Home Care Guideline: Key recommendations for providers

NICE has published a guideline to help deliver personal care and practical support to older people living in their own homes. This document outlines the key recommendations for providers of home care services.

Planning home care - focus on the needs of the individual

  • Ensure the person using the service, and their carers (if the person has involved them in their care), can direct the way home care is delivered. This is so that the person’s safety, comfort, independence and sense of security are always promoted.
  • Give people and their carers (with the person’s permission) a copy of their home care plan in a format that meets their needs.
  • Ensure a ‘care diary’ (or ‘care record’) is kept in the person’s home. This is a detailed day‑to‑day log of all the care and support provided, which also highlights the person’s needs, preferences and experiences. Offer the person a copy of it.
  • Ensure all people involved in providing care and support have access to the home care plan and to the care diary. Encourage them to read and contribute to both documents, as appropriate.

Allow home care workers enough time to provide a good quality service

  • Ensure home care visits are long enough for home care workers to complete their work without compromising the quality of their work or the dignity of the person, including scheduling sufficient travel time between visits. Take into account that people with cognitive impairments, communication difficulties or sensory loss may need workers to spend more time with them to give them the support they need. Some may need workers to spend more time helping them eat and drink.
  • Home care visits shorter than half an hour should be made only if:
    • the home care worker is known to the person, and
    • the visit is part of a wider package of support, and
    • it allows enough time to complete specific, time limited tasks or to check if someone is safe and well.

Prioritise continuity of care

  • Ensure continuity of care so that the person knows the home care workers and the workers are familiar with how that person likes support to be given, and can readily identify and respond to risks or concerns, by:
    • introducing people to new home care workers, and
    • building teams of workers around a person and their carer, and
    • informing people in advance if staff will be changed and explaining why, and
    • working with people to negotiate any changes to their care, for example when visits will be made, and
    • recognising that major changes (for example moving from home care to use of personal assistants) can make people feel unsafe
  • Home care workers should avoid missing visits. They should be aware that missing visits can have serious implications for people’s health or wellbeing.
  • Closely monitor risks associated with missed or late visits and take prompt remedial action. Recognise that people living alone or those who lack capacity may be particularly vulnerable if visits are missed or late.

Manage and support home care workers

  • Have a transparent and fair recruitment and selection process that:
    • uses values based interviews and approaches to identify the personal attributes and attitudes essential for a caring and compassionate workforce, and
    • ensures workers have the necessary language, literacy and numeracy skills to do the job.
  • Ensure home care workers are able to recognise and respond to:
    • common conditions, such as dementia, diabetes, mental health and neurological conditions, physical and learning disabilities and sensory loss
    • common care needs, such as nutrition, hydration and issues related to overall skin integrity, and
    • common support needs, such as dealing with bereavement and end of life, and
    • deterioration in someone’s health or circumstances.

Ensure home care workers have the knowledge and skills needed to perform their duties safely by providing, as part of the full induction and ongoing training package, specific training on:

  • what constitutes ‘safe’ care
  • identifying and responding to possible or actual abuse or neglect
  • identifying and responding to environmental risks
  • safe care policies and procedures.
  • Respond promptly to workers when they request support to deal with difficult situations.
  • Observe workers’ practice regularly, at least every 3 months, and identify their strengths and development needs.
  • Appraise workers’ performance regularly and at least annually. The annual appraisal should include a view of workers’ learning and development needs, and feedback from people who use the service and their carers.

Read the guideline.

Implementing this guideline

Providers and commissioners should work together to implement the recommendations in this guideline. A costing statement has been published  and other tailored resources will be made available to support implementation of the guideline.