Policy gaps regarding social homecare in the context of end-of-life; a policy document analysis
Abstract
Background
Social homecare workers (personal aides/assistants) are crucial for people wishing to receive end-of-life care at home.
Aim
To determine current UK social care policy priorities and gaps regarding end-of-life care provision by homecare workers, including support and training for this workforce.
Design
Policy document review and content analysis; eligible documents were current UK policy documents informing homecare worker practice/service delivery, identified by team expertise, networks, study partners and bibliography review of included documents. We quantified (existence, frequency) predetermined codes of interest in relation to end-of-life/palliative/care of the dying/bereavement, homecare workforce, and support and training.
Where homecare worker codes were contextually situated, we extracted and tabulated the surrounding text and examined for reference to training and support. We subjected extracted text content to framework analysis through the lens of Bronfenbrenner’s Adapted Ecological Systems Theory.
Results
1,464 homecare worker codes were identified in the 36 included documents, but only 72 times/17 documents in the context of end-of-life care. In the context of end-of-life care and homecare workers, education and training codes were present 3 and 35 times respectively. The need for end-of-life education and training was recognised, but in general, little detail about delivery and implementation was given (e.g., whose responsibility; funding; minimum standard and content).
Conclusions
The homecare worker role in end-of-life care is poorly recognised in national policy. Little guidance is provided regarding minimum training standards or delivery. Given an ageing population globally and expected increased demand for end-of-life homecare, national and international policy guidance should include this workforce.
KEY MESSAGE BOX
What was already known?
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Social homecare workers (variously known as personal assistants/aides or helps) play a significant role in providing end-of-life care for individuals in their own homes.
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The demand for homecare is increasing due to an ageing population globally and access to good quality provision of end-of-life care is a priority to support community-based care.
What are the new findings?
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There is a policy gap regarding homecare workers in the context of end-of-life care, with little progress since 2010.
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Few policy documents recognise the role of homecare workers in providing end-of-
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life homecare and there is little evidence that previous highly relevant policy recommendations (2010) have been incorporated in more recent current policy or enacted in practice.
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The need for homecare workers education and training in the context of end-of-life care is recognised, but few details about minimum content and standards, or delivery are given.
What is their significance?
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Although this is a UK-based study, given the ageing population internationally with likely increased need for care at the end-of-life, training, role definitions, and support to enable the homecare worker workforce to provide end-of-life care has relevance as a clinical and social care practice priority around the world.
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Policy guidance around end-of-life care should i) include the social homecare workforce; stipulate minimum training requirements in relation to end-of-life care, and ii) integrate this support and training into routine job descriptions, and as part of the working day.
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Improved training and support is an important step to increase the quality of end-of-life care provision.
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