What older people want: Commissioning home care for older people

What would matter more is a wee bit of attention, not to be in such a rush. Now they do everything, and everything is done, but ... well he wouldn’t feel that he was just, a vegetable, that he wasn’t a person. It’s all about personality ... the friendly touch.

Unpaid carer [2]

The number of older people with complex needs who are staying at home with the support of home care services is growing. Research evidence tells us what older people need and want from their home care service.

People who use services need significant support, which they receive through an intricate and varied system of formal and, often unpaid, care. [8] The greater a person’s disability, the greater are their likely needs as there will be a wider range of tasks they cannot do for themselves. [6] Many are at risk of not having their needs met this way. They are therefore at ‘the margins of independent living’. [9]

When asked, most service users say that they are satisfied with the quality and level of care they receive. But the evidence shows that older people tend not to complain. [2] Qualitative research with service users that took account of this reluctance produced four themes of what is important when it comes to care. These are now described.

Older people want to remain in their own homes

Older people prefer to stay in their own homes and communities until it is impossible for them to do so, rather than move into residential care. Most older people enjoy being in their home surroundings and view residential care with suspicion. [9]

Older people may struggle to adjust to receiving home care and fear the loss of their independence.

Older people want to have a good quality of life

Home care is not seen simply as fulfilling practical needs – older people want their home care to meet their social and emotional needs too. [10] No matter how frail or physically disabled they are, they want to go outside, continue friendships and take part in community life. [2] Yet relatively few care packages include support for activities outside the house. [1] They talk about having to rely on the goodwill of their paid carers simply to get out into the garden, let alone further afield.

Loneliness is a major problem for older people living at home. There are high rates of depression and loneliness particularly among those with complex health problems or who have suffered bereavement, which social interaction can alleviate. [2, 5, 6, 11]

People who use services feel that their carers do not motivate them to take part in activities and communicate with other people, or help them to make better use of their own resources. [5]

Older people want to develop good relationships with their carers

Most people being cared for at home want a warm relationship with their paid carers and place a lot of value on conversation. [1] A friendly and sociable carer is regarded by service users to be a marker for whether they are a good paid carer or a poor one. Paid carers themselves complain that they often don’t have time to talk to their clients, and that this part of their role is not recognised as important. [11] Many users feel that their paid carers are constrained by time during their visits – they can either talk or do, but not both. [5]

Continuity of care is seen as vital by users, who want a few regular carers who they can get to know well. [6] A high turnover/variety of staff has an emotional impact on service users, who get embarrassed when strangers carry out intimate personal tasks for them, or find it exhausting having to constantly repeat personal information to new people.

Practice example 1 shows how a good relationship with a carer transformed a user’s home care experience.

Older people want to receive high-quality, personalised care

Older people being cared for at home have varying and multiple support needs, and a ‘one-size-fits-all’ approach is not appropriate. People want a personalised and flexible approach to their care, which respects them as individuals. This is especially important for older people who do not have family or friends living nearby who can give them help.

• People want care that is tailored to their needs.
• They want to be able to get in touch easily with those who organise their care.
• They want support from one person who can help them prioritise the competing demands of their multiple conditions. [12]
• They want a care plan that is explained to them clearly and is easy to understand. [2]
• They want information about all the different services that are available to them in their local area.

Also:

• People who use services want to be seen as individuals.
• They want a care package that takes into account what they want and need, and that can be changed if their needs change. But many feel that carers are not encouraged to make changes to care packages.
• They want to be listened to, but many feel that their paid carers have no time to listen. [4]

The relationship that develops when people are cared for by familiar, regular care staff is the key to flexible and personalised care. [6]

However, service users feel that care provision is often based on what commissioners or carers think is important, and that they do not take the time to talk to them to find out what is important to them. Older people value professionals who provide care services that meet their own understanding of their needs and help to give them a feeling of being in control and of wellbeing.