Introduction

This quality standard covers home care given to older people in their own homes to meet their assessed social care needs. An age threshold is not specified for older people. Although almost 80% of people using home care services are over 65, the quality standard may also be relevant to some people under 65 with complex needs. The quality standard does not cover intermediate care, short-term reablement, home care for younger adults or children using home care services. For more information see the home care topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as registration and funding for social care, are therefore not covered by this quality standard.

Why this quality standard is needed

Home care is one of several services that can be offered to people assessed as needing social care support. The range and type of services classed as home care vary but may include support with personal care, activities of daily living and essential household tasks. This support can help people to stay independent and to take part in social and other activities. Home care is primarily funded by local authorities or the person themselves, but can also be funded by healthcare commissioners. Home care services are provided by independent home care agencies, local authorities and personal assistants.

In 2013/14 around 372,000 people over 65 used home care funded at least in part by local authorities (Community care statistics: social services activity, England 2013–14, final release Health and Social Care Information Centre). Despite the rising number of older people in the population, the number receiving public funding for care is decreasing.

A report from Oxford Brookes University on People who pay for care estimated there were 270,000 people funding their own home care (including help with housework or shopping) in 2010. The number of people funding their own care is expected to grow although the extent of growth will depend on many factors including public policy and personal wealth.

A number of recent reports have identified concerns about the quality, reliability and consistency of home care services. A 2012 themed inspection of home care by the Care Quality Commission (Not just a number: review of home care services) found that 26% of inspected services did not meet all the national standards of quality and safety. It highlighted specific key areas for improvement including: respecting and involving people; care and welfare; safeguarding; support for staff; and provider's assessment and monitoring of the quality of service.

The quality standard is expected to contribute to improvements in the following outcomes:

  • social-care related quality of life

  • health-related quality of life

  • admissions to residential or nursing care

  • involvement of people using services in decision making

  • satisfaction of people using home care services

  • satisfaction with integrated care

  • safety incidents

  • retention of home care staff.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experiences of people using the services and effectiveness of care services – for a particular area of health or social care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life**

Outcome measures

People manage their own support as much as they wish, so they are in control of what, how and when support is delivered to match their needs

1B Proportion of people who use services who have control over their daily life

Carers can balance their caring roles and maintain their desired quality of life

1D Carer‑reported quality of life**

People are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation

1I Proportion of people who use services and their carers, who reported that they had as much social contact as they would like

2 Delaying and reducing the need for care and support

Overarching measure

2A Permanent admissions to residential and nursing care homes, per 100,000 population

Outcome measures

Everybody has the opportunity to have the best health and wellbeing throughout their life, and can access support and information to help them manage their care needs

When people develop care needs, the support they receive takes place in the most appropriate setting and enables them to regain their independence

2C Delayed transfers of care from hospital, and those which are attributable to adult social care

Placeholder 2F Dementia – a measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life**

3 Ensuring that people have a positive experience of care and support

Overarching measure

People who use social care and their carers are satisfied with their experience of care and support services

3A Overall satisfaction of people who use services with their care and support

3B Overall satisfaction of carers with social services

Placeholder 3E The effectiveness of integrated care

Outcome measures

Carers feel that they are respected as equal partners throughout the care process

3C The proportion of carers who report that they have been included or consulted in discussions about the person they care for

People know what choices are available to them locally, what they are entitled to, and who to contact when they need help

3D The proportion of people who use services and carers who find it easy to find information about support

People, including those involved in making decisions on social care, respect the dignity of the individual and ensure support is sensitive to the circumstances of each individual

This information can be taken from the Adult Social Care Survey and used for analysis at the local level

4 Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm

Overarching measure

4A The proportion of people who use services who feel safe**

Outcome measures

Everyone enjoys physical safety and feels secure

People are free from physical and emotional abuse, harassment, neglect and self-harm

People are protected as far as possible from avoidable harm, disease and injuries

People are supported to plan ahead and have the freedom to manage risks the way that they wish

4B The proportion of people who use services who say that those services have made them feel safe and secure

Alignment with NHS Outcomes Framework and/or Public Health Outcomes Framework

** Indicator is complementary

Indicators in italics in development

Table 2 NHS Outcomes Framework 2016–17

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Reducing time spent in hospital by people with long‑term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions

Enhancing quality of life for carers

2.4 Health-related quality of life for carers**

Enhancing quality of life for people with dementia

2.6 ii A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life*,**

Improving quality of life for people with multiple long-term conditions

2.7 Health-related quality of life for people with three or more long-term conditions**

4 Ensuring that people have a positive experience of care

Improving people's experience of integrated care

4.9 People's experience of integrated care**

Alignment with Adult Social Care Outcomes Framework and/or Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 3 Public health outcomes framework for England 2016–19

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors which affect health and wellbeing and health inequalities

Indicators

1.18 Social isolation*

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.23 Self-reported well-being

2.24 Injuries due to falls in people aged 65 and over

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.13 Health-related quality of life for older people

4.14 Hip fractures in people aged 65 and over

4.15 Excess winter deaths

Alignment with Adult Social Care Outcomes Framework and/or NHS Outcomes Framework

* Indicator is shared

Safety and people's experiences of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services that include home care for older people.

Coordinated services

Services should be commissioned from and coordinated across all relevant agencies encompassing all of the person's needs and their whole care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to older people who use home care.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for older people who use home care are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing and caring for older people using home care services should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Social care practitioners should be aware of the Skills for Care Code of conduct and national minimum training standards for healthcare support workers and adult social care workers and Care certificate. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and informal, unpaid carers (such as family members, friends and neighbours) have in supporting older people who use home care. If appropriate, social care practitioners should ensure that family members and carers are involved in the decision-making process about all aspects of their care. We use the term 'carers' to mean informal and unpaid carers rather than paid care workers in this quality standard.