What is Single Handed Care?
Chances are you’ve heard the term Single Handed Care lately, read on to find out
Our definition of Single Handed Care
Why it’s important for our ageing population
What Single Handed Care is like for a service user
The term Single Handed Care, is one of the hottest topics in Social Care and Occupational Therapy at the moment.
But what is it and why is it important?
In October 2020, the Health Foundation published a report estimating the cost to stabilise and improve adult social care in England.
It shows based on current spending patterns by 2023/24 we will require an additional £2.1 Billion in social care spending just to keep up with the expected growth in demand from our ageing population.
It is no secret that our ageing population is the section of society that are going to require the most input from health and social care, in 2019 Age UK published a report to look at our demographics more in-depth.
12 Million Over 65’s in the UK
In the U.K today there are approximately 12 Million over 65’s. If we look closer at that total, it consists of 5.4 Million 75+, 1.6 Million 85+, over 500,000 90+ and an amazing 14,430 centenarians, (those over 100.)
By 2030, it is estimated that one in five people in the UK will be aged 65+ but the most startling statistic is according to Wittenberg, Hu, & Hancock, between now and 2070 the % of people over 65, who will require assistance with completing at least one every day task, such as cooking, cleaning etc, will raise by 116%. That could mean up to 7 million over 65’s would require care in the home.
So what has our ageing population, more people requiring care and financial pressures got to do with Single Handed Care?
Let’s look at what single handed care is?
The term Single Handed Care should be seen as an idiom and not a definition. The simplest understanding for the concept of Single Handed Care is taking a package of care, that currently has two carers to complete tasks and reducing it down to one carer. There are many advantages to Single Handed Care, but like implementing any effective change it needs good leadership and understanding.
So if Single Handed Care is so great, why hasn’t always been around and why is it so prevalent now? Standard practice has always been, that if someone was seen to be at “high risk of falls”, had “challenging behaviours” (this is an outdated term, which is really an expression of unmet needs) or had “complex” moving and handling equipment for “safety reasons” or “legal reasons” (often reasons that can be easily challenged) packages of care would require two carers.
When taken at face value this makes sense, hospital staff with massive pressures to clear bed’s have someone who is medically fit for discharge, but is inconsistent with their ability to stand up from a chair and walk to the toilet, the fear is, if they fall at home again they will just end up back in hospital. So the simplest solution is put in two carers, they way the Patient will be extra supported.
Or the most common example, someone ends up in hospital after a fall, prior to going to hospital they were independent with transfers and mobility, but after a few weeks in hospital they are now dependent on use of a hoist for all transfers. As they are medically fit, best practice is to get them out of hospital (because no one should be kept in hospital longer than they need to) since they need a hoist to transfer, then they will need two carers.
Is any of this thinking wrong, absolutely not. But is it the best approach?
As we have highlighted before, the NHS and Social Care are under extreme pressures, both financially with massive escalating pressure to spend and on their ability to deliver services to meet needs, such as having the right workers for the roles. By having two carers present at each care call, each package of care cost is doubled and one member of staff is not free to provide a service to someone else.
So by reducing carers from two to one, you have doubled your work force and saved money. For the NHS & Social care, this is a win win situation.
Single Handed Care in action
But let’s look at it from the most important person in the equation, the service user or patient. From my personal experience as a carer, for my 91 year old Aunt, Gladys, with Alzheimer’s Dementia.
I know first hand how having two carers present for care calls not only impacts on my Aunts personal dignity, but also her physical skills. When two carers are present, there is more chance of the carers ‘doing for’ instead of ‘doing with’.
My Aunt has lived with me for just under four years now, I strongly advocate for her to have one carer, despite having moving and handling equipment, which traditional care agencies would look at and instantly go, “well you need two carers for that, for health and safety reasons”. Zero account of my Aunt’s skills or personal choice. Just a blanket statement. Moving and handling equipment equals two carers.
Over the years my Aunt attended two care homes for respite. Each care home was brilliant, my Aunt was very well looked after. But the same situation applied, she had moving and handling equipment so needed two carers. Again, no consideration of her preference or skills. As a result, within a two week placement my Aunt lost skills, as carers where doing things to her not with her.
She would come home and need a month of intense rehab to get back to her baseline, we are at the stage now, where unfortunately she will not be able to go back into a care home for respite. The break for a week or two is not worth the hard work that is required after to help her regain the skills she looses.
I also stepped away from having care agencies deliver care to my Aunt, even after successfully demonstrating how one carer can not only provide the required support safety with the equipment, there was always a missing piece in the carers knowledge. This by no means is the carers fault or even the care agencies fault, they all where provided the adequate training as required by the regulatory bodies. But that was the height of it, adequate.
My Aunt’s needs are complex, she needs and deserves more than adequate. So we made the decision to hire private carers, which I trained up to enable them not only to deliver single handed care, but deliver care that helps my Aunt thrive.
Having one carer, maximised my Aunts independence by encouraging her to participate in activities. When we look at a simple activity such as dressing, just by her having to lift a top over her head twice a day she is practicing movements that build her strength and keep her joints mobile.
She has developed a healthier working relationship with the carers she has, if it’s one carer required it is easier to schedule and rota, leading to more consistency. By having fewer carers, particularly when working with people who have cognitive decline professional relationships develop quicker and most importantly are maintained.
My Aunt does not present the same every day, like everyone she has her good days and her bad days, but by having consistent carers who work with her they have come to understand what a good day vs a bad day means.
To me having one carer for my Aunt has resulted in -
Improved quality of life, for my Aunt and me
More personalised care with deeper understand of her individual needs
She has become physically stronger and maintained her strength over the years
Increased dignity
Better ability to engage in social interactions
Stronger level of mutual respect, between her and the carers
Better understanding of her own needs
More choice and control
Reduced hospital admissions
Most substantially more independence
Over the past year my Aunt has deteriorated as part of her condition, I can safely say, if we stayed with a care agency promoting the standard practice of two carers, “because of health and safety reasons” my Aunt would not of had the consistency she requires and undoubtedly would of ended up in hospital.
From talking to our carers they say being skilled to do single handed care has given them more jobs satisfaction and reduced frustrations normally felt when having to do calls with two cares, such as waiting around for someone to turn up and not knowing who you will be working with.
Care agencies and leaders in care provision fundamentally need to understand that moving and handling is not something that is static in practice. New equipment and new techniques are evolving on a daily bases.
We have a responsibility to the future over 65’s to ensure our services have the skills and knowledge essential in delivering the care which improves their quality of life, not something that is seen as the safer option, but ends up taking skills away, from both the Service user and the Carer.
My hope is that in the future of care, the term Single Handed Care doesn’t even exist, but has been replaced by an “individualised smarter care approach”. That having more than one carer for “complex issues” becomes the exception not the norm.
At Sunday Care Therapy we believe that everyone has the right to improve their quality of life and become more independent. That is why we aim to have individualised smarter care, to meet your needs and promote your independence.
We do this by finding out what is important to you.
This was written by an Occupational Therapist, Derek Sleater, Co-founder of Sunday Care Therapy.
Occupational Therapy is evidence-based, so please find research referenced listed below:
References -
https://www.health.org.uk/news-and-comment/charts-and-infographics/REAL-social-care-funding-gap
Wittenberg, R., Hu, B., & Hancock, R. (2018). Projections of Demand and Expenditure on Adult Social Care 2015 to 2040. Retrieved from https://www.pssru.ac.uk/publications/pub-5421/
