The term ‘complex care’ encompasses a range of needs requiring ongoing essential specialist support. In the past, people with complex needs were confined to formal care settings and their care was highly medicalised. People with complex needs have one or more conditions which mean they are dependent on specially trained carers. ‘Complex’ means they may be also dependent on medical technology and may require full time care[i]. In addition to their complex needs, they are also likely to need support with their basic care needs.
Advances in technology have enabled people with even very profound additional needs to remain in their own homes while receiving essential treatment and ongoing adaptive management of their conditions.
Enabling people with complex care needs to live in their own home and live the kind of life they want requires some careful planning. Plans of care must be based on a thorough assessment and understanding of the person needing care. This assessment should follow a holistic framework – i.e. it should be a ‘whole person’ approach which takes social and societal needs and desires into account as much as physical and medical requirements[ii].
Planning a complex package of care is a multi-disciplinary health and social care team undertaking.[iii] When planning a discharge home from a rehabilitation setting or a transfer from another care provider, all the needs of the individual should be assessed, and this requires input from a range of professionals. Additionally, a person-centred approach means putting the actual wishes of the individual at the forefront of all decisions made.[iv]
When a person is leaving hospital or a rehab facility with new complex care needs, their medical team will be heavily involved in discharge planning. Physiotherapists are essential contributors to long-term care planning, as they take responsibility for the care of respiratory conditions, ventilation and cough-assist devices as well as movement and physical therapy. Occupational therapists are a key part of the team involved in getting a person into their own home or an adapted living environment with every aid to accessibility and ease of care. Nurses and social care managers take all the different needs of the individual into account to make the best possible plan for their day-to-day care going forward.
Meeting an individual’s needs in the community
Creating an environment where a person can return to their home and have all their care needs met requires a practical assessment of their basic care needs, social and emotional needs, and their complex or medical requirements. Understanding what an individual needs is the first step towards meeting those needs through an adaptive and professional care package.
Basic care needs
When creating plans for care, healthcare professionals often talk about ‘ADLs’, or ‘Activities of Daily Living’. The ADLs are, broadly, a person’s most basic requirements to remain comfortable and in the best possible physical health. The care team must, as a minimum, ensure that any ADLs that a person is unable to manage independently are met by carers. The basic ADLs are usually considered to be:
Hygiene: many people require assistance in their own homes with washing and bathing, teeth, nails and haircare. Carers who assist with these needs should aim to maintain the standards that the individual would maintain themselves if they were able to.
Nutrition: Whether unable to acquire food and prepare meals or physically feed themselves, meeting nutritional needs is an incredibly important part of a carer’s role. Liaising with dieticians and nutritionists may be required for people at risk of under-nourishment. Observing the dietary preferences, ethical and religious choices people make in their diets is essential and an absolute human right which could be easily overlooked for people who are unable to advocate for themselves. The role of a carer is to advocate in the person’s best interests, in line with their choices.
Movement: Someone with reduced or little control over their own mobility may require regular positional changes and pressure area care to prevent wounds. Following physiotherapy plans to maintain healthy muscles and joints can fall under the remit of formal or informal carers. Carers who are dedicated to a single client can become well versed in their need for movement and mobility aids, helping them to maintain as active a lifestyle as possible, and enabling continued outdoor time, travel, social interactions and more.
Continence: Meeting care needs includes assistance with continence aids and managing basic bowel and bladder care.
Dressing: Not only part of a person’s physical personal care needs, dressing and choosing clothing and appearance is socially and culturally incredibly important. The way we dress can express a lot about who we are. Carers who can really get to know an individual and their family and social circle are well-placed to help maintain the social as well as physical aspects of their client’s appearance.
Social and emotional care needs
In addition to universal basic care needs, everyone should have the right to try and attain the kind of lifestyle they desire. If it’s possible for a person with extra care needs to continue to maintain their position in their family and friendship groups, social interests, career ambitions and education, then putting care in place to enable these goals to be realised is essential.[v]