Older People and Domiciliary Care

Currently, there are over 266,000 older people living in Northern Ireland. The Department of Health, Social Services and Public Safety’s (Department) policy document, People First, published in 1990 recognised that for those older people experiencing frailty and ill-health there should be a range of services to offer them support in their own homes. A report published today by John Dowdall CB, the Comptroller and Auditor General for Northern Ireland, examines what progress has been made in transforming a care system that in the 1990s was dominated by residential and nursing home provision to one which shifts the balance in favour of domiciliary care.

Main Findings

Based on June 2007 figures, around six and a half thousand older people in Northern Ireland receive domiciliary services specifically tailored to their needs while a further 30,000 receive simple elements of support which help them to live independently. The report found that, in line with the Department’s objectives, many aspects of social care and the promotion of domiciliary care have improved and continue to do so.

Between 2002 and 2007, domiciliary care provision has increased by 35 per cent which in the Department’s view demonstrates that domiciliary care has increasingly been replacing residential care as the first choice for people with a particular level of need. While the proportion of domiciliary packages relative to residential activity remained static between 2002 and 2006 at around 37 per cent, figures for June 2007 show that this proportion had increased to 41 per cent. Mr Dowdall concluded that while such welcome inroads had been made, the process of change and development is far from complete:

  • there continues to be a relatively high-dependence on institutional forms of care, for instance, 60 per cent of the £394 million spent by Trusts on older people in 2005-06 went to the residential and nursing home sectors;
  • the number receiving less complex services such as Home Help has fallen;
  • domiciliary care resources tend to be concentrated on those individuals with high-level needs; and
  • there remains a constant level of unmet need among those awaiting domiciliary care.

The report benchmarked where services stand in relation to many of these issues:

Prevention and rehabilitation

One of the ways in which Trusts are making significant strides to improve domiciliary care services for older people is in introducing a range of preventive and rehabilitation services which offer them the chance to improve their quality of life and ability to live independently and comfortably in their own homes.

Needs assessment

The introduction of a single needs-assessment tool for Northern Ireland from 2007-08 is designed to gather the information necessary to plan care services for people with complex needs, bringing an even greater degree of coherence so as to enable them to continue living independently at home.

Direct payments

Direct payments will allow older people to choose who will help them and what sort of help will be provided. The impact this will have on the balance of domiciliary and institutional care is uncertain, however, it does appear that, to operate effectively, the system will need to rely on: good information; easy access to advice; and measures to ensure that the quality of provision does not deteriorate.

Staff recruitment and retention

The domiciliary care sector faces serious staff recruitment and retention problems. It is important that the issue of staff shortages is addressed as quickly as possible in order to ensure that sustainable, good quality domiciliary care is available for those older people wishing to remain in their own homes.

Private/voluntary sector provision

Despite the aspiration of People First that the development of a flourishing independent sector alongside good quality public services should be encouraged, the majority of domiciliary care services continue to be provided directly by Trusts. Trusts must strive to meet the challenge of strategic commissioning with the independent sector to ensure that the local market for care is encouraged and all existing resources are used to drive the development of domiciliary care services that genuinely meet the needs of older people.

Quality of service

While older people told us of their great appreciation of domiciliary care services in general, there are some areas where satisfaction is not as high as it could be. We heard some concerns about the flexibility, reliability and competency of care staff which can impose great strains and anxiety on the person who is reliant on that service. The key to a good quality domiciliary care service is the relationship between the person using the service and the person providing it.