Last reviewed 11 April 2013
Much of the care delivered by domiciliary care staff will be provided in the home of the service user. However, a common part of the care plan for many service users will include meeting their social needs and helping them to get out of the home when they can. Martin Hodgson addresses some of the issues involved and the planning that must be completed to ensure that such activities are supported safely.
Such activities can include a daily visit to the shops or post office, or even a daily walk, but can also include more structured activities, such as visits to a day centre or club or trips further afield. Service users also have the same rights as anyone else to go on short breaks and to take an annual holiday and may need to be accompanied to enable them to access such opportunities.
The opportunity and choice to take a holiday should be available to all people in receipt of social care, including those with high support needs, and an increasing number of domiciliary care organisations are seeking to facilitate this right by providing staff as an escort.
The importance of holidays and outings
A holiday is generally understood to refer to any activity involving an overnight stay in accommodation that is not the normal place of residence of a service user. It can be just for one or two days or for a week or two and may even involve travel abroad.
An outing is a trip away from the service user’s home but not involving an overnight stay.
Remaining socially active is a key part of living with dignity and independence for service users. Getting out of their home means that service users can visit family and friends and enjoy a break from their regular routine. Many people in receipt of domiciliary care would lack the ability to travel on their own and would only be able to do so if they were accompanied by a carer or support worker.
While some people prefer to stay at home and avoid social contact, it is commonly accepted that the benefits of an active social life for service users will include:
improved general health and wellbeing
slower decline in physical and mental capacities
greater self-esteem and satisfaction with life.
Holidays and trips allow service users the chance to experience new things, meet new people and do things they enjoy. While some service users will enjoy accessing organised holidays through companies or charities that specialise in breaks for disabled people, or join in group holidays, others may prefer to organise trips independently.
Preparation and planning
All domiciliary care organisations that support their staff in accompanying service users on outings and holidays should have a policy or process in place spelling out the approach they will take. It is best if the option of providing an escort is included in the organisation’s statement of purpose and discussed with service users during their initial assessment or during a review. The need for accompanied trips can then be factored into the assessment and included in the plan of care if necessary.
Approval for a holiday should be obtained from a manager of the service before any arrangements are made. Dates and destinations must be proposed well in advance so the appropriate arrangements can be made. Final arrangements will have to be agreed by the manager and a risk assessment completed.
The care service will want to know the following information:
the destination, including the address and the names and contact details of anybody with whom the party will stay
the itinerary and travel or flight details
information about other people present on the holiday
costs and funding arrangements
arrangements regarding any medication and how this will be managed; this should include arrangements for injections, if required, and may depend on the country visited so arrangements should be made well in advance in consultation with the GP
the service user plan of care and how this will be managed on holiday, including any aspects of personal care
manual handling risk assessments and how these will be applied
any particular arrangements for equipment such as hoists and wheelchairs
any special dietary requirements
staffing levels calculated with reference to working shift patterns, levels of dependency, health and safety and working time requirements
information about the country/area of destination relating to hospitals and medical cover
travel vaccinations if travelling abroad
if travelling in continental Europe, European health insurance cards (EHICs) for every member of the party
an emergency plan (see below), including arrangements for emergency medical cover if required.
While on holiday
On beach and “sunshine” holidays, staff should ensure that people in their care are adequately protected against sunburn.
Extra vigilance is required for water activities. Many organisations specify that staff supervising a service user in the water should be sufficiently experienced and have appropriate water safety training. While assisting vulnerable adults in any water activity at the beach, staff should remain in the water with them and ensure that no individual is left unsupervised. Such activities should only take place on safe beaches where lifeguard supervision and safety equipment are available.
Individual service users should never be left unsupervised while using a private swimming pool, jacuzzi or hydrotherapy pool.
Records should be maintained of all financial transactions and submitted to the appropriate line manager on completion of the holiday or activity.
Staff should not drink alcohol while on duty accompanying people on holidays and trips. They should have appropriate rest periods, and a standard arrangement is to provide time off in lieu for hours accumulated while on accompanied holidays and trips.
Staff are expected to behave in a responsible, professional manner at all times while acting as an escort. Any staff member who does anything that could bring the domiciliary organisation into disrepute or endanger people in their care should be subject to appropriate disciplinary procedures.
Most staff should be able to accompany service users on day trips or visits with suitable flexibility on staff rotas. However, not all staff will be agreeable to overnight stays or holidays. Gender is an obvious issue, especially where personal care is concerned, and service users should also be given a choice about who accompanies them on holiday.
Accompanying a service user outside of their home does not take any particular skills above and beyond those that a care worker should possess, but patience and understanding will be needed, particularly if anything goes wrong. Staff will need to keep a cool head and be able to think on their feet. The independence and freedom of choice of the service user should be respected at all times and this might require negotiation and sensitivity, particularly if the service user’s wishes might expose the party to risk.
If the service of accompanied holidays is offered then a list of staff that are agreeable to such arrangements should be compiled. A training needs analysis should be conducted to identify any areas of training they may need.
Arrangements can be more complex where people are travelling in a party that include a number of service users with a group of staff. In some cases, the holiday may be a collaborative arrangement or hired through a charity or provider of holidays for disabled people. Such holidays may include volunteers and staff from different agencies.
If domiciliary care managers work with another agency in arranging a holiday, they must ensure that responsibilities for managing every aspect of the holiday are explicit and agreed between the organisations making the arrangements. Agreements and arrangements should be made in writing, including roles and responsibilities.
Staff in other agencies will be accountable to their own employers and procedures.
A group leader should be appointed who will generally be responsible for the day-to-day running of the holiday and for safety details and travel arrangements. This person should ensure that there are sufficient members of staff to supervise any outing and that staff selected are able to offer appropriate standards of supervision and control. Roll calls should be taken at regular intervals.
If the party is to split to undertake different activities, a full discussion should take place between staff and service users to decide which staff are to supervise whom. A meeting base and an estimated time of return should be agreed and communicated to both staff and service users. All staff should have a mobile phone containing the contact number of the group leader and other members of the party. Care should be taken that the phone can be used in the country of destination if taken abroad.
For situations involving personal care, and for accidents and emergencies, there should be at least one member of staff available at all times of the same sex as the individuals participating in the group.
Adventure-type holidays, such as skiing or outdoor adventure centres, may require additional safety or supervision arrangements and extra care should be taken in potentially hazardous settings.
When assessing the risks, staff and managers should consider the extent to which service users are able to understand hazards and make their own decisions. If the manager, member of staff or group leader in the case of a party has reasonable doubts about the overall level of risk, they should not proceed with the holiday or activity.
Safety and security
The Health and Safety at Work, etc Act 1974 makes the employer responsible for the health, safety and welfare at work of its employees all the time they are involved in the work of the employer. Employees are also under a duty to ensure, so far as is reasonably practicable, the health and safety of anyone who may be affected by their activities. This includes staff involved in supporting outings and holidays.
Many care staff accompanying a service user on an outing or a simple holiday will do so alone. Such lone working can bring with it an element of risk. Staff working alone in potentially isolated conditions have no immediate backup or support and so are at a greater general risk, including injury through an accident or illness or as a result of aggression or violence directed towards them.
Younger or less experienced staff are often at a greater risk than more experienced staff when working alone. Such workers also need to rely on their own judgment and initiative and may be at a greater risk of making mistakes or errors that could prove costly to the organisation.
Lone workers should not be at more risk than other employees. This may require extra risk-control measures to be put into place, such as additional supervision, protective equipment, better means of communication (eg mobile phones), or means of raising the alarm in case of emergencies.
Employers should take steps to ensure that all lone working is properly assessed for risk, including accompanied outings and holidays. They should check the adequacy of control measures used and review the risk assessment from time to time to ensure it is still adequate. Points to be covered will comprise:
safety and security on the holiday
the appropriateness and safety of accommodation arrangements
the appropriateness and safety of travel arrangements
financial arrangements and risks
communication and supervision
It is essential that staff are trained to know what to do in an emergency. Without a clear protocol for action, the result can be dangerous delay and indecision, especially where staff are lone workers.
The emergency plan might need to include:
the process to send money to the holiday destination
back-up staff who are able to travel to the destination at short notice
arrangements in the event that a member of staff must accompany a service user home, or to hospital, etc.
The responsible manager should ensure that sufficient planning and thought has been given to the outing or holiday and that the staff involved are competent enough to deal with any emergencies, such as a medical emergency. In particular, this applies to staff accompanying service users on overseas holidays, as normal communication links may be restricted and make it difficult for staff to seek advice.
Staff and service users on outings and holidays should be encouraged to take simple common-sense security precautions. They should try to keep to “safe” areas when on holiday and heed any government travel advice or restrictions. On foreign holidays they should:
pack and label their own cases
avoid carrying large amounts of cash
avoid putting passports, money or traveller’s cheques in one place, such as a handbag or wallet
beware pickpockets, muggers and mobile phone thieves
keep hotel or accommodation doors locked
keep medication in their prescription bottles or packets for customs checks
be familiar with the local laws and customs
use lighted streets to commute on foot.
Valuables should not be left lying around in the holiday accommodation where thieves can see them easily through windows. All domiciliary care staff on escort duty should carry a mobile phone and arrangements should be made for them to periodically make “check-in” contact with their line manager.