Complex care at home is care for adults whose needs go beyond standard personal care. Rates confirmed at assessment.
What complex care covers
Clients typically have one or more of:
- A PEG (percutaneous endoscopic gastrostomy) or other enteral feeding regime
- A urinary catheter (urethral or suprapubic)
- A stoma (colostomy, ileostomy or urostomy)
- A tracheostomy
- Long-term assisted ventilation or BiPAP/CPAP
- Spinal cord injury or another condition needing specialist handling
- Motor neurone disease, multiple sclerosis, Parkinson’s, Huntington’s, or another long-term neurological condition
- Complex medication regimes, including controlled drugs administered by carers under prescription
If your family member’s needs aren’t on this list, call us.
What we can do, and where the boundary sits
Helping at Home is a regulated home care provider. We are not a clinical service.
Within scope for our carers, with the right training and sign-off:
- PEG bolus or pump feeding to a prescribed regime
- Catheter monitoring, emptying and bag changes
- Stoma bag changes and skin care
- Tracheostomy stoma site care and inner cannula changes (where the care plan and competency sign-off permit)
- Suctioning at the level of competence signed off
- Administration of prescribed medication (oral, topical, inhaled, eye drops, controlled drugs where signed off)
- Repositioning, pressure area care, hoist transfers
- Routine BiPAP or CPAP mask application and removal
Outside scope for our carers:
- Diagnosing health changes (this is for the GP, district nurse, or specialist)
- Changing the prescription, the dose or the route of any medication
- Tracheostomy tube changes where the care plan specifies this is a nursing-only task
- Initial fitting or replacement of catheters
- Any task not on the individual care plan and not covered by sign-off for that specific carer and that specific client
Where the boundary sits is decided in the care planning stage with the clinical team. We don’t expand scope informally during a shift.
How complex care is set up
Care plans usually come to us through one of three routes.
Hospital discharge. A discharge planning team contacts us, and we join the planning meeting to confirm whether we can deliver.
ICB or community team referral. A clinician already involved, such as a district nurse or specialist nurse, refers the person to us.
Family enquiry. A family contacts us directly, and we start with a free, no-obligation conversation.
The steps are then similar:
- Care needs assessment with Courtney or Megan present
- Clinical handover from the existing team (hospital, district nurses, specialist)
- Care plan drafting, in line with clinical guidance
- Carer matching from our directly employed team
- Training and competency sign-off for the named carers on that care plan
- Start of care, with close monitoring in the first weeks and review at three months
Why competency sign-off matters
A trained carer is not the same as a competent carer. A carer can complete a PEG feeding course and still not be safe to feed a specific client whose regime they haven’t been shown.
Our complex care clients have a documented set of named carers who have been signed off for the specific tasks on their care plan, by a competent assessor (usually a senior nurse, the registered manager, or a specialist trainer where required). The sign-off is dated and reviewed.
If a sign-off carer is unavailable, cover comes from another signed-off carer in our directly employed team. If no signed-off carer is available, we tell the family and the ICB or commissioner immediately rather than send someone untrained. This is one of the practical reasons we run a “never agency” model. Agency carers cannot be reliably trained on a specific client’s complex regime.
Continuity of care for complex clients
We aim to give each client a core team of up to four carers. In complex care the team is sometimes smaller. The more specialist the training, the fewer carers are signed off for that client.
For some PEG or ventilation care plans, the team might be three carers running a 24/7 rota. For a stable catheter or stoma, it might be the full four. We agree the rota with the family at care plan stage, so you know who is coming.
Funding routes for complex care
Most clients are funded through one of:
- NHS Continuing Healthcare, where the person has a primary health need
- NHS Funded Nursing Care (less common for at-home care)
- A council care plan with top-up, where needs are eligible under the Care Act 2014
- Self-funding, where the family pays at our standard hourly rate of £31
What to do next
Call 01636 646915 for a free first conversation. We’ll tell you whether we can deliver the care plan you’re working with.
We provide complex care in Newark, Grantham, Bingham, Retford, Ollerton, Southwell, Collingham and North Hykeham, and the surrounding villages.
If you’re in a hospital discharge conversation, see our hospital discharge page.
