Home care: delivering personal care and practical support to older people living in their own homes

Why this is important

There is a lack of evidence on the cost effectiveness of different intensities of home care packages applicable to the UK. Additionally, the 2 included studies that consider the cost effectiveness of different intensities of home care only consider home care costs rather than wider resource use.

Why this is important

There is limited evidence on the components of telecare used as part of a home care package for older people, and their impact. Information is needed on types of telecare in use, because costs and outcomes are likely to depend on the combination of components.

It would then be useful to compare different telecare packages and determine effectiveness and cost effectiveness of individual components and combinations of components. This could include comparisons with home care packages without telecare, or ones that include other assistive technology. Important outcomes for service users are social care‑related quality of life and wellbeing, in addition to physical health, acceptability and accessibility (particularly for people with complex needs such as dementia). Cost information from a societal perspective is also needed, including health and social care services, the contribution of carers in the form of unpaid care and out‑of‑pocket expenditure for privately purchased support.

Why this is important

Workforce training is perceived to help improve the delivery of home care services to both practitioners and people using the services. Reviews for this guideline found a lack of evidence on the impact of home care‑specific training on outcomes for people using home care.

Studies of comparative design are needed to evaluate different approaches to home care training, and whether they change home care workers' practices in ways that improve outcomes for people and their carers, including safety and safeguarding. A scoping study is needed to identify the range and content of current training and ongoing support for home care workers, including specialist and generalist training. The outputs could inform future study design. Studies of qualitative design are needed to ascertain the views and perceptions of older people and their informal carers on worker competence. The views of commissioners and provider organisations on their experiences of training are also needed.

Why this is important

Dementia is one of the most common conditions in older people using home care services. Home care workers are expected to respond to a wide range of needs, providing both general support (for example personal care) as well as specialist needs. Some home care is delivered by dementia‑specific services but there is a lack of evidence about the effectiveness of this approach on outcomes compared with non‑specialist home care services (which may instead employ specialist workers or train some workers to develop specialist skills, for example). Future research could involve comparative evaluation or case control studies to determine how to structure the delivery of support so that both a person's specialist dementia needs and general support requirements are accommodated in the most effective way.

Why it is important

The Guideline Committee identified variation in organisational attitudes to, and perceptions of, risk in both provider and commissioner organisations. The review found a lack of evidence on the impact of different safeguarding practices on organisational culture, service delivery and outcomes. Studies of comparative design are needed to evaluate the effectiveness of different approaches to safeguarding in maintaining safety and wellbeing of service users and their carers. Analysis of routine monitoring data, for example from service audits, could illustrate how standards are being met by providers. Surveys and qualitative studies are needed to ascertain the views of older people, and their experiences in respect of safety and safeguarding practice.