UK policy discourse presents technology as a solution to challenges facing care services, including issues of quality and the mismatch between care workforce supply and demand. This discourse characterises technology as ‘transformative’, homogenous and wholly positive for care delivery, eliding the diversity of digital devices and systems and their varied uses. Our paper draws on data gathered through 34 interviews with care sector stakeholders and four in-depth case studies of UK homecare providers to comparatively analyse ‘storylines’ of technological solutions expressed by policy (macro-level), sector stakeholders (meso-level) and homecare managers and care workers (micro-level) alongside enacted experiences of technology-in-use. The ‘storylines’ presented by care sector stakeholders and homecare managers converged with those of the policy discourse, emphasising technology’s capacity to enhance quality and efficiency. Our case studies however highlighted several implications for care work and organisational practice in homecare provision: the technologies we observed sometimes produced additional tasks and responsibilities, undermining the efficiency and quality storylines. The experiences of care providers and workers engaging with technologies in homecare warrant further investigation and greater prominence to challenge a discourse which is at times overly simplistic and optimistic.

Little is known about risk management in homecare for people with dementia. We aimed to gain an understanding of the ways in which homecare workers assess and manage risk whilst caring for people with dementia in their own homes. We conducted a qualitative interview study with 17 homecare workers assisting people with dementia with their personal care. Interviews were face-to-face, semi-structured, recorded and transcribed verbatim. Analysis was inductive and thematic. A key theme of risk was identified, with three main sources: the client as a source of risk to the homecare worker, the clients' home and behaviours as a risk to the client, and the wider health and social care system as a risk to both clients and homecare workers. Three interrelated aspects of risk were found to influence homecare workers' decision making and actions: homecare workers' perception of the level of risk, their perceived ability to control the risk and their tolerability of risk. The higher the perceived risk, the stronger the action taken by the worker or agency to mitigate it and the greater the impact on the client. To support effective development of this workforce there is a need to devise training that incorporates the use of tacit knowledge and experiential learning. Risk management policies for homecare should acknowledge and utilise the expertise, experiences and values of homecare workers.

Governments across the world have been slow in reacting to meeting the needs of disabled people during the pandemic. This has exposed existing inequalities in social policies, as well as new support barriers. Debates over social care have focused on Covid-19's impact on those living in residential care. Little is known about the experiences of disabled people who rely on daily support in their homes.

This article reports on a year-long study examining the experiences of disabled people during the pandemic in England and Scotland. It focuses on the crisis in social care and offers evidence of how lives have been disrupted. For many, this resulted in a sudden loss of services, delayed assessments and break down of routines and communities. Findings underline the weakness of social care in its wider relationship with the NHS and show how the social care crisis has challenged the goal of independent living.

This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate a susceptible-exposed-infected-recovered/dead (SEIR/D)-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, corona virus disease 2019, provided accurate estimates of disease parameters can be obtained from real data.

This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.

Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies.

An increased demand for long-term care services coupled with the decreased availability of informal (family) carers in many industrialised countries has led to the employment of growing numbers of ‘migrant care workers’. Little is known about this heterogeneous group or of their experience of employment in long-term care. Providing an important insight into a hitherto little researched and poorly understood topic, this article presents the findings of a qualitative study in Ireland that sought greater understanding of migrant carers' experience of care work and of the intra-group differences among them. The findings suggest that some members of the long-term care workforce are more likely to confront obstacles and discrimination than others. The data indicate that the experiences of European, South Asian and African carers are significantly different and that relationships may exist between carers' region of origin and their experience of care work, employment mobility and long-term plans for remaining in the sector. The findings underscore the significance of acknowledging the unique barriers and obstacles faced by particular populations of care workers. A better understanding of the changing demographic profile and needs of both care recipients and their paid (migrant) care-givers is required to ensure that appropriate policy and practical interventions are developed to support both groups.

Concerns over growing numbers and proportions of older people in industrialised societies have prompted interest in the development of cheaper ways of providing long-term care for older people. While debate in the UK is currently focused on the costs of residential and nursing care, other European and Nordic countries have introduced schemes designed to encourage or sustain the provision of ‘social’ care by family members, friends and ‘volunteers’, on the assumption that this can be provided at lower net public expense than either residential care or formally-organised domiciliary services.

Drawing on material from a detailed comparative study, this paper describes four different models on which such payments are currently based. These models are discussed and evaluated, taking into account factors which include the eligibility criteria for payments; maximising the autonomy of older people and family care-givers; and the relationships between financial payments and access to services.

These models locate systems of payment within the broader context of financial and service support designed to help frail older people and those who support them. They therefore highlight the importance of considering both financial support and services in comparative studies of social welfare provision. However, further evaluation and policy development is hindered by the lack of evaluation of different models of paying for care and a lack of evidence about the experiences of older people and care-givers.