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23 September 2015

Promoting independence in old age: NICE guideline will support those who need help to live at home

The National Institute for Health and Care Excellence (NICE) has published its first guideline for the social care sector to promote high-quality home care services for older people at a time when demand for such services is set to grow.

Home care refers to practical support for people who need help to continue living in their own homes. During 2013-14, 470,000 people used home care funded by local authorities in England and almost 80 percent of them were at least 65 years old.

With more people living longer – it’s predicted that the number of people in England aged 65 or older will rise from 1 in 6 (16.3%) to almost 1 in 4 (23%) by 2035 – effective services will become increasingly important.

Professor Gillian Leng, deputy chief executive and director for health and social care at NICE, said: “The need for support at home is something that is likely to affect many of us. As we age, most of us will want to continue living in our own homes, surrounded by a lifetime of memories, for as long as we can.

“Helping a person remain as independent as possible is an important component to maintaining their wellbeing. Without good support, older people can suffer from social isolation, malnutrition or neglect. They may also be at risk of injuring themselves, perhaps from a fall or other accident, if they do not receive adequate help and could end up in hospital.”

Since the Care Quality Commission introduced its new inspection regime in October 2014, more than two thirds (68%) of home care services inspected so far have been rated Good or Outstanding. However, a report published last year by the Local Government Information Unit (LGiU) highlighted concerns that some working practices could affect the quality of a person’s care.

Sandra Duggan from North Yorkshire used home care services to help look after her late mother. She helped to develop the NICE guideline and said good care is vital for families: “When arranging home care for my mother I saw good care workers and some not-so-good workers so I know what a difference good care can make. My mother was able to stay in her own home for 5 years until she died, supported by her family and the home care workers.  I will always be grateful to the home care service for that. Home care workers are definitely undervalued. 

“These recommendations use evidence to define a quality home care service which can give families peace of mind. The guidelines will help local authorities, home care services and families to know what best practice looks like."

The NICE guideline for home care says that a ‘one size fits all’ service is not the best way to provide good home care. Instead, it advocates a ‘person-centred’ approach where the needs and wishes of the individual are heard and respected.

Bridget Warr, chief executive of the United Kingdom Homecare Association (UKHCA), chaired the group of experts which developed the guideline on behalf of NICE. She said: "As people age, many will need some support to achieve their wish to remain at home, near to friends and family. The help each person needs will differ and it is important that the homecare delivered is tailored specifically to the individual; his or her needs, wishes and aspirations.

“The guideline emphasises the importance of people receiving support from trained and competent staff with whom they are familiar. For this to happen, those commissioning and delivering home care must work together with the person wanting support to plan the right co-ordinated care in the way the person wants. They should be sure that there is adequate time allowed for the home care worker to provide good, sensitive support in a way that protects and enhances the person's dignity, wellbeing and independence.

“The guideline spells out how this can be achieved and will, I hope, help to provide focus for those many providers and commissioners who want to ensure high quality, responsive, sustainable support at home is available to those who want it."

The NICE guideline recommends that home care providers:

  • Ensure services support the aspirations, goals and priorities of each person, and that they and their carers are treated with empathy, courtesy and respect.
  • Make sure support focuses on what people can or would like to do, not just what they can’t do.
  • Prioritise continuity of care by ensuring the person has the same home care worker or workers so that they can become familiar and build a relationship.

The guideline also includes recommendations to support home care workers, from training and development to highlighting the need for services to give them enough time - not generally less than half an hour with each person - to do their job properly.

Miranda Okon, a home care worker in London and a guideline committee member, said that supporting staff is a vital part of improving the quality of home care: “The role of a home care worker is a valuable one to many older people and their families. I see 3 or 4 people a day and help them with things such as doing their laundry or shopping, cooking meals, or helping them to wash. I also make sure I have time to chat to them as I might be the only person they see that day.”

“Visits of less than half an hour are not allowed in the area where I work and this makes sure I am able to do everything I need to for each person without rushing. But this isn’t happening everywhere and if workers are in a situation where they have to choose which task to do before they have to rush out of the door this isn’t acceptable. Home care workers deserve proper recognition and support to do their jobs well and giving them enough time is vital to this.

"Regular training and development is also important: not only will it lead to a more skilled workforce, but may even help to retain staff by giving them a better defined career path.”

The NICE guideline also includes recommendations relevant to local authorities, Clinical Commissioning Groups (CCGs) and others who commission home care services. It says they should check that support is delivered through a coordinated team to promote integrated working and foster good communication. The team may include health and social care practitioners, advocates for the person using home care services and other individuals or groups who may provide support.

It also recommends that home care support is considered for older people with low to moderate needs to avoid, delay or reduce future dependency on health and social care services. Home care packages should also address the person’s wellbeing as well as practical support.

Max Wurr, Head of Policy and HR for the home care provider, City & County Healthcare Group, was also part of the NICE home care committee. He said: “No one is under any illusions that these are tough times for social care. Local authorities are spending less money in real terms on home care and providing such support to fewer people. However, we are confident that local authorities, along with everyone else in our sector, will welcome and support this guideline, which is based on the best available evidence and is intended to be aspirational but achievable.

“We want to set a standard for home care that achieves better outcomes for older people. This means including them in the design, planning and delivery of every aspect of their service and working together effectively with family carers, health professionals and other partners.”

Other issues addressed in the guideline include how to manage and address late or missed home visits, delivering telecare and putting a safeguarding process in place to help home care workers report signs of abuse or neglect.

Minister for Community and Social Care, Alistair Burt said: “Most of us envisage spending our old age in our own home and we want to provide the great care that can make that a reality. We asked NICE to develop this guideline so that everyone involved in providing home care has clear standards that we will expect them to follow. This will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve.”

NICE has also begun a public engagement exercise to inform the development of a quality standard for home care. This will be different to the new NICE guidance as it will focus on roughly 6-8 specific key areas of care most in need of improvement. Organisations and groups who have registered an interest in this standard are being asked for their views on which key areas should be addressed. The quality standard will be developed using existing NICE guidelines and other sources of information accredited by NICE. When it is published next year it will complement the NICE home care guideline.


For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

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 or by the person using services.

Although the range and type of services that can be classed as home care vary, it usually encompasses personal care (for example help to wash), essential domestic tasks and support with the activities of daily living, which might also include telecare (for example providing personal alarms).

Since the CQC’s new inspection approach began in October last year, ratings for 1,257 home care providers have been issued. Of these 4% (51) are ‘Inadequate’, 28% (355) are ‘Requires Improvement’, 67% (842) are ‘Good’ and 1% (9) are ‘Outstanding’. For more information visit

More comments on the NICE home care guideline

CQC’s Chief Inspector of Adult Social Care, Andrea Sutcliffe, said: “CQC inspections have found a wide variation in the delivery of home care services – we have seen some great care, but also care that does not meet the standards people who use these services have every right to expect. I hope that staff and providers will use the NICE guideline to improve the quality of care they provide which should help them to achieve a rating of Good or Outstanding.

“I am pleased that the NICE guideline has emphasised the importance of person-centred care and the need to recruit, support and train home care workers appropriately. These are key areas we focus on in our inspections.”

Dawn Warwick, joint chair of the ADASS older people’s network said: “We welcome this guideline for its focus on common standards and on the importance of being person centred. It properly emphasises the need to concentrate on what people can or would like to do, and treating them with due dignity, empathy and respect."

Colin Angel, UKHCA’s Policy Director, said: “UKHCA believes that the NICE home care guideline will be welcomed by homecare providers and front line care workers.

“The guideline highlights the necessity for individualised approaches to care and reflects the evidence-base of what we know will best support people with social care needs at home.  It is vital that these approaches are implemented by front-line workers and those responsible for commissioning services, particularly in relation to the time available to provide dignified care.

“We know that people who use home based care value the relationships that they build with those who support them, but can be frustrated if their care is not properly coordinated between different professionals.  Therefore we are particularly pleased to see the recommendation of a ‘named care coordinator’ principle in the guideline.”

Professor Martin Green, chief executive of Care England, said: "Care England welcomes the NICE guideline on Home Care. We hope that Local Authorities will commission this guideline, and fund and support Home Care Providers to be able to deliver it."

Janet Morrison, Chief Executive of Independent Age, the older people's charity, said: “There are many positive recommendations in this important new guideline, but one message stands out, which is that care workers can’t rush between home visits without compromising older people’s dignity and wellbeing.

Sadly, it is the frail and elderly who pay the price of flying care visits as a procession of stressed care workers come through their front door. Continuity of care is key, so that people can trust when they receive home care, they won’t just have their personal care needs attended to, but they will feel respected and supported to lead the life they have always led. For many older people, this will mean getting support to also remain sociable and, where they can, travel into town so home care isn’t just delivered in the confines of their own home.”

Leonard Cheshire Disability Director of Corporate Affairs, Andy Cole said: “Leonard Cheshire Disability welcomes this new guidance from NICE, which supports our view that high quality home care, should be built around people’s individual needs, aspirations and priorities.  

In particular, we welcome the clear guidance that home care visits lasting less than 30 minutes should not be commissioned, unless they are for specific time-limited tasks such as checking if someone is safe and well. Care workers need time to care; to talk to people, to deliver compassionate, personalised support, and to maintain safety and quality.

We are also pleased to see a clear focus on investing in the right support for people at the earliest possible stage. This is vital to enable everyone to continue living independently and would result in a cut in hospital admissions and reduce the need for care and support over the longer term.”

Katherine Rake, chief executive of Healthwatch England, said: "We know from local Healthwatch that the quality of home care services varies substantially across the country.

“We have heard from home care users and their families who are uncertain about what level of care to expect or do not feel involved in their own care. People have also told us that they are not always clear about what to do if they want to raise a complaint, as well as raising concerns that 15-minute visits are simply not long enough for a safe, thorough and compassionate service to be delivered.

"This new national guidance from NICE will help to set a benchmark for what we can all expect from home care services, as well as providing local Healthwatch with a tool to challenge and advise providers and commissioners to deliver the compassionate and individualised care we all need.”

Tony Hunter, chief executive of the Social Care Institute for Excellence (SCIE), said: “Good home care is a vital source of support for older people, so it’s really important to get it right. This guideline, which was developed by the NICE Collaborating Centre for Social Care – a partnership led by SCIE – provides succinct, evidence-based and action-oriented advice about home care delivery and practice. 

“It has been a great example of co-production in action because the guideline committee was made up of a varied group of people who work in home care and people who use home care services; so the guideline can draw on the knowledge of people who experience and provide home care every day.

“I hope that everyone who has an interest in good quality home care will read it and use it.”

About NICE

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Helping a person remain as independent as possible is an important component to maintaining their wellbeing. Without good support, older people can suffer from social isolation, malnutrition or neglect.

Prof Gillian Leng, NICE

I know what a difference good care can make. My mother was able to stay in her own home for 5 years until she died, supported by her family and the home care workers. I will always be grateful to the home care service for that.

Sandra Duggan, NICE home care committee member

Most of us envisage spending our old age in our own home and we want to provide the great care that can make that a reality... [This guideline] will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve.

Alistair Burt, Minister for Community and Social Care