Changing the Conversation in Homecare

In traditional homecare the first conversation is usually called the assessment. The purpose is to find out what the person’s needs are, and to do a risk assessment before the service starts. The conversation will be dictated by the paperwork.

How can we change this conversation from needs and risk, to what matters to the person, and learning about their priorities? Can we have paperwork that is person-centred, and yet still fulfills the expectations of regulators? This is what we are exploring with the new team of Wellbeing Workers. We want the first meeting to be a conversation, and the paperwork seen as the record of a conversation, not a form to fill in.

Here are the questions we want both the conversation and the paperwork to reflect:

What matters

How can we learn what matters to the person, and focus on their capacities? This is sometimes called ‘real wealth’ or taking a strengths based approach. It means learning about what matters to the person, their relationships, their community connections and contributions. This is also the starting point for designing a service that builds on their capacities and connections.

Outcomes and priorities

The Care Act (2014) requires that we look at the person’s outcomes and aspirations. If the person has had a social work assessment their outcomes and indicative allocation should already be identified. Can we build on this and learn what the person’s priorities for change are, and what is working and not working from their perspective?

Support as a sequence

Over the last few years we have been using an approach called ‘Just Enough Support’. This turns traditional ways of thinking of support on its head, and instead of starting with the support that paid staff can deliver, starting with assistive technology, family, friends, relationships and community. With the Wellbeing Teams we are building on this and using a ‘Support Sequence’ of questions that starts with self-care, and includes assistive technology, family, friends, Community Circles, local community resources and statutory services. We intentionally explore, in a sequence, whether these can help the person achieve their outcomes and priorities. Then we look at the support they want from the team – what, when and how.

Co-designing the service

The ethos behind this first conversation is to co-design the service together, within the budget available, using a range of support ideas and options. It is about co-production , the person at the centre of the decisions about what support they want and need and when this is provided. It is also about the ‘who’ and the person choosing their own team. Choosing their team in this context means matching the person to the team members available based on getting the best personality match and also looking at where there are shared interests. We are doing this through using the team members one-page profiles and one minute films where team members introduce themselves (on You Tube).

Commitments and keeping in touch

Finally, the conversation ends with agreements and actions. What are we committing to do next? What is the target start date for the service? This includes thinking about keeping in touch with the person’s family, and offering options like a close facebook group that the team and family can share photos and other possibilities that I describe in an earlier blog.

 Going at the person’s pace

I have described this as one conversation, but in reality it could take longer, depending on the person and whether their family are involved as well.

What about the risk assessment? This is part of the paperwork and conversation, and there is a that specifies what has to happen on each visit to address any identified risks.


I can imagine that if you are involved in providing care at home you may be thinking this is an impossible dream. We have made it even more challenging for ourselves, as we want to train and support every member of the Wellbeing Team to be able to have these conversations, rather than them being done by a manager and then handed over to colleagues. We are trying to reduce any ‘handoffs’ so that the person you meet first of all, is the person who both provides support and co-ordinates the rest of your team.

I know that this sounds very ambitious, and we are going to see how close we can get to this. We have completed the design of the paperwork, and we are working on the training and support that the team will receive, based on films of great practice, a clear competency framework, and coaching to competence. The induction for the first team starts in a few weeks time, and we will learn together whether we can significantly change the first conversation to design support in homecare.




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