Open access Is the quality of home care for older people in England really improving? Disagreements between the regulator’s and service users’ assessments

Francesco D'Amico, Juliette Malley, José-Luis Fernández (2016)

Home care is a vital and increasingly popular form of support that enables disabled and frail older people to live in their own homes. In England evidence about the quality of home care is limited to the regulator’s assessments of compliance with standards derived from inspections, which have shown improvements in quality over time. To evaluate how certain we can be about the trend reported by the regulator, we use data from two waves of a survey of the experiences of home care users aged 65 and over. We explore the trend in users’ experiences of home care across a range of aspects of process quality and satisfaction and use regression methods to control for variations in the ‘case-mix’ of people receiving services between the two waves. After controlling for case-mix we find that user-reported quality declined over the period from 2006 to 2009, with the largest decline being associated in the reliability of services. This study raises important questions about the direction of change in home care services and demonstrates the importance of analysing changes in quality using different data sources, reflecting different conceptualisations of and perspectives on quality.