Home care is one of several services that can be offered to people assessed as needing social care support. It can be funded by health or social care commissioners or by the person using services. Although the range and type of services that can be classed as home care varies, it usually encompasses:
personal care, for example help to wash
support with the activities of daily living, which might also include telecare (for example providing personal alarms)
essential domestic tasks.
Home care services may also help people to stay independent and take part in social and other activities.
A number of recent reports have identified significant concerns about the quality, reliability and consistency of home care services. A themed inspection of home care by the Care Quality Commission (Not just a number: Review of home care services) also highlighted some specific key areas for improvement.
The Department of Health asked NICE to develop a guideline to help address these issues (see the scope). The guideline was developed by a Guideline Committee following a detailed review of the evidence on home care.
The Care Quality Commission uses NICE guidelines as evidence to inform the inspection process and NICE quality standards to inform ratings of good and outstanding.
This guideline focuses on older people receiving home care and their carers. The guideline does not cover younger adults (although many of the recommendations may also be relevant to younger adults). This is because the largest group of people using home care is older people.
This guideline considers how person‑centred home care should be planned and delivered. It addresses how those responsible for managing, providing and commissioning home care should work together to deliver safe, high‑quality home care services. These services should promote independence and support people to do the things that are important to them.
This guideline has been developed in the context of a complex and rapidly evolving landscape of guidance and legislation, most notably the Care Act 2014. While the Care Act and other legislation describe what organisations must do, this guideline is focused on 'what works' in terms of how to fulfil those duties, and deliver support to older people using home care and their carers.
The guideline is for health and social care practitioners, home care provider organisations, home care managers, home care workers, commissioners of home care in local authorities and clinical commissioning groups, and people using or planning to use home care services.
Care and support should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care, in partnership with health and social care practitioners. Practitioners should recognise that each person is an individual, with their own needs, wishes and priorities. They should treat everyone they care for with dignity, respect and sensitivity.
People must also provide their consent to any care and support, unless they lack capacity to do so. If someone does not have capacity to make decisions, health and social care workers should follow the code of practice that accompanies the Mental Capacity Act. Healthcare professionals should also follow the Department of Health's advice on consent. Deprivation of liberty occurring in a home care setting would need to be made via an application to the Court of Protection as Deprivation of Liberty safeguards are explicitly applicable only to care homes and hospitals.
If the person using the service agrees, families and carers should have the opportunity to be involved in decisions about care and support. Families and carers should also be given the information and support they need in their own right.