Review of domiciliary care services

This report has been prepared by the Institute of Public Care for St Monica Trust, a Bristol-based not-for-profit provider of domiciliary services to older people. Its purpose is to examine the principles and practicalities of three broad models of home care provision – a standard 'home help' model, a more intensive model tailored to rehabilitation and enhanced independence, and a specialist model for complex needs such as dementia or end-of-life care – analysing current practice and likely future developments for each model, and identifying implications for providers and commissioners in the home care market.

Drawing on a review of available literature and follow-up interviews with existing services, the report looks at the associated business models for each option, the costs of services - compared across sectors and analysing factors such as typical visit duration and travelling time - and key considerations in staffing configuration and service design. For each of the three models, short case study profiles of existing services are also provided.

The report establishes a context of rising demand for domiciliary services, based on factors including an ageing population, greater retirement wealth and a growing policy emphasis on preventative care and personalisation of services. In light of this, it identifies three key principles of service design: an outcomes-based approach, focused on the service user’s goals; an emphasis on early intervention and prevention; and integration across health and social care services.

It concludes by setting out future marketing opportunities and risks for providers, based on each of the three models of care and the likely priorities of three groups of purchasers: local authority/clinical commissioning groups, personal/individual budget holders and self-funders. Specific implications and proposed next steps for St Monica Trust are provided.