Valuing the role of the domiciliary care worker

I am sure that people in the social care industry will have noticed recent reports in the press and media relating to domiciliary care workers, who provide a 24-hour service to people with dementia. The main thrust of the reports was whether or not domiciliary care workers should be paid for the whole time they are on duty. While I recognise the importance of what domiciliary care works should be paid I was really taken by the compassion and professionalism expressed by the workers in relation to the people that receive their care.

Domiciliary home care worker visiting elderly lady

This blog article is about the role of the domiciliary care worker and the contribution they make to the social care industry.

What does a domiciliary care worker do?
One only has to look at an extract from the following job description for domiciliary care workers to realise the commitment they make, often rewarded with very low pay ‘You will be visiting people in their own homes to assist with household tasks, some personal care and occasionally accompanying the client on visits such as to the doctor or hospital. Some domiciliary care workers are required to work nights offering assistance to clients who require around the clock care’.

As a domiciliary care worker you could be providing a full range of personal care from assisting with washing and dressing in the morning to aiding with toileting during the day. On a different day you might be assisting someone who is fully mobile but has dementia and requires assistance with cooking and cleaning. There is a great deal of variety in domiciliary care work, that requires the ability to meet changing situations that can challenge the care worker.

Why do domiciliary care workers take up the task?
It seems to me that to be a domiciliary care worker you need to have a genuine interest in helping people to maintain their quality of life and independence regardless of the potential barriers they face. You must be a patient person, who is kind and sympathetic to the difficulties faced by people who require social care.

The main stimulus for working in social care in the community appears to be job satisfaction. People seek employment in domiciliary care because they want to make a real, positive difference to other people’s lives. High turnover is caused by issues of pay, by conditions of employment, by the nature of the work, and by competition from other employers (Skills for Care, 2012). Other issues faced by domiciliary care staff include a changing client community, and the geographical and professional isolation associated with working in private homes (Skills for Care, 2010).

There is little doubt that we need to place a greater value on the contribution made by domiciliary care workers not only to their clients but to the social care industry as a whole. We cannot solely rely on their compassion and professionalism, but recognise their importance and reward them accordingly.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Funding Domiciliary Care and Care homes

Domiciliary Care Funding Decline

Funding Domiciliary Care and Care homes… the political and human context

In my recent blogs I have tended to focus on the delivery of care and improvements in best practice. However, in this bog I wish to turn my attention to the political dimension and the influence of politicians on the delivery of care and those who may or may not receive it.

Recent reports by the Kings Fund and the Joseph Rowntree Trust continue to highlight the funding crisis in the NHS and social care. This is a continually recurring theme. Over the past 20 years’ governments regardless of their political persuasion have failed to gain all party agreement and as a consequence we are left, failing to find a workable strategy.

The most recent Government approach to give responsibility for the funding of social care to Local Authorities is also likely to fail, unless the funding is made more specific and ring fenced. Latest figures show a significant drop of 26% in the funding of social care services.

The contraction in funding is also having an adverse effect on the taking up of domiciliary care and care homes provision where the availability is often dependent on where you live, the so called ‘postal lottery’.

I recently spoke to one of our customers who operates a social care service in the south of England. She says “80% of her care home places are privately funded” and they are relying less on Local Authority funding. We therefore have then a situation where there is more rationing of social care, fewer people receiving it and those that do, end up having to pay for it.

The situation is further exasperated through NHS bed blocking where many people’s needs could be accommodated in domiciliary care services or care homes. The net result is that NHS and social care providers are facing a chaotic situation. The consequence of which is some excellent social care providers pulling up sticks because they can no longer afford to run their services.

Given what may seem to be a pessimistic view of our current situation, perhaps we should take heart from a more positive view of the future. Patrick Hall, Fellow Social Care Policy says “the financial situation is complex and difficult to assess, but given the challenges of an aging population with a variety of long-term conditions combined with a changing family, community and cultural structure, it is difficult to be optimistic. But now is no time to stick our heads in the sand – we have to work together to reimagine social care for those who will need care and support in the next decades and beyond”. 

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Why is Documentation in Domiciliary Care Services so important?


I have no doubt that most registered managers recognise the importance of policies and procedures in their care service. But I often wonder if they recognise how important they are to the effectiveness and quality of their service. As a former principal inspector and now management consultant I was often surprised when visiting some providers to find that although they had policies and procedures in place, they could often be seen on bookshelves, only to be occasionally used when a problem arose or an announced inspection was due.

The position has changed somewhat today with the onset of online systems (such as the Bettal Quality Consultancy mycared4 EQMS) and the benefits of technology. However, given the pressures on managers and staff, it is debatable as to whether or not they are getting the best from their quality management system that contains the services policies and procedures and other documentation. In the course of this short blog I will attempt to identify the importance of a quality management system to your domiciliary care service and how you can make better use of your policies and procedures.

Implementation of policies and procedures

It is important to recognise, that in a domiciliary care service, policies and procedures are the means by which the service is designed to operate. It follows then that staff must be given access to policies and procedures and training to carry them out. It is particularly important in domiciliary care that staff have a clear understanding of what is required of them, because they often work alone without onsite observation or supervision. Equally, management must be confident that staff have been given the guidance and direction contained in their policies and procedures they need to carry out their role efficiently and effectively.

The relationship between domiciliary care policies and procedures and the quality of the service

The attainment of a quality service should form an integral part of the domiciliary care services policies and procedures. They should provide a blue print of:

• What needs to be done to attain quality?
• How quality will be measured?
• How policies and procedures are audited?
• How to analyse and action the level of satisfaction feedback received from people who use the service?

Documentation and the Care Quality Commission

CQC who carry out and inspection of a domiciliary care service will always review documentation including policies, procedures and records. It is recognised as the key to finding out what is happening in the service alongside the views of people who use it. It is therefore of paramount importance that domiciliary care services have in place a reputable and rigorous quality management system that meets CQC Fundamental Standards and ensures a quality service.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Creating a Positive Culture in Domiciliary / Home Care Services

There is a growing interest in promoting a positive culture in domiciliary care / home care services.

Increasingly, positive culture is becoming more recognised as important in contributing to the effectiveness of any service, yet it is an area that until recently that has tended to be overlooked. CQC have recognised the importance of a positive culture. In the Key Lines of Enquiry Well Led Prompts; the question is asked “How does the service promote a positive culture that is person-centred, open, inclusive and empowering?”

There is often a lack of understanding of what culture really means. A useful social care definition can be seen as ‘staff having a way of thinking, behaving and working that complies to the ethos and values of the service’. Culture affects practically all aspects of organisational life from the way in which people interact with each other to how they go about their work and the way decisions are made. It serves as a powerful force drawing people together and creating a sense of cohesion or division, defining what values and behaviour are acceptable and unconsciously telling people “how things are done around here”.

Why is culture so important? Research shows that the culture of a service directly affects the quality of life of Service Users. (My Home Life). It has become increasingly recognised that staff and Service Users are interdependent and this needs to be considered when fostering positive cultures in care services.

Creating a positive culture

Approaches to creating a positive culture will need to take account of the following:

• How management challenges the unquestioned routines that exist day to day.
• The importance of leadership.
• A recognition that managerial practices in the service are probably the most potent ways in which its culture is transmitted and reinforced.

A manager who sets out to create a positive culture in a domiciliary care / home care will need to recognise that their personal actions and behaviour are likely to evoke strong emotional reactions from staff. Setting an example by deliberate role modelling, teaching and coaching can have a profound effect on the willingness of staff to support or resist change and whether they participate or buy into it.

Regardless of the approach taken, management should look for congruency between what the service claims to be and what is practised. This combined with good communication, will play a powerful role in establishing and maintaining a healthy work culture. Honest discussion with staff about shared problems, responsibilities and potential solutions is a good starting point for improving culture at work.

Ethos and Values

Ethos can be defined as the beliefs or ideas by which a person or group lives. An example of ethos is the goals of a service set out in a mission statement.

The central characteristics of an ethos for domiciliary care/ home care services

The following are suggested characteristics of an ethos for domiciliary care / home care services:

• To be a service that seeks to learn and evolve, aiming to implement what is considered to be best practice in all aspects of service provision.
• Recognising that Service Users and their families have a right to a high standard of service.
• To support and empower families in achieving a fulfilling life for their family member.
• To support staff members to work to our ethos and values to achieve fulfilment in their working life.
• To work in partnership with statutory bodies and other stakeholders in the community to achieve high quality services and quality of life for Service Users.

Positive culture values for domiciliary care / home care services

The following are suggested core values that underpin and form part of the interdependent relationship between staff and Service Users:

• Service Users and their families will be actively involved in decisions effecting their care, treatment and support.
• The domiciliary care / home care services provide a service where management and staff see safety and security of paramount importance.
• All Service Users are treated equally and provided with equality of opportunity.
• Staff will always show compassion when providing care treatment and support.
• Service Users are always treated with dignity and respect.
• Staff will encourage Service Users to retain their independence as far as safely possible.

Promoting a positive culture

The establishment of a positive culture will depend upon:

• Staff who share, the values of the service.
• Promoting and encouraging a united feeling of identity where staff feel valued and are treated with trust, integrity and respect.
• Encouraging a feeling of belonging.
• Obtaining a commitment from all staff to work together for the benefit of Service Users and their families.
• Promoting a culture of honesty openness and transparency when mistakes occur.
• Investing time and energy into maintaining a positive workplace culture.


Value-based recruitment is an emerging theme in social care today. It emphasises the importance of assessing values and attitudes alongside skills and experience, which until recently held centre stage. This can be supported by having a clear Service ethos and values for staff and service Users.

Skills for Care Social Care Commitment

The Social Care Commitment is a promise made by people who work in social care to give the best care and support they can. This is an agreement from employers and employees to improve workforce quality, by focusing on the values and behaviours needed to work in a care service.

The manager and staff by signing up, acknowledge their responsibility for ensuring workforce quality, and opening up to a more transparent way of working. It focuses on key issues such as upholding dignity, staff development, and whistleblowing.
It’s a way of employers and employees mutually agreeing to take responsibility for driving up standards.

The manager in the role of leader in the domiciliary care/ home care service

There is no evidence to support the view that managers can control or manipulate culture, but as good leaders they can certainly initiate, influence and shape the direction of change to a more positive culture. Therefore, the role of leadership at all levels in achieving cultural change is almost indisputable and is a vital aspect of management development. To succeed managers must:

• Hold on to their ethos and values.
• Learn about what motivates their staff and encourage them to take part in cultural change.
• React positively to negative feedback: listen, learn and act.


An understanding of culture in home / domiciliary care services is important to the operation of the service and quality of life of Service Users. This is because culture affects practically all aspects of organisational life from the way in which people interact with each other to how they go about their work and the way decisions are made. In the end the achievement of a positive culture will largely depend on the acceptance and sharing of the ethos and values of the service and how these are followed in day to day practice.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy