Home Care in Later Life

What is Home Care?

As people grow older, physical strength, mobility, memory, and general health can decline, often gradually. These changes may make it difficult to manage tasks that were once routine, such as getting dressed, preparing meals, or taking medication correctly.

Despite these challenges, many older adults wish to remain in their own homes rather than move into a residential facility.

Home care, or domiciliary care, provides professional support in the home, offering an alternative to care homes that can help maintain independence, dignity, and quality of life.

What home care involves

Home care refers to services provided in a person’s own home to help with day-to-day living. This support may be practical, personal, emotional, or medical. It is intended to enable people to live safely and independently for as long as possible, even when they face increasing health or mobility issues.

For example, someone recovering from surgery may need temporary support to cook meals and avoid injury while healing. A person with Alzheimer’s disease may require long-term help with dressing, managing medication, and reducing risks such as leaving the hob on. Home care is also commonly used by people with limited mobility, vision loss, or chronic conditions such as arthritis or diabetes.

In addition to physical assistance, home care can help reduce loneliness, especially for those who live alone or have limited contact with family. Even short, regular visits can improve wellbeing by providing conversation, reassurance, and connection.

Types of home care support

Personal care

Personal care involves direct assistance with daily physical tasks. These are often intimate or sensitive activities that require professional, respectful handling. The level of care may vary depending on the person’s physical ability, mental state, and preferences.

Common tasks include.

• Bathing and hygiene.  Helping someone shower, wash, or manage personal grooming, such as brushing teeth or applying creams for skin conditions.
• Dressing and undressing.  Supporting people who have arthritis, tremors, or limited movement to put on clothing and manage zips, buttons, or fasteners.
• Continence care.  Assisting with toilet use, changing continence pads, or managing catheter or stoma care. This is especially important for those with neurological conditions or limited mobility.
• Mobility support.  Helping a person move between rooms, use a stairlift, transfer from bed to chair, or use walking aids safely.
• Meal support.  Preparing meals in line with dietary needs, such as soft foods for people with swallowing difficulties or diabetic-friendly meals for those managing blood sugar levels.

Companionship and emotional support

Many older people experience isolation due to bereavement, reduced mobility, or family living far away. Regular visits from a care worker can provide vital social contact, helping to reduce feelings of loneliness and depression.

This type of care may include.

• Conversation and social interaction.  Simply spending time talking, reading, or watching television together.
• Support with outings.  Accompanying someone to a GP appointment, to the shops, or for a walk in the park.
• Cognitive stimulation.  For those with dementia, carers may engage in memory games, music, or other activities that support mental function and reduce anxiety.

Nursing and medical care

Some people require medical care that cannot be provided by standard domiciliary carers. In these cases, qualified community nurses or specialist carers provide services under NHS or private arrangements.

Examples include.

• Administering medication.  Giving injections such as insulin, or managing a complex medication regime.
• Wound care.  Cleaning and dressing post-surgical wounds or ulcers.
• Monitoring health conditions.  Checking vital signs, managing symptoms of long-term illnesses such as COPD or heart failure.
• Specialist care.  Managing feeding tubes, tracheostomy care, or ventilator support for individuals with significant medical needs.

If the care is considered clinically necessary, it may be provided through the NHS. However, some people pay privately to access more regular visits or services not covered by the NHS.

Live-in and overnight care

Live-in care means a carer lives with the person in their home, typically working on a rota with another carer for breaks. This arrangement is suitable for individuals who require consistent support throughout the day and night.

Examples of when live-in care is appropriate.

• A person with advanced dementia who risks wandering or becoming disoriented.
• Someone recovering from a stroke who needs full-time help with mobility and personal care.
• Couples who want to stay together at home but need significant joint support.

Overnight care may involve a sleeping night (where the carer is present but only expected to assist if needed) or a waking night (where the carer is awake and provides active support throughout the night). This can help manage risks such as nighttime falls or incontinence.

Live-in care usually requires a spare room and appropriate facilities. It may be more cost-effective than a care home for couples, though it can be more expensive than hourly visits.

Who provides home care

Local authority-arranged care

In the UK, local authorities are responsible for assessing adult social care needs. Anyone can request a care needs assessment, which will evaluate whether they meet the national eligibility criteria.

If a person qualifies, the council may.

• Arrange care directly using contracted providers
• Offer a personal budget so the person can choose their own provider

A financial assessment will determine how much the person must contribute to the cost. In England, if savings exceed £23,250, the individual usually pays the full amount. Other nations have similar rules with slight variations.

Private care agencies

People can also arrange care themselves through regulated agencies. These organisations employ trained carers and handle recruitment, DBS checks, training, and cover for staff absences.

Advantages of using an agency include quicker setup, no employer responsibilities, and access to a pool of trained staff. However, it can be more expensive and less personalised than hiring someone directly.

Direct employment of carers

Hiring a carer privately gives the individual complete control over the care provided, including choosing who provides it, what times they attend, and what tasks they perform.

This arrangement means the person becomes a legal employer and must handle payroll, tax, pensions, and holiday entitlements. It offers continuity but also involves legal obligations, which some people manage using payroll services or through a family member.