Care at home

Improving domiciliary care for people with dementia
Two thirds of people with dementia live at home and one third of this group live alone. Currently, aside from the support provided by family and friends, domiciliary care, or home care, is probably the most important service involved in supporting people with dementia at home. Domiciliary care services have a key role in enabling people with a dementia to live well and remain at home for as long as possible, and in providing vital support for carers.

Social care in England is undergoing an immense cultural change in the way support is provided. The Putting People First transformation agenda outlines a new personalised system, available to all, focussed on prevention, early intervention, enablement, and high quality personally tailored services (HM Government, 2007). People will have maximum choice, control and power over the support services they receive. The National Dementia Strategy (Department of Health, 2009) sees the implementation of Putting People First as the major vehicle for delivering improved personal community support services for people with dementia.

People will be able to direct their own support including having access to direct payments and personal budgets. (See the Mental Health Foundation Dementia Choices website for useful tools to assist with the development of self directed support specifically for people with dementia www.mentalhealth.org.uk/our-work/training-and-development/current/dementia-choices/). Inevitably there will be some older people with dementia who do not wish to go down that route and it will be essential to ensure that they too are able to receive personalised support that offers them choice and control.

We are currently at a time of transition between the old and the new systems. In terms of older people’s services, domiciliary care provision sits right on the cusp of that transition as one of the standard service responses but with the potential to deliver highly personalised care and support. Both commissioners and providers of services face significant challenges in transforming care provision and in also addressing the particular needs of people with dementia and their carers in the context of the broader changes to be delivered.

This report reviews the current position of domiciliary care in delivering quality support for people with dementia and their carers, considers the challenges faced and makes recommendations regarding how to move forward with improving provision. It is designed to be a resource for those involved in commissioning and providing domiciliary care, including contracting and finance staff and those working on the personalisation agenda.

The report draws on research undertaken during 2010-2011 in the South West of England (South West Dementia Partnership, 2010) and the recently published reports from the Alzheimer’s Society (2011) and the Personal Social Service Research Unit of the University of Manchester (Challis, D. et al, 2011) .

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References

  1. Alzheimer’s Society (2011) Support. Stay. Save. Care and support of people with dementia in their own homes. Alzheimer’s Society, London. http://alzheimers.org.uk/site/scripts/download.php?fileID=1030
  2. Challis, D. et al, (2011) Community support services for people with dementia: The relative costs and benefits of specialist and generic domiciliary care services. Personal Social Services Research Unit, Manchester University, Manchester. http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Other_reports_and_guidance/Dementia_and_domiciliary_care_-_PSSRU_full_report.pdf
  3. Department of Health (2009). Living well with dementia: A national dementia strategy. Department of Health, London. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_094051.pdf
  4. HM Government (2007). Putting people first: A shared vision and commitment to the transformation of adult social care. HM Government, London. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081119.pdf
  5. South West Dementia Partnership (2010) Domiciliary Care Key information report. and South West Dementia Partnership (2010) Domiciliary care provision in the South West for people aged 65 and over: Data set 2010. www.southwestdementiapartnership.org.uk/domiciliary-care