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.
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 (NHS Digital. Community care statistics: social services activity, England 2013 to 2014). Despite the rising number of older people in the population, the number receiving public funding for care is decreasing.
An Oxford Brookes University report 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
retention of home care staff.
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:
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.
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.
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.
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.