Quality in home care for older people: factors to pay heed to

23 home care providers were interviewed concerning what promotes or impedes quality aspects of service-giving, as defined by older customers – like service from familiar staff or flexible help. The influence of Social Services purchasers and of structures for purchasing care proved notably important. Purchasers affected service quality through the amounts of time which they commissioned and through whether they would purchase help for customers’ quality of life as well as for their physical survival. Quality was affected through whether care was purchased through fixed quantities of time or through the fulfilment of specified tasks. Some purchasers controlled details of everyday care-giving which other purchasers left to providers’ discretion. Also influential was the attitude of providers themselves to giving miscellaneous occasional help like changing light-bulbs, finding reliable private tradesmen or taking customers with them on shopping trips. Some providers readily gave such help and found it unproblematic to do so. Others prohibited it, though this seemed not always implemented earnestly. The most marked differences in willingness to give flexible help occurred between different independent sector providers, rather than between independent and Social Services in-house providers. A third type of influence on quality of home care was ‘economic’ factors like the purchasing power of local home care pay rates within the local labour market, local geography and demography. Some questions are itemised which merit inclusion in any evaluation of the quality of a home care provider