Health and Safety – Re-assessing Risk in Live-in Home Care

In a world obsessed with health and safety law, regulations and requirements, we’ve now reached the stage where every industry or service is required to risk assess every activity from large to miniscule. And while the stated intention of health and safety regulations is ‘prevention of injury, harm or death’, it could also be said that at its underbelly, its purpose is to reduce claims for compensation due to injury, illness, loss or death. What is missing from health and safety regulation, or law is a true and deep concern for the true well-being and health of humanity.

One question worth asking is what are we risk assessing and why? The other, are we risk assessing what matters and will make a genuine difference?

It is worthwhile looking to see what care agencies are required to risk assess in a client’s home before a live-in carer is assigned.

Live-in care clients are assessed in advance to gather information on health history, medication, social and family details. In addition, the home environment is risk assessed room by room and outside spaces to flag all potential environmental risks and record them in the client’s care plan. This is a legal requirement designed to alert and protect both carer and client.

One care agency reported a requirement to complete a risk assessment in a client’s kitchen on ‘safe use of a kettle’. Another was asked to risk assess a client’s medication and particularly where it was stored. The latest requirement (one of many new additions) was for all medication in the client’s home to be kept in one place – a locked cupboard, even if the client self-managed medication and had full mental capacity. A risk assessment for a typical kitchen might describe it as ‘risk of burns from heat producing appliances’

Now while all of these risks have their place and are important, one glaring omission remains – the client themselves.

What risks, if any, do clients pose to themselves and others?

In my experience as an elder carer, I would say the client is often the greatest hazard to themselves and not for reasons related to old age, physical or mental decline, or sensory impairment. In the absence of self-care, elders (and all of us) are particularly at risk. Most are more at risk from their own relationship (or lack of it) with themselves than they are from the more tangible and external environmental risks which they are more likely to be aware of. In fact, the latter occurs often to highlight the way we care for ourselves.

Statistics confirm the world is in the midst of a global pandemic of chronic ill-health diseases: cancer, diabetes, chronic obstructive pulmonary disease (COPD) obesity, heart disease and dementia. Chronic diseases are estimated to kill almost 41 million people a year worldwide, making up seven out of ten deaths globally. Of these deaths, approximately 17 million are classed as premature, with people dying significantly younger than expected on average. (1)

Life and lifestyle choices for the majority are a proven pathway to chronic ill-health conditions. Few it seems are overly concerned about statistics now accepted as normal and every day. This is a cruel paradox. We could ask how is it that health, safety and care regulators have devised risk assessments in the home (or elsewhere) that ignore clients or employees? The client remains unseen or relegated to the side-lines. Under this paradigm risks in the client’s home are limited to outside factors. With no reference made to risks clients pose to themselves, and no space for conversations with client or carer about the responsibility they have for their own health.

How would it be if care plans and risk assessments were re-written to factor in the hazard that is the client themselves?

Why is it that highlighting habitual behaviours that potentially and often do cause harm and lead to injury, illness, disease or death are ignored? Importantly, habitual behaviours may not be overt, but when practised over time, they become embedded and normalised to the extent the person is blinded to the risks they are causing themselves.

Recently, I was required to write a client’s weekly review after four weeks live-in care. I paused when asked to complete the section headed ‘risks.’ I realised risks observed were unrelated to those listed in the care plan. Risks observed were intrinsic to the client.

The client, aged 85, mother of five, with pulmonary fibrosis and macular degeneration was recently discharged from hospital to convalesce at home after a two week stay with pneumonia. The client aware of the risk to herself of returning home without full-time support, put in place live-in care with myself assigned to support her for four weeks. What eluded her was a lack of awareness of the nature her convalescence journey would take and how she herself would impact on her own recovery. The risks she faced were not of the external environment, but intrinsic to herself: she was the hazard and the inner battle she had with herself risked a return to full health and healing.

This is the entry made in the end of month report.

‘A chronic inability to support and truly nurture self. This client, readily accepted support from myself as carer, (still external to herself) but displayed an inability to offer the same quality of care to herself.’

It is quite likely, if some of her behaviours were present pre-illness, they may have contributed to the onset of pneumonia in the first place. Now post-hospital discharge, they were not ones to return to and this was her dearest wish. To get back to where she was before her illness.

What was needed was acceptance that the different stage of life she was now in required a deeper connection to herself, slower pace, more time for herself and ability to let in and accept support of family, friends and paid home carers. Most important was to allow her body to truly heal and not be in a rush to get somewhere. Discontentment, frustrations, constant anxiety and feelings of insecurity risked her return to full recovery.

Live-in carers, provide a nurturing space for clients to recover and/or heal and offer guidance through their own reflection and movements of another way to be. When the carer leaves, it is for the client to be responsible for their own self-care and nurturing.

In summary, this client provides a powerful example of what happens when we live with a lack of awareness or understanding of self-care and self-nurturing. We all have a personal responsibility for our own health and well-being but are we willing or able to truly care for ourselves?

1. https://www.imperial.ac.uk/news/203373/many-nations-falling-behind-global-efforts/