Home nursing and support work

Families are rarely told this clearly, and it is the most useful distinction in home care.

There are two different kinds of worker who come to houses. They have different qualifications, different legal scope and different jobs. When that gets blurred, people either pay clinical rates for domestic help, or worse, end up with someone doing a task they are not qualified to do.

This is general information, not advice. Anything clinical belongs with the treating team.

The two roles

Nursing. A registered nurse or enrolled nurse holds a clinical qualification and is registered. Their work includes wound care and dressings, injections, catheter and stoma care, subcutaneous fluids, oxygen, clinical observations and assessment, pain management, palliative nursing, and administering medication. They also assess and escalate, which is a distinct skill: knowing that something has changed and what to do about it.

Support work. A support worker is not a clinician. Their work is personal care such as showering, dressing and grooming, domestic assistance, meal preparation, transport, social support and companionship, prompting and supervising, and reporting what they observe. It is skilled work that requires training, judgement and considerable patience. It is not clinical work.

Both matter. Most households need far more support work than nursing, and the support work is what determines whether daily life holds together. But when a clinical task appears, it needs a clinician.

The line, in practice

Nursing work, broadly, is anything that involves:

• A wound, a dressing or broken skin
• An injection, or anything under the skin
• A catheter, a stoma or a feeding tube
• Oxygen or nebulised medication
• Administering medication, as opposed to prompting it
• Clinical assessment, observations or decisions about a condition
• Compression bandaging
• Palliative symptom management

Support work, broadly, is:

• Showering, bathing, dressing, grooming, toileting
• Help with moving about and transfers, within a documented plan
• Meals, shopping, domestic assistance
• Prompting and reminding about medication
• Transport, appointments, social support
• Noticing and reporting changes

The most commonly confused item on those lists is medication. Prompting is support work. Administering is clinical. Exactly where that line sits depends on the task, the training and the plan, which is why the answer should be in writing rather than assumed.

Why it matters to you

Safety. A pressure area assessed by someone unqualified to assess it is the mechanism by which a small wound becomes a hospital admission.

Money. Clinical time costs more than support time, correctly. You do not want a nurse doing the vacuuming, and you do not want to be billed as though one did. Checking this is part of reading what your Support at Home statement should show.

Funding. Clinical care and everyday support are treated differently under Support at Home, including in how personal contributions work. That is worth understanding rather than guessing, and the current position is at myagedcare.gov.au.

Accountability. If nobody has written down who does a task, then when it does not get done, nobody failed to do it.

Questions worth asking your provider

1. Which tasks in this plan are nursing, and which are support work
2. Is the nursing delivered by your own staff or subcontracted, and either way who is accountable
3. What are the rates for each, separately
4. Who is authorised to do medication, and in what way
5. What happens if a support worker arrives and finds something clinical, such as a new wound
6. Who do we ring after hours, and does a real person answer
7. Who reviews the clinical side, and how often

Question five is the one that separates providers. The correct answer is a defined escalation path with a name and a number, not “they would let the office know”.

Our full list of questions to ask an in-home care provider covers the rest.

How the two should work together

Badly run, these are two separate organisations who have never spoken, and the household becomes the messenger.

Well run, they share one plan and one record. The nurse who dresses a leg ulcer writes down what the support worker should watch for. The support worker who is there four times a week is the one who notices the redness spreading on a Tuesday and escalates it, five days before the next nursing visit would have found it.

That is the real value of the arrangement, and it depends entirely on the information being in one place. At Aldera that is the One Story record, and the Care Lead is the person who holds the whole picture so the household is not the one joining it up.

What we do and do not do

Worth being direct, because it has two parts.

Our own workers are support workers. Personal care, domestic assistance, meals, transport, social support, respite, dementia support, overnight support and post-hospital support. They do not do clinical tasks, and we would not ask them to.

We coordinate the clinical care around that. Where a household needs nursing or allied health, we arrange it, hold the single plan that everyone works from, make sure the support workers follow that plan exactly, and are the number you ring when something changes. The clinical work itself is delivered by the registered nurse or clinician who is qualified to do it. Coordination sits with us; delivery sits with them.

That split is deliberate, and it is worth asking any provider to state theirs. A provider vague about which of the two it is doing is a provider worth asking harder questions of.

If you want help working out which parts of an arrangement are which, ring us and a person will answer.