This project is no longer active and all user accounts are now disabled. It is archived here for reference purposes only.

3. PRACTICE ISSUE THREE: Long term services to maintain people at home


Homecare has traditionally been associated with cost savings in comparison to residential care. This is only likely to be true when the level of care needed is low (Mottram, 2007). Homecare is increasingly targeted at those clients with the highest needs and the number of older people (aged over 65) receiving an intensive service of over ten hours per week has increased from 9.0 clients per 1000 population in 1998 to 18.1 clients per 1000 population as at March 2010 (Scottish Government, 2010). The evidence suggests that homecare staff have a crucial role in enabling older people to remain at home. A meta-analysis of 15 studies showed that homecare programmes were effective in reducing mortality and admission to residential care although there was no reduction in admissions to hospital (Elkan et al, 2001). Eloranta and colleagues (2008) argue that the social aspect of homecare is crucial in terms of empowering older adults. It also has a significant role to play in identifying risk factors that might become a threat to older adults remaining at home.

Implications for practice

For homecare to be effective:

  • It needs to be targeted at those with the most complex needs
  • The importance of recruiting and retaining a committed and well-trained workforce cannot be overstated
  • Empowering service users to be involved in decision making can improve outcomes in relation to homecare
  • Staff need awareness and understanding of wellbeing to promote service user outcomes.

Homecare and daycare for people with dementia

Services for people with dementia have been shown to reduce the stress faced by family care-givers and can delay the onset of institutionalisation. Older people with dementia are often reluctant to accept services as a result of believing they do not need support and fears about losing services. Lack of tailored services is another explanation for refusal of services as is undiagnosed depression (Durand et al, 2009).

Implications for practice

For homecare with people with dementia to be effective:

  • It needs to be task-centred to ensure independence is promoted
  • Workers need to understand dementia and have appropriate training
  • It will require more time than traditional day care with those who do not have dementia.