Foot health – how much consideration have you given it? If your answer is very little, we completely understand why. You’ve probably come to accept foot health is just a toenail trim for your residents; treating it as a non-essential add-on pampering treatment, because let’s be honest, that is all most care home residents currently receive from their foot health provider. But what if we were to tell you quality foot health treatments administered by regulated, qualified professionals, will improve your resident’s quality of life, prevent falls and hospitalisations, and can even reduce the chances of premature death. Would you give it more consideration then?
Care Home Podiatry are launching the Campaign for Better Foot Health to give you all the free training, guidance and resources you’ll need to give foot health the attention it rightfully deserves. Our mission is to improve care home standards to ultimately improve care home residents’ lives, because the truth is both care home providers, and most importantly care home residents have been shortchanged for too long. We firmly believe everyone should have access to #betterfootcare. We’d love for you to engage with the Campaign for Better Foot Health to make this a reality.
If you haven’t read Part 1: Why is foot health so important in care homes? And Part 2: What is wrong with foot health in care homes? Have a quick read before diving in to Part 3.
Part 3: How to ensure your care home residents get safe and effective foot health treatments
Hopefully by now you are thinking that foot health requires some consideration; the scary implications of poor foot health treatments outlined in Part 1, coupled with the lack of regulations and professional guidance on who can deliver foot health treatments to care home residents and what these treatments should look like as outlined in Part 2, create the perfect storm for inadequate foot health provision across the care home sector.
We appreciate how difficult it must be to give adequate care and attention to so many aspects of your residents’ health. That’s why we’ve put together this trusty simple step by step ‘how to’ guide, simplifying the process of sourcing a foot health provider and ensuring clarity on the services you, and most importantly your residents, should be receiving for their investment.
Step 1: Source a Foot Health Professional
If you’ve read “Part 2: What is wrong with foot care in care homes?” you’ll know that there is a confusing array of foot health providers operating in care homes. The lack of rules and regulations who can provide treatments to care home residents leaves your door wide open to non-qualified individuals. The easiest way to ensure you are sourcing a qualified foot health professional is to source a provider through the Royal College of Podiatry. They’ve got a handy Find a Podiatrist (rcpod.org.uk) search which allows you to enter your care home postcode to find your closest visiting practice. At the very least you’ll know that a Podiatrist/Chiropodist has completed a 3 year University degree in Podiatric Medicine. On top of this it is a legal requirement for Podiatrists to be registered with The Health Care Professions Council (HCPC), who monitor clinicians to make sure they’re staying up to date with their training and take action if there is any alleged misconduct in their work.
Step 2: Check your Foot Health Provider
We’re sure you carefully check and vet all of your nurses, carers and domestics at your care home – so why don’t you take the same approach with external professionals?
- Look your Podiatrist/Chiropodist up on the HCPC register Check the Register and find a registered health and care professional | (hcpc-uk.org) to check they are fully qualified and don’t have any ongoing conduct investigations. The HCPC also lists any additional qualifications your Podiatrist might have (like being able to prescribe medications).
- Ask for references for your Podiatrists work – you should be able to contact other nursing homes the Podiatrist has worked in or previous employers.
- Ask for copies of the Podiatrists insurance and DBS check – these are essential for any foot health undertaken in your care home and the Podiatrist should have these to hand.
- Get feedback from your residents and carers after the first visit – they’ll soon tell you if there is a problem with the standard of care the clinician is providing.
Step 3: Use a Combination of Private and NHS Services.
If you’ve read Part 2 of our series, you’ll know that in most cases care home residents cannot access routine foot care services from the NHS, and where they can often the gaps between treatments can be long.
For this reason, it’s recommended that you source a trusted provider (using the first 2 steps) to tend to your resident’s routine foot health.
There are some specialist areas where NHS services should be used. For example, NICE guideline ng19 recommends that on discovering a Diabetic foot wound:
“…refer the person within 1 working day to the multidisciplinary foot care service or foot protection service.”
Completing a timely referral to these essential NHS services could be the difference between getting the foot ulcer healed or needing a foot or leg amputated. A trusted Foot Health Professional will be aware of when NHS services are required and will make any necessary NHS referrals while being on hand to answer any foot health queries, concerns or NHS eligibility questions between routine appointments.
4. Demand More from your Foot Health Provider
So you’ve done the leg work and sourced a reputable foot health provider to tend to your residents foot health. Now it’s time to put them to work!
All too often we have encountered instances of private providers attending care homes and doing the absolute bare minimum. A quick toenail cut (often in communal areas for speed) and off they go. This is simply not good enough.
Your foot health provider should be providing the following as standard:
- Foot care plans – ask your visiting foot health provider to provide individualised foot care plans for your residents – these can be incorporated into your residents’ care plans – perfect for your CQC inspections.
- Outcome Reports after every treatment – these should be meaningful reports to ensure continuity of care and to facilitate collaboration with your care home staff.
- Annual Diabetic foot assessments – it’s part of the NICE guidelines that people with Diabetes have an annual Diabetic foot health assessment. The CQC have been known to ask for evidence of these in residents care plans when competing an inspection. They can be completed by any health professional, but we believe your visiting foot health provider should be completing these as standard – they are the experts after all!
- Wound care advice – all qualified foot heath providers are experts in wound care of foot wounds and ulcerations. Mostly these will be treated by NHS Podiatrists, however your visiting private Podiatrist should be on hand to offer treatment and dressing advice to care home staff.
- Insoles and molded silicon toe props – these specialist treatments can make a huge difference in the comfort and foot health of your residents. In residents with Diabetes insoles could even reduce the risk of developing a diabetic foot ulcer! Unfortunately these treatments aren’t always provided as standard by professionals however they should be! Ask your visiting foot health provider which of your residents might benefit from insoles or silicon toe props.
- Vascular examinations – Peripheral arterial disease (PAD) is a common vascular disease in the UK that affects the arteries which carry blood to the limbs. PAD is known to be under diagnosed and undertreated, resulting in avoidable amputations and five-year mortality rates comparable to those of many cancers. Your visiting foot health provider should conduct vascular examinations as standard to help improve detection, diagnosis, treatment and timely referrals.
Step 5: Coordinate and Embed Foot Health Across All of your Care Homes.
Now we’re getting to the gold standard of foot health provision.
The common set up is every Care Home Manager sources their own individual provider, and each resident pays for their foot health treatments out of their personal fund. This really could, and should, be better.
What happens to your care home residents who never have money in their personal funds? Or those whose families have forgotten to top up before a foot health visit? They miss out on essential medical care.
Given the clinical implications outlined in Part 1, it seems absurd that foot health is currently in the same category as hair care across the care home sector; an ‘add on’ luxury. Foot health treatments administered by foot health specialists are not a pampering pedicure, they are an essential aspect of your resident’s healthcare that can diagnose, prevent and treat medical foot health problems. As we’ve said before neglecting foot health risks life and limb.
The only way to ensure equitable access to this essential care is to embed the cost into room costs. Outside of London this would be on average a £2.30 weekly fee. There are also some additional perks to this approach – it minimises administrative hassles – no chasing families to top up personal funds and it enhances family satisfaction – no annoyance at any additional bill.
However, the pinnacle of best practice lies in standardised care across your care homes. Instead of each manager sourcing individual providers, opt for a unified provider across your care home group. This fosters standardisation across a care home group and provides the type of clinical governance structure through thorough risk assessment, standardised clinical standards, incident reporting documentation, and prompt response protocols, that you just wouldn’t get through individual providers.
Using a national provider rather than individual providers also gives your care home staff, and most importantly your residents, access to the breadth and scope of Podiatrists clinical specialisms, anything from Diabetes, to falls prevention, to biomechanics, to neurology. An individual nurse simply couldn’t specialise in every aspect of your residents health, being part of a clinical team gives a nurse access to a broader knowledge base so they can provide the best care for your residents. The same applies to Podiatrists. The best care is always a team effort.
So that’s it – the Why’s, the What’s and the How’s of foot health in the care home sector. We sincerely hope these guides can help you establish a foundation for safe and effective foot health services for you, and most importantly your residents. We believe the care home sector has been shortchanged for too long. We hope you now agree that it’s time everyone has access to #betterfootcare.
