New Models of Homecare and Re-ablement

New Models of Homecare and Re-ablement

The Context

There has been an increased focus in home care provision to move away from ‘time and task’ commissioned care towards more personalised ‘outcomes’ focused care. However, the dominance and persistence  of ‘time and task ‘commissioned care demonstrates just how difficult it is to move away from.

Networks Across the UK

England

Scotland

Wales

Evidence on New Models of Homecare

Discussion Material
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    What is a time and task model of homecare?

    This term refers to a way of paying for and delivering care services in the home. Care provider companies are paid in blocks of time (often 15 minute blocks) to deliver a specific list of care tasks such as helping someone get washed and dressed, feeding or medication. 

    The Homecare market in the UK

    Each of the four UK nations has a slightly different approach to homecare funding, and the degree of outsourcing of services, which has influenced the ‘market’ for care.  Care providers delivering publicly funded commissioned care are more likely to operate on a ‘time and task’ basis, whereas private paying clients are more likely to receive longer visits, consistent carers and relationship-based care. Care providers supporting private clients typically charge more than Local Authority commissioned rates.

    What do people receiving homecare say they want?

    People using home care services say that they want more person-centred care which meets their needs in a holistic and integrated way. They want to be involved in their care plans and have their voices heard. They also want to be cared for by caring and compassionate staff, who are well-trained, and consistently by the same people so they are able to build relationships. There needs to be good information about the services available, so that people can understand their care options. Overall, people want to see a focus on wellbeing, prevention and promoting independence, as well as to maintain connections within their communities. 

    What do alternative and new models of care look like?

    There are many examples of care being organised differently and care providers who are trying to work to the principles of good care outlined above, and who do not operate on a time and task basis. Some of the ways that the move away from ‘time and task’ are being addressed are described here with some examples.

    Outcomes-based commissioning

    Has been a focus of a previous IMPACT network, Commissioning Differently.  While there have been some attempts to move away from commissioning on a time and task basis, the fact that this is not widespread highlights the difficulties in moving away from this model. The approach used by Wiltshire Council is offered as an example, which includes the difficulties faced in trying to implement something different.

    Family-based support

    Is an approach where people in need of care and support live within a household, either on a temporary basis or more permanently. This includes schemes such as Shared Lives and Home share.

    Technology-driven care

    has also been a focus of a previous IMPACT network, Technology for Prevention and Independence. This includes commercially available technology such as Alexa and smart devices, to apps which help unpaid carers to stay connected. Many care providers now use technology to record and monitor care, but it has also been used to develop online platforms which help to connect care workers with people looking for care.

    Integrated care

    has seen a renewed focus in policy over the last few years which calls for a greater integration between Health and Social Care. Research suggests problems arise when poorly designed models target the wrong population or they don’t take into account patients’ preferences.

    Community assets

    is an approach which draws on the skills and strengths which exist within communities to provide support. One example is community catalysts which help establish single points of contact for support and also help establish microenterprises to create social care jobs.

    Social Prescribing

    brings together GP surgeries and community assets to support people within the community. Evaluations of the programmes have shown that it improved people’s sense of wellbeing and made them feel more connected.

    Re-ablement

    is a specific enabling approach that focuses on helping individuals with physical or mental disabilities to adapt to their condition by learning or re-learning daily living skills. Reablement is different from ‘traditional’ homecare because it is about “doing with” as opposed to “doing for” someone, and is a “risk aware”, as opposed to “risk averse” approach. An example of developing this approach within homecare services is that of Vale Community Resource Services in Wales which works with individuals in their own homes to maximise functional independence in daily activities, thereby reducing the need for hospital admissions and long-term social care services. It involves multidisciplinary teams offering tailored support. 

    Buurtzorg and Wellbeing Teams

    Developed in the Netherlands with nurses, this model of care has developed as Wellbeing Teams within social care in the UK. It centres around small groups of autonomous care workers who are responsible for the care of a small geographic area or neighbourhood, which reduces travel time and means that people receive consistency in the care workers who support them. BelleVie Care based in Oxfordshire and orthumberland operate based on this model.