Why do I need two Carers when one will do?

Michael Mandelstam MSc DipLib – an independent legal consultant who is generally regarded as the authority on manual handling in social care, believes it is an area that warrants further investigation as it does appear that blanket policies are being applied. His view is that ‘balanced decision making is essential in the context of manual handling, this means balancing the safety (and human rights) of paid staff with the assessed needs and human rights of service users’ (Back Care Handling of People Series 5, p15).

There is a significant cost to those purchasing care, which may of course include the service user, if two carers are supplied to operate hoists possibly several times a day over the course of many weeks, months or even years. The costs are not just in paying for the time of the care workers but also in the addon-costs of USC and relevant taxes, holiday and sickness pay, uniforms, travelling expenses, training and so on. There are costs to care providers in organising two people to be in the same place at the same time, again potentially several times a day which can be a significant logistical challenge – countless ‘care hours’ are wasted while waiting for the second person to arrive. Many service users already feel that their privacy is being compromised by having carers coming into their home several times a day, and this is exacerbated by the presence of two carers, who may of course not be the same two every time. The use of a hoist may also be a source of some anxiety for either the carer and or the service user and both could feel overwhelmed by the combination of people and equipment. Moreover, it can be argued that in having to provide two carers for some care packages, that provision for other service users may be restricted or unavailable because of the lack of resources i.e. carers.

The question of whether it is appropriate for informal carers (i.e. the service user’s family members) to be the second carer is also considered as part of the research, as this could have an impact on the logistics and costs of some care packages. However, it should be stressed that this is only where they are willing and able to assist, and it should not be seen as a substitute for appropriate provision by a care agency.

With current concerns over the economy and rising costs, purchasers will need to look at every opportunity to ensure that outgoings are as cost-effective as possible. As long as ‘suitable and sufficient’ risk assessments are carried out and safety is never compromised there may be many instances where the service users care needs can be safely managed by one carer or, perhaps, one formal carer with assistance from an informal carer where this is appropriate. This should not be seen as a ‘reduction in service’ – which is unlawful without good reason – but as the same care package i.e. the same number of visits for the same length of time per visit, with one carer instead of two where the risk assessment identifies that this is appropriate.

Is it required by Law?

I am curious to find out where the policy of automatically supplying two carers has come from, because initial reading of relevant legislation and research into case law has not identified any case where the law specifies a number of people to operate a hoist. The only guidance found was that a ‘suitable and sufficient’ risk assessment should be carried out by ‘trained and competent’ persons, and that hoist operators should have ‘appropriate‘ training or instruction. This guidance is repeated in numerous places and is freely available to anyone who is interested. [Health and Safety at Work Act 2005, Lifting Equipment and Lifting Operations Regulations 1998 LOLER,  Provision and Use of Work Equipment Regulations 1998  PUWER]

Is it required because of Insurance Companies?

A reason often cited by care providers is that the two carer policy is a requirement of their insurance cover. Now insurance companies can only act within the bounds of current and relevant legislation and therefore cannot dictate that care providers have policies other than those which the law already requires. It is also very clear that the law frowns upon ‘blanket‘ policies, and indeed considers them unlawful, advocating individual assessment of a specific situation, and balanced decision making.

So, if the law does not demand that two carers be present for hoisting transfers and insurance companies may not dictate that two carers are present, where does the policy come from and what implications does it have?

Michael Mandelstam gives his opinion on this subject stating that; ‘Unnecessary expenditure, by local authority or service user, may also result from over simple rules imposed by care providers’ giving the example of a’ blanket policy imposed by care provider: A care provider tries to impose a two-pronged policy to the effect that if any service user requires assistance with a transfer, then a hoist must be used, and two paid staff must always be present… it takes account neither of the individual need of the service user, nor of the level of risk to staff. It could also result in unnecessary expenditure (where the risk does not demand two staff) by the local authority or by service users who have been assessed as able to pay for home care services’.

Mandelstam also cites an example of care agencies carrying out their own risk assessment which identifies that a service user must be hoisted rather than manually transferred because ‘it (the care agency) knows its staff to be insufficiently competent and therefore at greater risk of injury’ and an example of care agencies applying a blanket policy of refusing to work with informal carers ‘unless in every case the informal carer goes on a formal training course’. (Back Care Handling of People Series 5. p27). This despite the fact that their own staff very often do not attend a formal hoisting training course, but feel that including such training briefly in a general Manual Handling course is sufficient.

Mandelstam recommends that careful risk assessment should be carried out to identify any safety issues connected with a specific hoisting procedure. However, his recommendations only endorse current legal requirements as stated in L.OL.E.R; P.U.W.E.R and the Health and Safety at Work Act. This course of action is also recommended in the HSE publication – Handling Home Care (2002. HSE Publications), though there is a suggestion (p27) that one carer is sufficient in specific situations.

Is a Lack of Training the culprit for the Policy of Automatically Supplying Two Carers?

Insurance companies and most hoist manufacturers from a recent study (HOP5) recommend a dedicated hoist training course whereas care providers are happy for hoisting to be included in a general Manual Handling training course. As many Manual Handling training courses are a half day or less, or delivered by video clips with no practical elements, it could be suggested that there is insufficient time to fully explore all the safety and practical issues around hoist operation.

‘Sufficient time must be allowed to permit explanation, demonstration and practice, both in the classroom and the workplace.

The benefits of a dedicated hoist training course such as those provided by Enable Supplies are that it gives the learner the opportunity to try a range of hoists and slings; they can practice various hoisting transfers and have their practice observed and corrected if necessary by qualified trainers. There will be opportunities to have questions answered, and the importance of risk assessment and planning of transfers can be emphasised.

The benefit to the family is a Carer who is competent and comfortable in the operation and use of the slings and hoist, and also means one carer is sufficient once a proper risk assessment has been completed.