Homecare workers as proxy healthcare professionals: Evaluating appropriateness, acceptability, and impact

Background: Domiciliary workers, also termed ‘homecare workers’, support people living at home and may be asked to carry out healthcare interventions that they are not trained, supported, or monitored to do. With rising pressures on health services and older people choosing to live at home with complex multi-morbidities, there is a growing need for homecare workers to have the skills and knowledge to support certain healthcare interventions.

This provides an opportunity for homecare workforce role expansion at the interface of health and social care.

Research questions (RQs): The key questions this work will address are: RQ1) what is the available evidence around healthcare delegation in homecare? RQ2) how and to what extent are healthcare tasks delegated to homecare workers, by whom, and why? RQ3) how is this perceived by, and what are the experiences of homecare staff, people using homecare services, and other key stakeholders involved in managing and delegating healthcare tasks? RQ4) is there an appetite for homecare workforce role expansion and what is needed to support this?

Aims and objectives: This work aims to evaluate the positioning of homecare workers as proxy healthcare professionals, including the appropriateness, acceptability, impact of, and appetite for this. Our objectives respond to the research questions, with the aim of: a) contextualising the integration of healthcare provision in homecare, and understanding the processes of delegation (RQs1,2); b) understanding whether healthcare delegation in homecare is considered appropriate and acceptable by key stakeholders, and exploring the perceived impact of this on homecare staff and recipients (RQs2,3,4); c) co-designing outputs to support homecare providers and the workforce (RQ4); and d) delivering key messages and updated evidence-based information on homecare workforce role expansion (all RQs).

Methods: This mixed-methods study will use complementary and triangulated methods to answer our RQs across four phases of work. Phase 1: a scoping review of national and international approaches to integrating healthcare provision within homecare for older people. Phase 2: consultations with professionals involved in the planning, commissioning, and regulating of homecare services, plus a nationwide homecare provider survey.

Phase 3: qualitative work with diverse homecare providers, including interviews with homecare staff and people using homecare services, and diary entries with a sub-sample of care workers. These will be analysed together with care workers’ job descriptions and anonymised client care plans. Phase 4: cross-cutting co-design workshops to develop practical outputs for homecare providers, focusing on impact and knowledge mobilisation.

The research will involve diverse participant groups in terms of key EDI characteristics such as age, gender, ethnicity, disability, and location.

Timelines for delivery: This is an ambitious 30-month project, starting in March 2025. To drive timely impact, we plan to disseminate findings following each phase of work.

Anticipated impact and dissemination: We will produce a competency framework for homecare providers and interactive vignettes on healthcare delegation for homecare staff training. We will also develop accessible summaries and key messages from our findings including an infographic, and updated evidence-based information contributing to the ongoing dialogue around workforce expansion and career development pathways.