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Many countries were already turning to domiciliary care as an alternative to residential care homes before the pandemic. The closure of care homes due to the well-publicised issues caused by COVID may hasten this change.
Domiciliary care allows people to stay in their own homes, which they often prefer. It may also be more cost effective and sustainable for a growing older population.
Domiciliary care providers support a wide range of people to live independent and fulfilling lives, including disabled adults, children and their families. But it is not without its risks during the pandemic.
People who use these services and their carers may be even more vulnerable during a second wave if care homes begin to close. The pandemic may also increase the demand for domiciliary care visits as more people are sent home after being hospitalised with COVID.
The risk
By the very nature of domiciliary care, carers move between homes with the potential to spread COVID among vulnerable people. A lack of resources, such as clear guidance, training, support and personal protective equipment, may prevent them from providing good care and put both themselves and those in their care at risk. Both will also be left unfairly exposed as they do not have the same access to regular testing as care home staff.
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Deaths of people who receive domiciliary care in the UK are currently triple those in previous years. And for those with learning disabilities, deaths have more than doubled. Yet this has not been widely reported, in part because of problems with the data, but also because domiciliary care is not an area of focus for those dealing with the pandemic.
Domiciliary care is often referred to as the “poor relative” of the care sector, with the UK government spending much less on it than other countries. Staff are often undervalued, paid meagre wages and have precarious contracts.
Increased financial instability in the care sector as a result of the pandemic will have several undesirable effects, including placing greater pressure on family members and voluntary agencies to provide care. If care workers are unavailable or if people choose to cancel their care because of the risk of COVID, there could be longer term consequences.
Older people and those with disabilities may be left unable to look after their own basic needs, which has already been reported. If the domiciliary sector and care workers are not supported or available to provide safe care through a second wave, people could be left even more vulnerable.
They would face increased isolation, malnutrition, reduced mobility and worsening dementia symptoms and wellbeing. They may also be unable to access medication and healthcare.
For the domiciliary care sector, losing business may ruin many companies, and experienced carers would lose their jobs. Care may no longer be available when people decide they want it again and so they may end up in hospital unnecessarily, which will place more pressure on these services. Or care providers may be staffed by people with less experience who are not able to provide as high a standard of care as before the pandemic.
Get ready now
Constant changes to already muddled COVID policies and regulations, lack of investment and minimal acknowledgement of the plight of the domiciliary care sector is compounded by the issues raised above. An ongoing pandemic, coupled with care home closures, may increase the risks to domiciliary care workers and the people they care for.
To mitigate the consequences of a second wave, it is crucial to ensure that domiciliary care providers, carers and service users are protected, valued and supported. Care sector structures should be helped to become resilient and there must be immediate support for infection prevention and control, testing, food and other support services for vulnerable people with care needs. A failure to do so will leave those in receipt of care, care workers and care and health systems at increased risk.
Heather Catt receives funding from Public Health England and the UK Prevention Research Partnership.
Elizabeth Dalgarno does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.