Single handed care: what works and when it is safe
Single handed care is now a well established option within many care packages, but it should never be approached simply as a way of reducing the number of carers. The starting point is always the individual: their abilities, needs, routines, environment and the risks involved for both the person and those supporting them.
This post explains what single handed care means, the factors an Occupational Therapist considers when reviewing a double handed package, when a change may be appropriate, and when retaining two carers is the safer and more proportionate outcome.
What single handed care means
Single handed care means that a task or care routine can be carried out safely and effectively by one carer rather than two. In some cases this is enabled by equipment such as a ceiling track hoist, profiling bed, slide sheets, turning or stand aids. In others, assessment may show that the existing method can be changed, that the person can contribute more than previously recognised, or that two carers are no longer required for a particular task because the client’s health has improved.
The important point is that the number of carers should always follow from the assessment rather than drive it. A change should only be recommended where the proposed method is safe, realistic for the individual / environment and can be safely implemented, consistently, by the care provider.
Why double handed packages are being reviewed
There are several reasons why a double handed care package may be reviewed. Care needs change over time, equipment and manual handling techniques develop or evolve and a package that was appropriate when it began may not remain the best solution indefinitely.
Commissioners and care providers also face significant workforce and financial pressures. Those factors are relevant, but they should not replace individual assessment. A well-designed single-handed package can sometimes improve consistency of care, reduce unnecessary intrusion and use resources more effectively, but only where this can be achieved without compromising safety, dignity or outcomes.
The person receiving care should be involved in the discussion. Some people feel reassured by two carers; others would prefer fewer people involved in intimate care if their needs can be met safely by one. Their views are an important part of the assessment alongside the clinical and moving and handling considerations.
When single handed care works well
Single handed care is more likely to be feasible where the person’s presentation and care routine are reasonably predictable, the task can be completed using a clear and repeatable method, and the environment allows the required equipment to be used safely.
The Occupational Therapist will consider the person’s ability to participate in the task, including their mobility, weight bearing, balance, cognition, communication, pain, fatigue and any fluctuation in function. They will also consider the physical environment: available space, access around the bed or chair, floor surfaces, door widths, equipment storage and whether carers can position themselves and equipment safely.
The care provider is part of the picture too. Where a new technique or item of equipment is recommended, carers need appropriate instruction, training and competency processes through their employer. The OT assessment should clearly describe the proposed method and identify any training or implementation requirements.
When retaining two carers may be necessary
Of course there are often situations where a single-handed approach may not be safe or proportionate. Significant fluctuation in the person’s ability, complex or multi-stage transfers, unpredictable movement, limited co-operation or comprehension, behavioural or cognitive factors, medical instability, bariatric considerations or environmental constraints can all increase the level of risk.
None of these factors should be treated as an automatic rule in isolation. The question is how they affect this particular person, this task and this environment. If assessment shows that one carer cannot safely complete the task with an appropriate method and equipment, retaining double handed care is the correct outcome. A review that recommends no change is therefore not a failed review. It provides a current, reasoned and documented basis for continuing the existing package.
Manual handling, single handed care and the law
Moving and handling decisions sit within a wider legal and professional framework. The Manual Handling Operations Regulations 1992 require employers, so far as reasonably practicable, to avoid hazardous manual handling, assess unavoidable risks and reduce those risks as far as reasonably practicable. For care providers, this means that any proposed method must take account of the safety of their employees as well as the needs of the person receiving care. The Care Act 2014 places the individual and their wellbeing at the centre of assessment and care planning. A decision about the number of carers should therefore be based on the person’s assessed needs and circumstances rather than applied automatically across a group of people. Dignity, privacy, choice and family life are also important considerations when changing established care arrangements. In practice, this means discussing proposed changes with the person and, where appropriate, those involved in their care, and recording the reasoning behind the final recommendation.
The key principle is straightforward: single handed care can be a safe and effective option, but only when the individual assessment supports it and the proposed method can be implemented safely.
What a review actually involves
The OT review looks at the care tasks that currently require two carers, the person’s functional abilities, the consistency of their presentation, the techniques currently being used and the equipment and environment around them. Wherever possible, the assessment should reflect the routines and situations that are causing the difficulty rather than considering the person in isolation from the task.
Where a different approach appears feasible, the OT may trial or demonstrate equipment and techniques, or recommend a further trial as part of implementation. The extent of this will depend on the person, the equipment involved and what has been commissioned.
The written recommendations should set out what was assessed, whether a change is appropriate, the proposed method and equipment, any identified risks, and any training or competency requirements for the care provider (Risk assessments and handling plans are key). Where a change is implemented, a handover and review may also be advisable to make sure the method remains appropriate in practice.
The equipment side
Equipment can make a significant difference to whether a task can be completed by one carer. Common examples include ceiling track and mobile hoists, profiling beds, slide sheets, turning systems and standing aids. The right solution depends on the person, the task and the available space; equipment should not be selected simply because it has worked elsewhere.
A clear functional and risk assessment helps commissioners and providers understand what is required and reduces the risk of equipment being ordered that does not meet the assessed need.
Detailed, clear handling plans and appropriate hand overs for any new equipment are essential.
The guide to profiling beds covers the specification questions that come up most often, and pressure relief is worth reading alongside it, since seating and mattress decisions often change at the same time as a transfer method. Getting the recommendations right at the assessment stage saves a great deal of time later. Equipment ordered on a rough description tends to arrive and not fit.
How we work with local authority teams
Inclusion provides moving and handling assessments and care package reviews for local authority teams and other commissioners. Our Occupational Therapists bring independent clinical reasoning to the review, consider whether existing arrangements remain appropriate, and provide clear written recommendations and handling plans that commissioning and care teams can act on.
Depending on the project, our input can include assessment, equipment recommendations and trials, implementation advice, training where commissioned, and follow-up review. We can support individual complex cases or larger programmes of double handed care reviews.
You can read more about our moving and handling assessments or about how we work with local authority OT teams on waiting list and caseload support.
If you have a caseload of double handed packages waiting for review, talk to us about how we can help and we will set out what it would take.