Recommendations: Commissioning home care for older people

Both my parents have been enabled to stay independent as long as they can due to the adult social care they have been provided with ... [They] are able to enjoy a dignified life, in their communities, at little cost to the state, and remain in control and as independent as they can be.

Daughter, West Midlands [1]

Around the world, commissioners are being challenged by how best to care for rising numbers of older people with complex needs. The aspiration is rightly to give people the choice as to whether they receive care in their own homes if local resources allow because home care is what many people with complex needs want. And it is also cheaper than care that is provided in institutions such as hospitals and care homes.

The following recommendations show what commissioners can do at different stages of the commissioning cycle to improve how they assess, plan, contract and monitor home care services that satisfy what older people want, and make it less likely that they will need the costlier health-based services of hospitals and care homes. The recommendations are based on the emerging evidence of good practice in the UK and abroad.

Assessment

Commissioners should:

• develop their understanding of older people with complex needs and see them as people rather than as a series of individual needs
• involve older people who use services and their unpaid and paid carers in designing services
• understand the particular needs of older people within their local area and look at what provision already exists in the area
• establish clear and unambiguous criteria for acceptance into domiciliary care services that are designed to address unmet needs.

Planning

Commissioners should:

• develop values that inspire a positive attitude to home care such as flexibility and person-centeredness
• design a clear plan of how to commission integrated services to improve the outcomes that can be achieved
• work together with others, involving users and unpaid carers and encouraging health and social care staff to work together too
• consider a single point of entry to services
• investigate the role that assistive technology can play.

Contracting

Commissioners should:

• use evidence-based intervention programmes
• create diversity among providers
• think about how effective provision can be achieved with existing staff
• make sure that staff development and training are considered in the contracting model
• embed an outcomes-based approach in the contracting process
• contract with clear expectations regarding quality of care
• have robust contractual arrangements in place and monitor outcomes.

Monitoring

Commissioners should:

• move away from task-focused to outcomes-based commissioning
• develop quality monitoring methods that place older people’s views at the heart of assessing quality of care
• think about the impact on carers when commissioning increases the number of care packages that people receive at home
• pay attention to the extra needs of people from black and minority ethnic groups and other excluded groups.

Further research

• Home care for older people with complex needs is an emerging and important area of social care. More evidence is needed on certain aspects of such care, for example what a personalised service looks like and the costs of specific services.