Commissioning Home Care for Older People: Scoping the Evidence

Abstract

Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations:The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.

Delivering Personalised Home Care for People with Dementia: An Investigation of Care Providers’ Roles and Responsibilities

“…As publicly funded care compared less favourably to self-funded care in terms of the availability of time for the individual, the role of 'social health' (Huber et al, 2011) may be considered as an underestimated opportunity for prevention and management of dementia (Vernooij-Dasson & Jeon, 2016). Such opportunities for social and emotional needs and activities for wellbeing were rarely articulated as part of LA contracted care, in spite of the potential for improving functional abilities and promoting well-being (Jasper et al, 2019). Using home care hours more flexibly and responsively, shaped by home care agencies and their staff, together with clients, may encourage a more satisfactory use of existing resources (Bracken-Scally et al, 2018;Alderwick, Tallack, & Watt, 2019;Bottery, 2019).…”

ESSS Outline: New models of care at home

“…Despite the push, progress towards personalisation and outcomes-based commissioning has been slow and inconsistent. There is little evidence (Jasper, 2019) of a shared understanding of either term or how to fully measure them.…”

“…The need to broaden the commissioner role and to commission for better outcomes through a collaborative partnership model between home care agencies and commissioners is recognised, taking a more relational approach with providers and other stakeholders. This should include voluntary and community organisations providing social support (Jasper, 2019;Sutcliffe 2021). Davies (2021) found:…”

“…There is evidence (Jasper, 2019) of some joint commissioning of home care with NHS commissioners -such as intermediate care services which include home care for older people provided on a short term basis on discharge from hospital. This kind of approach potentially offers the opportunity to design a service around the health and social care needs of older people with complex needs, in a single service, with a greater focus on ʻcare at homeʼ rather than home care.…”

The challenges of commissioning home care for older people in England: commissioners’ perspectives

“…Policy directives have changed the expectations made of commissioners, with the role of local authorities in England in overseeing social care developing and changing over the last three decades. Responsibilities have changed from a direct provider of care to an enabling agency (Jasper et al ., 2019). Successive government policies championed competition between providers as the mechanism to drive improvements.…”