Ongoing project

SUPPORTED

Informing the delivery of homecare at the end of life

Project summary

The Challenge

Little is known about the training and support homecare workers need to care for people with advanced illness approaching the last months of life.

The Approach

Operating in Bromley, Hull and Bradford, we will carry out interviews and policy analysis and develop and test a training resource.

The Outcome

Improve the quality and sustainability of care by homecare workers through training and informing employment practices, commissioning, and policy.

Lead academics

Funded by

Project partners

Bradford Teaching Hospitals NHS Foundation Trust

Improving end of life homecare

Our researchers work with the homecare industry and support agencies to develop training and inform employment practices and policies.

The Challenge

We know little about the skills and support homecare workers need to provide care to people with advanced illness approaching the last months of life. Homecare workers support the person and their family and work alongside other health and social care providers. However, they are often poorly trained and supported themselves.

Despite their critical role, little is known about the experiences of homecare workers, their training/skills needs and the best ways to support them to provide sustainable, quality, integrated care. The aim of this study is to provide insights into their role in providing care for people with advanced illness approaching the last months of life, and to develop the content of training resources that address these needs.

We aim to better understand the homecare worker role, experiences, and challenges. We will do this by talking to homecare workers themselves, as well as homecare clients, their family and friends providing care (‘carers’), and health and social care staff. We aim to identify good practice, training gaps and needs for homecare workers and ways to include and support them within the wider care team.

Health care worker assisting man with shaving

Homecare workers are a vital arm of the health team, their importance, and the significance of this has been unforgivably forgotten. I know from decades of experience that people want to be in their own homes. Personally speaking, I love my home and garden, why, would I leave to live in a care home?

Reshma Punjabi, member of Service User and Carer Advisory Group for SUPPORTED study

The full research team

Liz Walker PI/ Professor of Health and Social Work Research
Miriam Johnson PI/ Professor of Palliative Medicine
Jane Wray Senior Lecturer in Nursing, Senior Clinical Nurse Advisor NHSEI
Caroline White Ethics lead/ Research Associate
Mark Pearson Reader in Implementation Science
Alison Bravington Research Fellow/ Pictor Technique
Paul Taylor St Luke's Senior Clinical Lecturer in Palliative Medicine
Jamilla Hussain Consultant Palliative Care/ Honorary Senior Research Fellow
Joan Bothma Registered Care Manager at Cera Care
Research Associates

The Approach

Dying at home gives people a more controlled sense of death, in a less clinical environment and surrounded by loved ones….I don't enjoy seeing people die but knowing I can honour someone's last wishes as they peacefully pass away at home is a privilege.

Michelle Dale, Homecare Worker and member of the Homecare Worker Advisory Group for SUPPORTED Study

The SUPPORTED Study is a partnership between researchers from the Universities of Hull, Sheffield, Kings College London, and Bradford NHS Teaching hospital and is funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research NIHR135128/HSDR.

We will conduct a multi-methods study using multiple in-depth case studies across three sites (Hull, Bradford Metropolitan District, Bromley [South London]), delivered in three work packages. Work package 1 focuses on understanding the experiences and needs of homecare workers (including training and skills development) and the views of home care clients and family/friend carers, and other health and social care staff about the homecare worker role, including identification of good practice. It will include interviews/focus groups with homecare workers, clients, carers, and health and social care staff in Hull, Bradford, and Bromley. For the interviews, we will use a visual interviewing method called Pictor. This involves participants making a diagrammatic representation of care they have provided (homecare workers) or received (clients and carers) and of their support network, and then ‘telling the story’ behind their diagram. All participants can also participate in a conventional interview if preferred.

The PICTOR video is taken from another study, but is included to help demonstrate the SUPPORTED Study methodology.

There will also be an analysis of relevant national policy and strategy documents. Work packages 2 and 3 involves identifying the training/skills needs, developing recommendations and creating a training resource that can be evaluated and tested. We will make recommendations and develop homecare worker training resources which will be tested and evaluated. We will also identify ways to include and support homecare workers in the wider care team around the service user/carer to enhance the delivery of care, and reduce isolation and burnout.

The study includes two advisory groups, one that includes service users and carers and another that includes homecare workers. Members of these groups were involved in developing the study proposal, and the design and development of the study including participant documents. The groups will also be involved in sense-checking and dissemination of findings.

If I was coming across barriers, how would people who did not speak English be able to access the care they needed. South Asian elders would not question Health Professionals as it is seen as a sign of disrespect and it may impact on the service they receive.

Samina Begum, member of the Study Management Group for SUPPORTED study

The Impact

The overall aims of the SUPPORTED study are to improve the quality and sustainability of homecare delivered to people with advanced illness approaching the last months of life. We will achieve this through developing training, supporting skill development and empowerment, and informing employment practices, commissioning and policy. Upon completion of the study, we will have a better understanding of the role and experiences of homecare workers who provide support to people living with advanced illness approaching the last months of life, and the views of care recipients, their carers, and community practitioners.

We will also better understand the organisational views and priorities reflected in national policies, highlighting gaps and opportunities for action, including the production of a clear set of policy recommendations. In addition, we will identify ways to include and support homecare workers in the wider care team providing services to clients/carers to improve support, reduce isolation and burnout. Finally, the data collected will inform the development of a training resource that will be co-designed with homecare workers and homecare managers. We plan to test and evaluate the resource which has potential to be used in supporting homecare workers locally, nationally, and beyond.

To find out more about the study, please take a look at our study newsletter:

Publication

Forward, C. et al. (2024) ‘Needs and experiences of homecare workers when supporting people to live at home at the end of life: a rapid review’, BMJ supportive & palliative care (Print), p. spcare-004737. Available at: https://doi.org/10.1136/spcare-2023-004737.

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This study will give us the level of evidence with regards to the quality and skill of social care, but also be instrumental in supporting the spread and implementation of quality end of life care and training within the sector.

Joan Bothma, Head of Care at Carepoint Services Ltd & SUPPORTED Study Management Committee Member