staff and their patients could be exposed to. While this is not a comprehensive list, here are six common risks:

  • Transporting: Care providers must transport medical supplies and devices to each of their patient’s residences. However, if the vehicle’s refrigeration unit were to malfunction or fail, medication—such as insulin—could be rendered ineffective. In addition, all the materials stored within the vehicle are at risk of theft, tampering or contamination.
  • Moving and handling: Some patients may have reduced mobility and require assistance to complete tasks such as getting in and out of a chair or bed, going to the toilet or getting dressed. If the care provider does not have a clear strategy on how to best assist the patient or has not received adequate training, an attempt could cause harm to both the patient and the care provider.
  • Medicating: If improperly or incorrectly administered, stored or disposed of, medication can be harmful. A care provider should only assist with administering medication if it is outlined in the patient’s care plan.

Contracting or transmitting an infection: Care providers may be required to provide treatment for a patient with an infection or to clean up infected body fluids—such as blood, vomit, saliva, etc. Improper protection or inadequate safety procedures could allow care providers to become infected. In addition, care providers could potentially transmit bacteria or viruses from an infected patient to a healthy one.

  • Bathing: Care providers who are improperly trained or fail to use a thermometer to test the water temperature could injure or scald their patients or themselves.  
  • Lone working:  Generally, care providers will be working alone when assisting patients. This could expose care providers to risks—such as patient emergencies, physical and mental exhaustion, patient violence, and other challenges in moving and handling patients.

How to Mitigate Risks

While the potential risks associated with domiciliary care can be severe to the health and well-being of those involved, there are several simple methods you can use to mitigate those risks, such as the following: 

  • Complete detailed risk management schemes: As care providers will have to enter a patient’s home to provide bespoke treatment and assistance, a detailed risk management scheme should be developed. The scheme should outline potential risks associated with the layout of the home, the patient’s condition, and the required treatment and assistance. Periodically, the scheme should be evaluated and altered to better accommodate the patient’s needs.
  • Provide comprehensive staff training: Care providers will be expected to perform a variety of tasks to ensure that patients’ needs are met. For that reason, care providers must receive comprehensive training including, but not limited to, first aid; safe bathing; patient handling and moving; and the handling and clean-up of potentially infectious waste. Care providers should be retrained in required skills at least annually to ensure that they are able to provide safe and up-to-date treatment for their patients.

Purchase robust insurance cover:

  • Domiciliary care
  • Public liability
  • Professional indemnity
  • Medical malpractice
  • Medical device and equipment
  • Legal expenses

The Next Step

Domiciliary care is able to provide adults with impairments or disabilities with the opportunity to retain a sense of their independence. However, this form of care can present both care providers and the patients with hazardous risks. Yet, with the proper risk management practices, your organisation can ensure the safety of its staff and clients. For more information on what your organisation can do to mitigate potential risks, contact Business Insurance Service today.

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For more information and for insurance solutions to protect your domiciliary care business, contact Business Insurance Service today.

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