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Healthcare assistants lead in dementia care


Healthcare assistants play an unacknowledged managerial role in the care of dementia patients, research has revealed.

The study, from Nottingham University and funded by a Department of Health research programme found HCAs provided the type of care most important to dementia patients themselves and created a “positive therapeutic environment”.

HCAs provide virtually all of the hands-on care. How they are fed, dressed and bathed is what people with severe dementia care about

The National Audit Office has estimated over half a million people in England have dementia and expect this to double in the next 30 years – posing questions around the workforce and skill mix requirements to meet that need.

Researchers spent three months working as HCAs and interviewing them. They found HCAs managed families and gave emotional and practical support to informal carers as well as controlling the level of general activity on the ward.

Lead researcher on the project Justine Schneider told Nursing Times: “HCAs provide virtually all of the hands-on care. How they are fed, dressed and bathed is what people with severe dementia care about.”

Professor Schneider said that managing the ward atmosphere was the “distinctive contribution” that HCAs made which had a therapeutic effect on the patients.

“They determine the level of stimulation in the ward. They facilitate family members coming onto the ward, they would make sure the level of stimulation was not too high or too low, taking someone out of the group environment if necessary or putting music on to liven things up if they had got a bit sluggish.”

The research poses questions about whether the job descriptions and supervision policies HCAs are subject to actually recognise the distinctive contributions they make. It also proposed more use was made of the band 4 position to recognise HCAs who were managing other HCAs.

“Much of what HCAs do is not codified in formal academic learning” Professor Schneider said. “More attention needs to be paid to the unqualified whose skills are so important to the growing number of people with dementia.”

Jeremy Wright MP, who chaired last June’s Parliamentary group on dementia, said in his preface to their report: “It is truly remarkable that those who work in care settings receive so little training in dementia care and that the training which is available is of such variable quality.”


Readers' comments (12)


    I have said this before the Health care assistants are now taking on the role of the old SEN. they are performing all the hands on care for the patients ,this frees up the staff nurses to to do all other care.such as medication dressings treatments. and so on.

    The only problem i can see is that they have no recognised qualification. and on the other side of the coin those staff nurses who wanted to be nurses,hands on nurses are not fulfilling their ambition.

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    a further comment is that of course the health care assistant has the ability to do the real care of the patients with dementia they are on the wards all the time and they observe that the patients are in need of this care.and if there is anything about them they perform the role they are there to do.

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  • I think this is stating the obvious a bit, of course HCA's provide the hands on care, do most of the washes, etc. Isn't this in their job description?

    I agree with Sandra though that there is no recognised qualification for this, I do not think qualifications are what is neccessarily needed though, what IS needed is for HCA's to be put on a register and held accountable for their actions the same way as Nurses are.

    And I would also argue Sandra that those staff Nurses - as you say those who are freed up to do the clinical tasks that need education and training - who want to be 'hands on Nurses', I think this is doing those Nurses a little disservice. There are a huge ammount of Staff Nurses who will still give as much hands on care as is possible around the clinical roles they perform. The problem lies in the skills mix that management are persisting in filling the wards with. The fact is, Staff Nurses are expensive to staff a ward with, so management will have fewer trained Staff Nurses and a lot more HCA's, who they will then ask to perform more duties. This is wrong.

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  • I as a health care assistant in a dunlaoghaire hospital in ireland value the opportunitys of working with patients with dementia and find it totaly enriching. Also, I am very lucky that the hospital realy do value the contributions of its care assistants and encourage and pay for their training training even in dementia care. Where I work all staff are equally valued which is paramount in team development & bonding. this is also reflected in the delivery of care to all our patients as a happy team will always work that bit harder in the delivery of total patient care, without complaining but rather think of it as a pleasure.

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  • yes yeppe now we have got that on paper what else this has been going on for years! yes level two basic care but are pushed to do other skills no extra pay! that includes level three hcsw we are are doing skills upto band four it is all ongoing

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  • I do agree with you Mike, HCA's have to do all the basic care as what stated on their job description. Apart from that, putting all HCA's on the register and should be held accountable for their actions the same way as registered nurses are. Now adays, most of the employers (public or the private sectors are employing more HCA's than registered nurses as employers are cutting their budgets.

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  • where i work you are accountable for all your work and are not regestered even with anumber of added skills like venapuncture, cathertrisation, e c g's, etc
    we are responsiable and accountable if something gose wrong we take the can?and thi is added on to our norm day of basic patient care? but are still classified as the under dogs but we keep things a float?

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  • While I take Mike's point about the obviousness of daily care being provided by HCAs, I think the research also highlights organisational and managerial responsibilities that are not that obvious and not in any job description. More importantly, that the provision of daily care is obvious does not mean that its importance within dementia care is sufficiently recognised or renumerated. Devalued staff working in devalued services caring for devalued members of the population.

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  • As a band 3 HCA in the community, we are treated very well and are positively looked on as part of the nursing team and not just HCAs. There are many opportunities as a community HCA and my job role includes wound care, venepuncture, male and female catherization, diabetes care and much much more, so how is that for hands on nursing care? I to would like to see HCAs being regulated and held accountable for their actions by the NMC. The role of the Level 4 Associate practioner is beginning to develop in the community. And i feel that the learning available to HCAs is endless.

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  • HCA's are going to all be on a register - check out the ISA info! More accountable, trackable and yet still ridiculously low paid. Some of the postings seem to feel its OK for HCAs to be doing all the hands on, after all its in their job description - but lets get real here, HCAs actually are doing a SEN job so SHOULD be able to get to band 4 quite quqickly. This wont hapapen as it will be to expernsive. As a band 3 HCA you can be expected to carry out catheterisation, ECGs all OBs, venapuncture, dressings, neuro obs.... list is endless, but lets not forget that at Band 2 you do most of these also! The learning available to HCAs is endless but the pay scales are not.

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