Skip to navigation | Skip to main content | Skip to footer

News and events

Why we need social innovation in home care for older people

(7 September 2016)

The CRESC Researchers' report was released in September 2016 and is available for download. Its key findings are outlined below.

Home care is an essential service in care provision for older people and is important not only to large numbers of recipients of the service, but also as a significant employment sector. Done well, home care encourages social participation of the cared-for and can vastly improve their quality of life. In this report, CRESC researchers argue that social innovation in home care is essential to mitigate the multiple crises the sector is currently facing (financial, care quality, workforce recruitment and retention, and a shortage of providers).

When it comes to home care, the government’s ideal is to encourage personalisation. Personalising home care by putting the cared-for at the centre of their social care needs is beneficial because services adapt to the outcomes users are seeking to achieve, and it gives users more choice, control, and independence. To facilitate the ideal of personalisation, the existing approach of the government is to pursue ‘market citizenship’. This means that purchasing power is given to users, who then use it in a constructed market of care provisions. Local authorities are responsible for these markets, and should ensure that there are a variety of high-quality care providers to choose from.

CRESC researchers argue that market citizenship is unsuitable for older users because the additional choice is often perceived as a burden that limits their freedom rather than enhances it. This, coupled with the fact that local authorities and providers are also not fulfilling their roles in the constructed market, leads to fewer good decisions from users and the achievement of fewer desired outcomes.

Another problem is that this framework permits home care providers to continue to adopt a branch retail business model to their practices. The authors of this report argue that the specifics of the sector are such that these models are inappropriate and adopting them results in waste. Retail business models can allocate specific time-slots to specific tasks. Doing so allows them to be efficient, minimise labour variation, and maximise consistency in their product’s quality. However, the nature of tasks specific to home care (helping someone eat, dress, wash, etc.) have a very different nature and thus providers lose focus on the kind of nurturing and outcomes that actually make living at home valuable. These models also result in waste spent in paying for transport time of carers and thus a temptation for the employers to underpay and overwork their staff.

Finally, home care provision is commissioned unimaginatively, and the practices of Local Authorities (LAs) in outsourcing this work is perpetuating this problem. The authors of this report argue that Radical Social Innovation is needed to encourage LAs to engage with the specifics of service provision, forms of service, and business model. This is a drastic alternative to the centrally-driven government policy change that we currently see in the sector and involves civil society, providers, workers, and older people themselves. This approach promotes a much broader notion of full citizenship for older people and carers who have a right to decent employment. The authors propose three ways in which Radical Social Innovation might operate through LA commissioners:

  1. Open book accounting with contextual information about staffing and hours per branch.
  2. Consider the whole set of living and care arrangements available, rather than Home Care only. Doing this would also include factoring costs of alternative, much more expensive, options for older people that may be incurred if home care fails.
  3. Consider other types of care need such as social interaction and other factors that sustain people at home.

More focus on these issues will enable the sector to move towards an outcomes-based system that focuses on the specifics of each person’s need.