The Challenges Facing the Domiciliary Care Market

What is domiciliary care? 

Domiciliary care, also known as home care, is care and support delivered in comforts of an individual’s home. Most of the care is personal including help with day to day activities such as cleaning, washing, dressing, and preparing meals.  

It also covers reablement services to make the transition from being discharged from hospital even smoother, as well as supporting adults living with disabilities.  

It is estimated that around 249 million hours of homecare are delivered each year and therefore home care has become an essential part of social care delivery to allow individuals to maintain their independence for as long as possible.  

Who manages the domiciliary care market? 

The UK domiciliary care market is managed differently depending on the country you are in. Each country however does have a regulatory body who monitors and inspects how all care and support is being delivered. For example: 

• England has the Care Quality Commission (CQC) 
• Wales has The Healthcare Inspectorate  
• Scotland has The Care Inspectorate and Healthcare Improvement Scotland  
• Northern Ireland has The regulation and quality improvement authority  

Regardless of the country you are in, the regulatory body will be inspecting care providers, agencies and homes to ensure they are delivering the best person centred care possible.  

With the new upcoming CQC inspections happening in England, the CQC will also be interested to see how care providers and local authorities work collaboratively to tackle the current issues facing the domiciliary care market and how they can show that they can work with people to provide better support and safety, whilst delivering care that matters to the individual.  

What are the challenges facing the domiciliary care market? 

Currently there are a wide range of challenges facing the domiciliary care market. One of the most crucial being funding issues. Each year, despite the demand increasing ,  budgets seem to be getting more and more limited and stretched even further.  

The Health and Social Care Levy put forward in 2021 proposed a 1.25% levy on employee earnings and employer wage costs which would raise an estimated £12 billion a year. It was thought this financial aid would largely help the healthcare sector to alleviate the pressure caused by the pandemic.  However, many argued that this was not enough to make a meaningful change to the health and social care space.  

It was forecasted that out of the £12 billion there would only be £2.9 billion over three years dedicated to making improvements and reforms in social care. This, undoubtedly has raised many concerns and uncertainties around the future of social care investment.  

As well as the lack of funding there are also many more challenges that are facing the domiciliary care market affecting everyone involved from care providers, to care workers and caregivers, to then the individuals themselves.  

Challenges in home care for care providers: 

1. Staff recruitment and retention  

One of the biggest challenges in home care for care providers is securing and maintaining a well led and trained care workforce. The need for more and more care workers as the demand continues to rise is crucial but with budgets limited often a lot of local authorities and care providers do not have enough care workers to meet their demand.  

Many care workers are also leaving due to long hours, continuous overtime due to being short staffed, and being burnout from the pandemic. 

Another reason why many care workers are leaving the profession is due to financial reasons. The lack of pay rises and low wages as well as the cost of living crisis has made it very difficult for care workers leading to many finding alternative jobs that would pay them more.  

Competition for staff is so intense that other sectors that are able to afford higher wages do to try and recruit more care workers to cover their jurisdiction. It can also be difficult due to limiting budgets for care providers and local authorities to offer longer term contracts so often care workers will leave to find something more permanent.  

2. High employee turnover  

Due to the lack of staff retention, a lot of care providers have high employee turnovers. This leads to care providers constantly having to recruit and train new staff members which can be costly and time consuming. 

It also, and arguably most importantly, can disrupt the continuity of care as individuals cannot build long-term relationships with their care workers. This can lead to patients losing trust in the system, get frustrated with having to explain their conditions over and over again, and ultimately have worse outcomes by not receiving the person-centred care that best meets their needs.  

3. Care Coordination  

Coordinating care for clients who may require multiple services can get complicated. Home care providers often need to collaborate with various other healthcare professionals, community organisations and family members to ensure all care needs are addressed properly.  

Without following a co-production approach and having effective communication between different organisations, care providers are at a risk of arranging and delivering lower quality care that does not meet individual care needs.  

4. Safety and Security  

When commissioning home care it is crucial that both the safety and security of both the caregivers and care receivers are considered.  

Home care providers may face a variety of safety risks especially when visiting a new client for the first time. It is essential therefore time is taken to assess all risks to ensure care and support workers are fully prepared and that individuals feel comfortable and safe in their care.  

5. Compliance  

Another issue for home care providers is the matter of compliance. It is essential that all regulations are followed to stay compliant and that all workers know what the regulations are and if they differ depending on the jurisdiction they are in.  

In order for this to happen it is imperative that all ongoing staff keep up to date with education and training, as well as all administrative processes. This does take time which often carers and support workers do not have.  

This can lead to support workers not keeping up-to-date with training and legislation changes putting the quality of care they deliver at risk. 

Challenges in home care for care workers: 

1. Heavy Workloads  

Home care workers often have high caseloads and are responsible for providing care to multiple clients in a limited time frame.  

Due to the high demand there is often short timeframes to get from one client to the next, so if they end up being with a client longer due to emergencies it can delay other visits and lead to a higher risk of missed medications.  

Managing these workloads therefore can be physically and mentally demanding leading to fatigue, staff burnout, and in a lot of cases carers leaving the profession altogether.  

2. Safety Risks  

Providing care in clients homes can be very physically demanding, even more so if they don’t have the correct equipment in the home. This can make tasks longer as well increase the risk of injury for both themselves and the individuals too.  

There are also other safety risks for carers including unsanitary conditions and potentially violent or unpredictable behaviours from clients or other family members. Ensuring personal safety therefore is a major concern for home care workers.  

3. Limited Training and Support  

Due to the demand being so high some home care workers may not have the time to upkeep their training if regulations change. They may also receive limited training and support in general, especially when managing complex medical conditions or emergencies.  

Without sufficient training the quality of care delivered will be reduced, the stress levels in home care workers will increase, as well as the risk of staff burnout.  

Challenges of home care for individuals: 

1. Limited resources  

Like already discussed the limited budgets can result in individuals receiving limited resources compared to what they could receive in hospital or at a healthcare facility. The lack of available resources therefore can impact the level and quality of care that can be provided at home.  

Due to the high demand, individuals can also be left waiting long times to receive the home care they need due to long waiting lists. This can also lead to patients who are seen as medically fit in hospital experiencing delayed discharges until their care can be arranged. 

This therefore contributes to making discharge delays even longer so then new patients being admitted are left even longer waiting for hospital beds.  

2. Caregiver Burden  

Due to potential long waiting times to arrange home care, the responsibility of delivering the care required in the meantime can be left to family members or informal caregivers. The responsibility of the round-the-clock care, managing their medications, and performing medical procedures when needed, can be overwhelming leading to caregiver stress and burnout.  

3. Safety Risks  

Like discussed previously safety risks for individuals are another challenge facing the domiciliary care market.  

Some home environments may have physical hazards such as fall risks or limited accessibility, so modifications to their homes may be needed to improve these conditions. This again can take time and increase their risk of falling more.  

4. At home monitoring  

Another key challenge for individuals using home care is that monitoring their conditions at home can be difficult. Family members and loved ones may also live far away so checking in on individuals between care visits can be limited.  

In the event of an emergency quick and appropriate responses are crucial and delays in emergency services can increase the risk of further decline in someone’s health further.  

Regular monitoring and recognising early warning signs is essential to keep individuals safe in their own home. Often for this to happen specialist equipment is needed which can take time to be delivered and set up in someone’s home. It can also be expensive and may lead to individuals having to pay for the equipment instead of their local council.  

5. Social Isolation  

Individuals receiving home care may experience social isolation due to limited interactions with others. This social isolation can negatively impact their mental health and wellbeing.  

The lack of social support can also affect the caregiver’s mental health as they may have limited opportunities for respite or support from others.  

Home care challenges for care agencies: 

One of the other areas which causes challenges in the domiciliary care market is with care agencies. At Access Adam Care Commissioning we conducted a study to focus on ways to maximise supply capacity and drive efficiencies in the market.  

Here our new MIC (Market Insights and Consultancy) service has helped coordinate and conduct a fact-finding exercise on behalf of one of our customers. The customer required information insight from their local domiciliary care market to understand the current conditions to help support them with better decision making to prevent further challenges being faced.  

In our study we spoke to 131 homecare agencies and found that: 

• 74% cite recruitment challenges and staff shortages as the main factors in their inability to take on additional care packages  
• 98% of agencies surveyed are currently recruiting  
• Recruitment is unanimously seen as very difficult at present  
• Agencies have highlighted that lack of funding is having a significant impact on their ability to recruit  
• Pay is cited as a major factor in the inability to attract and retain candidates  
• Agencies feel that new recruits are being overwhelmed, creating a risk of staff turnover  
• Several agencies are unable to recruit drivers. Although they have candidates, they can only take on a certain number of non-drivers as they must double them up with a driver  
• The market is currently at 86% capacity in terms of hours. The remaining 14% is not being utilised as the hours are not in line with vacant care package call times
• Prestige Nursing stated that “the quality and number of candidates is the worst it’s been in years” 

A key aspect of the study was to identify why homecare agencies are struggling to take on additional care packages.  We have been able to identify key themes care agencies will need to address to help homecare providers and agencies to overcome these barriers. These key themes include: 

• Recruitment and improving the appeal of the role  
• Addressing the pay gap between homecare and other sectors e.g. “63% are only paid for the time spent in homes of the people they care for. By only receiving payment for time spent in the home of the client, care workers; hourly pay rates fall well short of the governments national living living.” Homecare.co.uk  
• Support new recruits  
• Rota alignment and call times  
• Optimise transport for carers 
• Work in partnership with PA agencies  

How to overcome the challenges facing the domiciliary care market?  

 As we have discussed there are a variety of challenges facing the domiciliary care market for everyone involved. One way many of these challenges can be reduced is by investing in digital solutions to best support your care market now and in the long term to help deliver better outcomes.  

To be able to invest in digital solutions many local authorities are having to continuously stretch their budgets further, this is making future planning more and more difficult. To overcome this, the government has announced an additional £500 million in social care funding to help digitally transform local authorities’ adults and children’s social care services.

This additional funding will help local authorities invest in a variety of digital solutions to overcome some of the key barriers which care providers, agencies, caregivers, and the individuals themselves have been experiencing including:

1. Staff retention  
2. Compliance  
3. Social isolation  
4. Remote monitoring  
5. Future planning  

1. Staff retention  

One of the ways staff retention can be improved is through investing in more enhanced care monitoring systems. This can help improve staff retention and reduce staff turnover by optimising visits, gaining better visibility of care delivery, and helping to reduce workloads.  

East Sussex Council found that after investing in our CM solution staff felt a lot happier with the day to day running of their care service. Previously support workers were having to call the office at the end of everyday to find out their schedule for the next day.  

After investing in our Access CM solution our mobile app allowed them to access all the information they needed about the care each patient required as well as their rotas in advance. They were also able to get notifications of real-time updates wherever they were if are any changes to the schedule happened due to emergencies.  

Through using our medication management module eMAR they have also been able to reduced their medication administration errors by 70%. This has also helped improve the administration processes as they are now in a better position to demonstrate their compliance compared to their older paper-based systems.  

This has helped improve their staff retention as many support workers were leaving due to issues with their work-life balance as the older processes and constantly having to call the office to find out their schedules took up a lot of their free time even if it was their day off or their annual leave.  

2. Compliance  

Compliance was another home care challenge we have already discussed in detail. With the demand and waiting lists increasing, the pressure to arrange appropriate and compliant homecare is huge. Sometimes individuals end up with care which does not fully meet their needs, especially if their needs change.  

Investing in a digital solution to ensure your local authority only works with 100% fully complaint providers helps to ensure your homecare service is compliant all the time and meets all the care needs of the community, even if they change.  

For example both MLCSU and Staffordshire County Council found by investing in a commissioning solution together they could improve their compliance, transparency and visibility of their care packages.  

Prior to the investment Staffordshire Council only had a provider view of their joint funded care packages. After the investment both MLCSU and Staffordshire Council could see a full audit trial and could identify changes in care packages as well as the expense of them quicker.  

Our Access Adam Care Commissioning solution allowed them to have multiply bidders for their care packages filtered to their needs. We also made sure each care package had at least 3 bids per request and that any non-compliant providers could not be onboarded until their certifications were updated care regulations were met.  

This helps reduce the risk of individuals receiving poor quality care and due to the quicker onboarding process it also helped reduced hospital discharge delay times, as patients found that their continuing healthcare at home was arranged much quicker than before.  

3. Social isolation  

One of the other challenges of home care we discussed is that individuals and their informal caregivers may struggle with social isolation due to receiving care in their own home and not having as much social interaction to what they have had previously.  

A way to overcome this is by investing in social prescribing. Social prescribing is a way to refer individuals to services and interventions to best meet their non-clinical needs and help improve their mental health and wellbeing. This could be a coffee morning, a gardening project, or even a book club.  

Here carers can identify which individuals and loved ones are suffering with loneliness and isolation, to refer them to a Social Prescribing Link Worker. Here the patient and the Link Worker can work together to identify what their goals are and find services that best match their needs as well as arrange transport to and from services if needed. This helps to improve the mental health and wellbeing of the patients as it encourages them to get out the house, keep moving, and meet new people.  

Social prescribing can also be beneficial for their loved ones or informal caregivers too if the responsibility and stress of looking after a loved one gets too much. Richard’s social prescribing journey helps explain how social prescribing helped him to meet people like him so he didn’t feel so alone and how he got help in arranging respite care when he needed it.  

Age UK Barnet found from investing in our social prescribing platform they were able to digitise their processes to allow more time to be spent helping individuals improve their health and wellbeing. Through using our software in the last 12 months they have been able to make over 7,000 social prescribing referrals and have found 77% of patients have felt happier since engaging with social prescribing.  

4. Remote monitoring  

One of the final challenges that are a cause for concern for care providers, individuals and their loved ones is being able to monitor and manage conditions at home.  

Assistive technologies, digital telecare, and remote monitoring are some of the most popular ways to be able to achieve this successfully, and allow individuals to remain as independent as they can in their own homes for as long as possible.  

Technology enabled care is growing year on year and with the demand for homecare increasing, and with our current aging population, investing in some can help your local authority manage their home care services better.  

The Government of Jersey found after investing in our digital telecare and working with Airtel Vodafone they were able to work collaboratively with other partners and stakeholders to ensure the Government of Jersey’s objectives were delivered. 

They found that 95% of patients in Jersey were happy to switch to the new service and that it was very quick to install. This is because our digital telecare uses more than just reactive alarm functionality it also uses digital monitoring tools to help improve individuals quality of life to build confidence and reduce dependency. Our digital monitoring tools help to prevent readmissions to hospitals and lower the risk of falls as changes in behaviour can be flagged before something more critical takes place.  

Patients being discharged from physical wards to virtual wards is another way challenges can be overcome. Virtual wards allow frictionless at home care to be offered anytime to enable clinicians to provide safe and effective community care. This can help improve patients engagement and patient outcomes as they can be cared for at home, the place where patients feel happier and more comfortable and often where they recover a lot quicker.  

Summarising the domiciliary care problems and how to overcome them 

In this article we have summarised the variety of home care challenges care providers, caregivers, and the patients themselves are dealing with.  

We concluded that one of the biggest issues is funding and the lack of it, as well as the issues of staff recruitment and retention, and being able to maintain high quality care standards within a patient’s home.  

We have reviewed that there are a number of ways which these problems can be avoided and overcome through investing in different digital technologies. Despite the initial cost we have explored how in the long term it can help stretch budgets further whilst delivering better person-centred care.  

For example it can improve staff retention by making support workers day to day tasks easier and more efficient to save them time, improve their work-life balance, and most importantly avoid staff burnout and support workers leaving the profession.  

Through using digital technologies to improve staff retention, improve patient outcomes and safety, improve their mental health and wellbeing, as well as allow patients to remain as independent as possible, local authorities can save money and time due to GP and hospital attendance reducing as support workers can become more proactive in the care they deliver.  

Learn more information on how our local government software can help your local authority overcome the challenges in the domiciliary care market today.  

Contact us and find out more about how customers have overcome these challenges so you don’t have to so you can concentrate on providing the best quality continuity of care in your area which your support workers are happy with as well as the patients and their families too.