Domiciliary care meaning

The word domiciliary refers to occurring in someone’s own home. There for, domiciliary care refers to care provided within your own home also known as ‘home care’, ‘at home Care’ or ‘care at home’.         

A Care Home on the other hand is a facility away from home where a person can stay either short or long term. With an aging population and for those wishing to remain in their own home, the need for domiciliary care has increased substantially over the last few years.

Within the domiciliary care industry, the person receiving the care is referred to as the ‘Service User’. The term Service User can be widened to include the family or those orchestrating the care. We appreciate this term seems a bit impersonal but will continue to use it for this article as the person receiving the care could be anyone (yourself, mum, dad, friend etc) and ‘Service User’ will cover all bases.

The governing body for care in England is the Care Quality Commission (CQC) (Scotland and Wales are governed by the Care Inspectorate). Domiciliary care agencies in England providing regulated activities such as personal care will need to be registered with the Care Quality Commission. Domiciliary care can also be provided by introductory agencies who introduce you to a Carer but do not manage the care ongoing or self-employed Carers where there is no middleman. See more on the CQC and regulated vs unregulated care agencies.

For those living in the UK, this article will provide a definitive guide to researching, vetting, and ultimately choosing the right domiciliary care agency for you allowing you to feel comfortable that you have made the right choice. Feel free to use the bookmark icons on the side of the page to skip to certain sections.

When you may require domiciliary care

There may be several reasons that a person requires domiciliary care. These reasons can include:

· Personal Care: Bathing, Grooming, toileting, and other hygiene related tasks.

· Post hospital stay: Also known as convalescent care, patients can receive the care they need within their own home following a hospital admission. The person may have undergone surgery or have been recovering from an illness, ailment or fall.

· Respite Care: Giving a family member or full time Carer a break.

· Medication administration: The Service User may require physical assistance or a gentle reminder that their medication is due. CQC regulated agencies will be able to assist with medication via a Dossett box (separates the medication according to required days / times). They will also need to record this action on a Medication Administration record (MAR Chart).

· Meal preparation: Carers can help prepare meals for the Service User. Sometimes the Service User may wish to do the cooking themselves or assist with this.

· Domestic chores: Assistance with general household duties overlaps to a certain extent with the care provided although care agencies may not take on a Service Users purely to carry out domestic chores.

· Companionship: Sometimes a bit of company is all that is needed for someone. This can also be a comfort to family members knowing that someone is popping in for a chat and a cup of tea.

· Outings: Cares who drive and have the required insurance (business cover) can take the Service User on outings of their choice. This often adds a much looked forward aspect to the care they are receiving.

· Palliative care: For those with terminal illnesses, being able to spend their last days within the comfort of their own home with those they love may be their preferred choice to being in a hospice, hospital, or care home. Most home agencies will be able to provide palliative care although some will have more robust training, more experienced Carers, and better relationships with the community palliative care team such as the clinical nurse specialists.·

· Live in care: Some people require the assistance of a full-time live-in carer. A live in carer will live with the Service User within their own home. The live in Carer may stay for weeks or months at a time depending on the arrangement with the care agency. They will of course have some time off which will be agreed at the outset with the care agency.

Benefits of domiciliary care

· Control: Having care within your home often puts you in the driving seat in terms of who is delivering the care. You can also choose the time and type of care you would like to receive.

· Independence: With the right support, people can stay in their homes for as long as they would like until this is not possible even with adequate support.

· Personalised care: A CQC registered agency is legally obligated to put a person-centred care plan in place that has been approved by the person receiving the care. The Care plan should outline information on the person themselves and what is important to them as well as everything needed for the Carers to know when delivering the care.

· Cost effective compared to a care home: As a rule of thumb, a care rota with less than 3 visits a day / 21 visits a week will usually be cheaper than a care home.

Are there any potential disadvantages of domiciliary care?

· Privacy and confidentiality: Some people receiving the care may not want their neighbours to know they were having visits from a Carer. If this is the case, you can let the Care agency know and you can also request non uniformed Carers and Carers not parking on the driveway etc. Also, Carers will have access to personal information about that person. Reputable care agencies will have robust systems in place to ensure that general data protection regulations (GDPR) are adhered to.

· Risk of abuse: There is obviously a huge amount of trust associated with one-to-one care in the home as the care is being delivered behind closed doors. The most common type of abuse associated with the elderly is financial abuse where the person receiving the care is coerced or forced into giving away personal items or money. It is therefore crucial to carry out adequate research when choosing a care provider to give the Service User and their family peace of mind.

· Coordination of care and record keeping: If the Service User is receiving periodic visits where the Cares are seldom together in one place, it is vital that each Carer adequately records information about their visits in their ‘care notes’. This is so the next Carer attending the Service User knows how the person was at the last visit so they can assess change of condition, what they ate and drank as well as anything else pertinent to that visit. This also allows the office to keep up to date with recent developments.

· Safety concerns: If the person is receiving periodic care, it is important to ensure that they are safe in-between visits. This is especially important when caring for people with mobility or memory issues. If the person, you are looking after is coming home from hospital or has significant mobility issues then you can request the help of an occupational therapist whose job it is to ensure that your home is safe and that you have any equipment necessary to continue living at home as independently as possible. See more on Occupational Therapy assessment within your own home.

· Service User being reluctant: Some people who may require some extra support at home can be reluctant with the idea as they may feel as though their independence is being somewhat limited. The irony is that often, having a bit more support at home can allow the person to be more independent knowing that they have support there just in case they need it. They may also have someone who can take them out and about should they wish to do that.

Will any of my care be funded?

There are two main types of funding for home care or care home requirements:

· Social Services funding: Whether you qualify for social services funding will depend on your financial situation. The council will carry out a financial assessment known as ‘means testing’. If you have savings (excluding your home) over £23 250, you will generally not qualify for social services funding (accurate as of Oct 2023).

· NHS Continuing Health Care Funding (CHC): If the Service User has a complex medical health condition, they may qualify for this additional funding source regardless of your financial situation. If you think you may qualify for CHC funding, ask your local GP about the application process.

Where to start when looking for a good domiciliary care agency

Don’t worry if you are not exactly sure of what kind of care you require at present. This is not uncommon if you are looking at domiciliary care for the first time. You can use the below steps to get started….

1.  Service User buy in: Is the person who is going to be receiving the care happy with this or are they hesitant? Having the person receiving the care involved in the decision-making process can often help the transition. Reassure the person that they are not obligated to continue receiving care if they are unhappy and perhaps it is worth just giving it a try. Also, letting the agency know about anything that may make the transition easier such as language or common interest considerations. If the agency can put a Carer in place that can make a good first impression based on a common interest, this will be a big plus.

2.  Location: Identify where you would like the care provided.

3.  Type of care: Identify the reason for the care required as this will to a certain extent, dictate which providers you approach. 90% of providers will be able to carry out the most common tasks required such as personal care, medication administration, outings, meal prep and domestic chores. You may however require a more specialist type of care such as wound dressing or palliative care which some agencies will be better equipped to facilitate than others.

4.  Times and rota structure:  Having a general idea about what rota structure you would like will help the agency identify if they are able to provide this. It is a shame to let an agency carry out an assessment only later to find that they do not have capacity to provide this type of care.

5.  Identify potential agencies: You can use tools like Compare Caring to identify local agencies, view Care Quality Commission (CQC) ratings, fees and services offered all in one place. You can also press the ‘contact’ button to have your details sent directly to the agency who will then give you a call back usually within 10 minutes.

6. Look at the Agencies Care Quality Commission report: Every regulated home care agency in England (Scotland and Wales are governed by ‘Care Inspectorate’) is legally obligated to display their ‘CQC widget’ (interactive CQC ratings poster) on their website. You can click on this ‘widget’ which will take you into the Care Quality Commission’s website where you will be able to view the full report. The CQC rating is given following an in-person inspection by the CQC of that agency. See more on CQC ratings how to utilise the inspection reports and ratings they give each agency.7

. Speak to the agency on the phone: See below some useful questions to ask…

What to ask a potential domiciliary care agency when speaking to them on the phone

It is important when speaking to a potential domiciliary care agency that you ask several questions before booking an assessment:

· What are your prices?

This is an important question to ask at the outset and be given an answer prior to assessment. Most agencies should be open and honest about this on the phone. It is important for you to be able to budget effectively. Find out if there are any hidden costs such as assessment fees or mileage. Average costs for domiciliary care can range between:

o   Live out / visiting care: £20-£35 per hour

o   Live in Care: £1000 – £2000 per week

· Are you a regulated or unregulated agency?

This will affect how the care is provided.

· How long have you been in business for?

For regulated agencies, this will usually be from the time they have been registered with the CQC. Ask how many customers they have as well as how many Carers. This will give you a good idea as to whether they can cover sickness or holidays when your usual carer is off. If they are a new agency, how long has the Manager and the team worked in the sector for.

· What is the process if you wish to move forward?

A CQC regulated agency will need to do an in-person care assessment before putting Carers in place. Most reputable agencies can have Care in place following an assessment within 48 hours depending on the size of the rota. Remember that this may be longer if you are enquiring on a Friday or over the weekend.

· Who is in charge?

If you have an issue or need to speak to the agency about something, who is your direct point of contact. Once care is underway, most of the contact that you have will probably be with the Care Coordinator (handles your rota). If you need to speak to a manager about something else though, it is important to know who that is.

· Can you guarantee arrival times?

Whilst this is something that you would assume would be a given, a lot of home care agencies due to their other rota responsibilities will not be able to guarantee the arrival time you have requested. If this is particularly important to you then this is an important question to ask. There are agencies out there that can guarantee arrival times.

· Do I get the same Carers?

Most of the time, you will want the same Carer/s coming to your home so that you have chance to build a relationship but also so that they get to know your routine, likes and dislikes without you having to guide them through this each time. It is therefore important that the agency will attempt to give you a regular group of Carers within your rota. Most agencies will be able to set up the rota so that they Carers can have default shifts (the same shifts every week). If you are having two visits a day (14 visits a week), a general rule of thumb is to have around five Carers in the rota to allow for holiday and sick. It is always good to not be dependent on too few Carers either as this can cause problems if for any reason your usual Carer is off.

· Can I change the Carer if I am not happy?

A good agency should be able to accommodate a request to have a Carer taken out of your rota as long as it is a reasonable and constructive request. Remember that the Carers will need a little time to get to know the Service User and the routine so having a little patience at the outset can really help. Try and work with the Carer first to see if things improve before asking for them to be removed from the rota.

· What notice period do I need to give if I want to cancel a shift?

You may on occasion need to cancel a shift once this is booked. Agencies will usually still need to pay the Carer once they have been booked into a shift if cancelled too close to the shift start time so may require 24 hrs notice without you being charged which is reasonable.

· Is there is a standard contract length?

Most agencies will not commit you to a set number of hours or shifts. The whole idea of home care is that it should be flexible, and you should not be obligated to continue if you are not happy.

· What is your training and vetting process for Carers?

All regulated care agencies are obligated to carry out disclosure and barring checks (criminal checks) on the Carers that they bring on board as well as employment reference checks. They will also be required to carry out mandatory training such as Moving and Handling and health and safety training. If the Service User requires a specific type of Care not covered by the mandatory training, enquiries should be made to see if this will be carried out. An example of this is a shift where the Carers will be required to operate a hoist. This will require specific training with the Carers which will usually be required to updated annually.

At the assessment

When the domiciliary care agency comes out to assess, this is a good chance to get a better feel for them. Are they on time, organised, professional and knowledgeable. Remember that at no point are you obligated to proceed with the Care. Some agencies may request that you pay an assessment fee if you are not proceeding but this should not be more than £100 and will be discussed with you before you book the assessment.

A reputable agency will not pressure you in any way and you should feel relaxed in their presence. Ensure that you have seen and authorised the care plan before care starts as once care is underway, this will be the most important point of reference for Carers to use ongoing. Ask for your care rota to be sent out the week before ideally. Check this every time to highlight any errors. Always ask for a new rota to be sent out following any changes made to your rota.If you would like to explore local domiciliary care agencies, why not use Compare Caring’s free search tool to get you started.