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New models of Homecare

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New Models of Homecare

Source: TheKingsFund:www.kingsfund.org.uk  Dec 2018

Home care (also called domiciliary care) is social care provided in people's own homes, and may include help with washing, dressing and preparing meals. Service users include people with disabilities and older people. Care may be delivered for a short period of time following a stay in hospital (eg, reablement) or long term, for ongoing support needs. Like all social care, home care is means-tested, which means that some individuals will be eligible for care paid for by the local authority and some individuals will pay for care themselves, with others using a combination of the two.

Individuals who are eligible for local authority-funded care may choose to receive a direct payment or personal budget, which they can spend as they wish, or have the local authority arrange care on their behalf.

Eligibility for local authority funded care is also dependent on a needs assessment, and tightening eligibility has meant that home care is increasingly restricted to those with more complex needs (Age UK 2013).

In 2015, more than 350,000 older people in England were estimated to use home care services, 257,000 of whom had their care paid for by the local authority. A further 76,300 younger people with learning disabilities, physical disabilities or mental health problems were also estimated to be using publicly funded home care in 2015 (Wittenberg and Hu 2015).

Most home care, including that paid for by the local authority, is provided by the independent sector, and home care providers who deliver personal care (such as help with washing) are regulated by the Care Quality Commission (CQC). Outside of this, many people will rely on family or friends for some or all of this support.

Local authority-funded home care is usually commissioned via a competitive tendering exercise for the tasks which need to be completed and the time that will be required to complete them.

Providers are paid on a New models of home care The King’s Fund 2018 5 rate-per-hour basis. This is commonly referred to as 'time-and-task' commissioning. As well as their duties to meet the assessed needs of individuals who require care, under the Care Act 2014, local authorities also have a duty to ensure that there are sufficient services, of a sufficiently high quality, to meet need for home care. As the single largest purchaser of home care, local authorities have significant influence on markets and there is wide variation between them, exemplified in wide variation in the rates paid for care.

There have been several research reports looking at what people want from care delivered in their home and exploring what good-quality care looks like, with strong common themes (Healthwatch 2017; Maybin et al 2016; CQC 2013; ADASS et al 2017.2017); SCIE 2014; NICE 2016).


These include the following:

  • Person-centred care – caring for all the person’s needs together in a holistic, integrated way.
  • Valuing and involving people, as well as their carers and family members – ensuring that people are able to express their preferences, views and feelings. This may include ensuring that people have choices and that their views about how to make improvements are sought, listened to and acted on.
  • Continuity of care – ensuring that care is consistent and reliable. This may include ensuring that people have a properly reviewed care plan, that care workers are known to the person and limited to a small number of people visiting, providing reliable and flexible visit times, planning for missed or late visits, and ensuring that people are able to contact services between appointments.
  • Personal manner of staff – a caring and compassionate approach to care. This may include effective communication, getting to know the person and building relationships to ensure that care happens the way the person likes it.
  • Development and skills of staff – ensuring that staff are equipped with the training, supervision and experience to do their jobs effectively. This may include regular meetings for staff, personal development and training on particular conditions such as dementia
  • Good information about services and choices – ensuring that people know where to get advice and understand their choices about local care options, including quality and financial advice.
  • Focus on wellbeing, prevention, promoting independence and connection to communities – to be able to stay in their own homes and be supported to do things themselves. This may include linking people to be able to contribute to their local communities and social groups.

Challenges faced by the home care market have been outlined elsewhere (Age UK 2017; Humphries et al 2016; CQC 2013) and represent a somewhat different picture to the principles outlined above. The fragility of the home care market has been raised as a concern by the CQC, which has highlighted large churn among providers registering and deregistering (CQC 2017). Concerns have been raised about quality and there have been increase in the number of complaints and a fall in satisfaction (Local Government and Social Care Ombudsman 2016; Humphries et al 2016; NHS Digital 2016).

Home care providers employ around 670,000 people and there are around 90,000 vacancies across social care at any one time. More than half of care workers are employed on a zero-hours contract and turnover for domiciliary care staff is at 36.8 per cent (Skills for Care 2017b).

Demand for home care is forecast to increase significantly. Older users of local authority-funded home care are predicted to rise by 82 per cent, from 257,000 in 2015 to 468,000 in 2035. Users of privately funded home care are projected to rise by 49 per cent over the same period while younger adults with learning disabilities using home care are predicted to rise by 51 per cent (Wittenberg and Hu 2015).

At a time when population projections might indicate a rise in demand for social care, the amount local authorities are spending and the number of people eligible for local authority-funded home care are falling (Phillips and Simpson 2017). Against this backdrop of varying quality of care and rising demand, some innovative models and approaches to commissioning and delivering home care are emerging. This report explores those new approaches and considers their potential to provide care that is more closely aligned with what people want. New models of home care The King’s Fund 2018 7 Purpose and approach This report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:

  1. 1. Technology and digital 2. Co-ordinated care planning 3. Recruitment and retention 4. Autonomous team working 5. Alternative approaches to commissioning 6. Personalisation 7. Integrated care approaches 8. Community assets and connections 9. Family-based support and communal living