What Are The Duties Of A Care Assistant Working In Home Care?

"In some instances you can complete tasks together, like drying pots. This is a great way to get to know a service user. Working together may offer a sense of empowerment to the individual." - Emma Barnes, Domiciliary Care Assessor

Drawing from her own experience, Emma Barnes explains exactly and in great detail what a Care Assistant does in their job each day, and what is required from them when working in home care.

Topics Covered In This Article

Care Assessors Prepare Care Plans For Care Assistants

Person Centred Work Is Varied

Personal Care

Medication Assistance

Mobility

Specialised Support

Infection Control

Nutrition And Hydration

Domestic Support

Administration

Conclusion

Introduction

I currently work as a Care Assessor in the domiciliary care sector for a home care company in the North of England.

As explained in my previous article “How I Changed My Career Path To Work In Home Care” I began my career in the social care sector as a Care Assistant for the same company.

I have worked in the care sector for over 6 years and throughout this period of time I have also undertaken higher education to help grow and evolve within my role.

Within this article I'm going to explain the duties and tasks that you can expect to carry out when working as a Care Assistant in the domiciliary care sector.

Care Assessors Prepare Care Plans For Care Assistants

As a Care Assessor, I prepare and adapt care plans for service users and their families which are used to inform Care Assistants of the duties and tasks required within the care calls an individual receives.

Care plans are person-centred documents containing a multitude of information, including but not limited to: service user personal history, medical history, multi-agency contacts, visits, allergies, personal preference and risk assessments.

A care plan can be produced with a service user alone, with family/friends, with multi-agency collaboration or with a spouse.

As a Care Assessor, it is my responsibility to ensure a service user has the maximum amount of input possible into the production of the care plan. By doing this, any instruction a Care Assistant receives from a care plan is centred around the wishes of the service user.

The reason this is so important to discuss within the realm of Care Assistant duties is because I have found in many situations, a care plan can be a Care Assistant's main source of information surrounding the duties required for that individual.

In many cases, a service user may be non-verbal or lack the capacity to make informed decisions on a daily basis.

It is therefore vital a Care Assistant utilises the information in a care plan to adapt the knowledge they have gained in training to give individualised care and undertake the duties relevant to each specific service user.

Person Centred Work Is Varied

As care work is person centred, every day is varied and every individual requires unique support which can also change over time.

There are, however, many tasks and duties a Care Assistant will encounter on a daily basis.

It is the Care Assistant’s responsibility to adapt their skills to a service users needs and remain respondent, calm and professional at all times.

This article will touch upon the areas of support I have encountered within my working life but it will only give a basic overview of the duties of a Care Assistant.

The role is such a varied role, it is difficult to put into writing every experience that may occur within a Care Assistant's career.

Although as a Care Assistant you will receive the training needed to prepare you for the role, it is the type of job in which you will gain knowledge from each and every experience you encounter.

This, for me, is the most attractive part of the role.

I love to learn and I found my previous roles became stagnant over time, which has not happened so far in the care sector!

As a Care Assistant working in home care you will be assisting with personal care including showering/bathing/washing, dressing and shaving (both wet and dry).

In many calls you may also assist with medication administration and cream application.

You may help with toileting including commode emptying, incontinence pad changes and cleaning.

You may assist with transfers using mobility equipment including hoists, standing aids and lifts.

A Care Assistant may do a service user's shopping and cooking, also assisting with feeding and PEG feeding, if required.

If service users have specific needs, a Care Assistant would need extra training to support with catheter and stoma care, including changing and emptying of the bags used.

Throughout all calls with personal care inclusion, a Care Assistant may monitor skin integrity and complete body maps, implement pressure turning and follow medical instructions.

Infection control and the correct use of personal protective equipment is vital to protect all service users and staff.

Care Assistants will also be expected to regularly complete medication record charts, log books, incident forms and attend regular training.

Most calls require assistance with light domestic duties including bedding changes, hoovering, pots, washing and bin emptying.

Although this may sound overwhelming, care calls are adapted to need and therefore the amount of time you are given to spend with each service user is adaptive to the tasks required within that call.

This can also change and evolve alongside a service users needs, ensuring you will always have enough time to fully complete all of the duties required for that individual.

Let’s look at that list in full!

● Personal care

● Medication

● Toileting

● Shopping

● Cooking

● Feeding

● Catheter / Stoma Care

● Pressure turning

● Skin monitoring

● Record keeping

● Bed change

● Hoovering

● Washing

Now I have touched upon the different areas of care a service user may require from a Care Assistant I will explain these duties in detail.

Personal Care

The term personal care can cover a multitude of actions that assist a service user with their hygiene and personal appearance.

Of all of the tasks undertaken by a Care Assistant, I feel personal care is the area of support which requires the most individualised flexibility due to individual preference and requirements.

Assisting with showering/bathing/washing has to be a non-judgemental process ensuring dignity is maintained whilst risk assessing danger factors.

An individual has the right to decide when and how they wish to get assistance with personal hygiene, this is not the choice of the Care Assistant.

In some cases, it may not be possible for an individual to access their bathroom or stand for long periods of time, limiting the way in which they can wash themselves.

Some service users may not be able to reach certain areas of their body or may not have the capacity to understand the need to regularly clean their bodies, this is when the care plan is the ultimate guide to adequate assistance.

If a service user needs assistance with personal care, it would be my advice to prepare the area before use.

Ensure any equipment required (soap, sponges, flannels, towels) is to hand and the pathway is hazard free.

If a service user is able to communicate their needs, be respondent and respectful – offer privacy by leaving the room if required, closing blinds/curtains and covering private areas as much as possible.

Ensure you leave an area clean and tidy, wiping up any spillages of water and picking up any hazards from the floor.

An individual also has the right to decide what clothes they would like to wear for the day, and again, the amount of support required when assisting a service user to dress is dependant on their dexterity and mobility.

If a service user requires assistance with shaving, it will be specified in the care plan how and how often the service user would like this done.

When shaving, an individual may simply require you to bring them the utilities they need but there may be instances you are required to complete a full face shave, dependent on the service users ability.

We all have our own preferences for how we like to wear our hair, if we want to wear jewellery and if we like a spray of our favourite perfume, service users are no different!

Asking these questions and assisting with these small tasks can really elevate the experience for individuals and ensure they are able to continue with life in the way they would if they were still able to live independently.

Service users may experience differing levels of incontinence.

Some may use continence aids regularly and if they are unable to manage their needs independently, it is the Care Assistant’s duty to assist with this.

When changing pads and assisting with toileting, offer privacy to ensure dignity and dispose of pads in the way specified in the care plan.

Many individuals using the nursing team to manage continence needs will have separate waste removal systems in place to dispose of contaminated waste.

If mobility limits an individual’s ability to access the bathroom, a commode may be in place for convenience.

It is a Care Assistant's responsibility to clean this regularly and make sure it is positioned correctly for the service user’s access.

Whilst undertaking any form of personal care, a Care Assistant must be vigilant surrounding a service user’s body.

Any noticeable changes to skin integrity can be reported to the service user themselves and the office to prevent infection or alleviate discomfort.

If you notice unusual bruising or abrasions it is also vital you complete a body map and report the incident as it could be a service user is experiencing abuse or has injured themselves without passing on the information.

Medication Assistance

Many elderly people take regular daily medication to manage pain and illness. This can include tablets, creams, inhalers and drops.

Managing medication can become difficult for service users as their dexterity or memory decreases.

There are steps in helping individuals to manage their own medication including alarms and nomad boxes, but some individuals will require support from Care Assistants to do this safely.

A Care Assistant’s role in the management of medication is dependent on each individual’s situation and the role can range from a quick reminder to preparation and administration.

Care Assistants are not expected to administer invasive medications such as injections or pessaries, although they will be required to support with creams, tablets drops and patches.

Each company has individualised policy surrounding medication which is usually directed by the Local Authority.

Within my working area, there are Medication Record Charts which are prepared by the pharmacy and include full instructions and direction for medication administration.

It is important that even if this process is in place, consent is gained to administer medication at each visit.

A service user has the right to refuse medication and in that situation a Care Assistant’s role would be to record and report that decision.

As with personal care, administering medication is much easier if you prepare any utensils you may require before beginning the process.

If you find yourself unsure of any directions, it would be my advice to contact the pharmacy before administration as overdose or underdose can harm a service user.

Mobility

The mobility of a service user impacts every aspect of their daily lives.

If an individual’s mobility has deteriorated or they are at high risk of having falls, it is likely they will have been assessed by an Occupational Therapist.

An Occupational Therapist offers individuals equipment and support aids to help them mobilise in the safest way possible.

As a Care Assistant you may be tasked with simply ensuring this equipment is to hand – making sure it is in the correct position for mobilising and clearing any hazards from the transfer path.

For individuals when mobility has decreased beyond this point, the equipment may be more complex and require the assistance of someone else.

You will be educated on different types of equipment within your initial training. Hoists are, in my opinion, the most complex type of equipment and are used when an individual has lost the majority of their ability to walk or stand.

A hoist requires Care Assistants to put a sling around the service user and mechanically lift them using a machine in the property.

Every hoist and sling is different and instructions for use can be found in the care plan.

An Occupational Therapist will advise the service user and company of the specific manual handling instructions before use.

This can be a scary experience for service users and I have found that chatting and showing confidence in the situation can help in calming a service users concerns.

It is a Care Assistant’s duty to ensure the service user is safe and comfortable at all times, only using any form of equipment if it is approved for use and not damaged in any way.

Specialised Support

Specialist support is required for service users experiencing less common or more advanced conditions.

I call this specialist support as it does require more knowledge than that which is gained within the basic training you will receive when you begin your journey as a Care Assistant.

Dementia care is the most common area of specialist support I have recognised within my career.

Forms and levels of dementia vary massively and this, in turn, impacts the way a service user with dementia needs to be supported.

In many instances multi-agency support will be in place for a service user and clear instructions for support techniques will be in the care plan.

Care Assistants working with dementia patients must be patient, vigilant and have the ability to communicate positively both verbally and using their body language.

Dementia can vary rapidly on a day to day basis and a Care Assistant should be able to adapt to this and to record and report any changes or concerns to their line manager / support system of the service user.

Stoma and catheter care are also quite common tasks undertaken by a Care Assistant.

Your company will arrange catheter skills training for you surrounding this from your local nursing team.

Soiled bags from either form of care must be disposed of correctly to avoid contamination and promote a safe environment for the service user.

As the process is designed for personal use by the service user, it is a fairly simple and straight forward procedure to undertake and is very similar from service user to service user.

End of life support for service users can be an emotionally draining task and has to be approached with compassion and empathy.

The tasks undertaken throughout end of life care may not be much different to tasks which are normally undertaken in care calls although the mental health, mood and motivation of a service user to complete those tasks may decrease.

It is a Care Assistant’s responsibility to manage the situation in the most appropriate and respectful way possible, reporting and recording any refusals of care or changes in health.

Within all aspects of care, multi- agency communication helps the service user as everyone can work together to ensure the best care possible is provided.

It is even more important when undertaking specialist support that Care Assistants communicate with GPs, pharmacies, nursing teams and local authorities to ensure the duties they complete are compliant to the level of support the service user needs.

Infection Control

Infection control has been at the forefront of all care and support more recently due to the COVID pandemic and the risk infection has to individuals in at risk groups.

Following infection control procedures not only protects service users, it also protects you and your family from external risk.

As I have only worked for one company throughout my care career, I can only specify on the procedures in place within my experience.

As most domiciliary care companies are private, I am sure they will vary across the sector.

At present, Care Assistants are following guidance from the government in regards to personal protective equipment and when it must be worn.

This includes gloves, masks, aprons, foot covers and visors / goggles.

Personal protective equipment is provided free of charge to all care staff in my company.

All staff receive full training surrounding donning and doffing, use and correct disposal of personal protective equipment.

Care Assistants also need to follow hand washing procedures and ensure their training and knowledge is up to date.

This duty is to be undertaken with all service users, regardless of any other needs or tasks required within the call.

Nutrition And Hydration

A Care Assistant can offer varied levels of support when it comes to a service users needs surrounding nutrition and hydration.

In some instances, specifically if a service user is fairly independent or lives with family, there may not be a requirement at all in this area.

On the other end of the spectrum, it may be that shopping, food preparation and feeding a service user are all duties provided by a Care Assistant.

If there are specific tasks (like shopping) required it is likely a separate care call will be in place for this.

It is important when supporting with food and drinks we put aside our own norms and really cater to the specific wishes of a service user.

We may like our toast well done and buttered, for example, and they may like theirs lightly toasted with jam!

Communication is the key to getting this right – ask the questions, read the care plan and don’t ever assume someone’s preference.

It is also a Care Assistant’s responsibility to recognise if someone’s weight is declining or they are refusing food and drinks regularly.

This could indicate underlying issues and intervention may be required from GPs or nursing teams.

Generally, as you get to know service users individually, a routine will be formed and this aspect of care will become easier to administer.

Domestic Support

Light domestic duties undertaken within a care calls can include washing pots, wiping down sides, putting a wash on, drying clothes, ironing, hoovering, emptying bins, making beds, clearing floors and general tidying.

It is unlikely time will permit all of these task to be completed surrounding your other tasks in the care call.

It is common that certain tasks are completed at different times of the day and this will be specified in the care plan.

If there is spare time in a care call and all tasks are completed, offer to complete a domestic task if it is required.

If someone needs full domestic support (they have no support system and cannot complete the tasks themselves), it is likely a separate domestic call will be in place to complete more time consuming tasks like cleaning the bathroom or kitchen fully.

Many service users like to try and complete some domestic tasks independently and it is important as Care Assistants that we do not take this away from them.

It may be that in some instances you and the service user can complete tasks together, like washing and drying pots.

This is a great way to get to know a service user and working together may offer a sense of empowerment to the individual.

Administration

Care Assistants do need a good basic level reading and writing skills as there are daily administrative tasks which need to be completed.

During a care call, as previously mentioned, you may be required to administer medication to a service user.

A part of this process is to follow the instructions of a medication recording chart and to write on the chart according to your actions when administering the medication.

The charts are completed using a pre coded format which is clearly printed on the chart itself.

You will learn how to read and record on a medication record chart within your basic training.

A log book also has to be completed at all calls. This is where you will write everything that has happened in the call, the tasks you have completed and anything you have reported to the office.

Again, this is shown to you during basic training as there are specific things that should not be written in there - including if you suspect any form of abuse.

Body maps should be completed if you recognise any inconsistencies in a service users skin such as sores, bruises or abrasions.

Accident / incident forms should be completed if there are any accidents or near misses.

This will likely be done away from the care call, either in your office or via email. Regular training is required for all Care Assistants and this will require some form of writing including work books or short tests.

Your company will most likely inform you when your training is due but I find it useful to be aware of when I will need to undertake any annual training so I can be proactive in making sure my training is up to date.

Other charts in the property may need completing occasionally such as input / output charts for food and drink and continence management charts to monitor bowel movements.

These are put in place by specialists if they need to monitor these thing; you would be informed if it was a requirement for you to complete these in any call.

Conclusion

Although I have covered as many areas as I can, duties vary immensely as do policies and procedures within each specific home care company.

I hope, though, that this gives a comprehensive overview of the skills you will gain if you decided to work as a Care Assistant.