1. SAFE@HOME: Understanding safety, risks and harm benefits balances of home-based care

As more people need care within their own homes, thinking about how safe that care is, the quality of the care and how to balance risks with personal choice has never been more important. Our research study, called SAFE@HOME, is looking at what safe home-based care means for older adults (over the age of 60 years old). To do this, we are reviewing what has been written about care, looking at safety notifications describing care, and are listening to the people who give, receive or used to receive, or manage care at home. This blog will focus on why this work matters, what we are learning, and how it might help shape safer care at home.

For many people, home is not just where they live, it is a place where they should feel most comfortable and able to be themselves. It's where memories and routines are made and where being independent matters most. When medical or social care is needed, home-based care will often help to meet a person's needs within a familiar setting.

There are many different types of carers and they can be described as paid or unpaid carers (such as family members and friends). Carers can support people by preparing their meals and drinks, helping them to the bathroom and to wash, supporting them to take their medication, or giving them company. It is often very personal and takes place in the private space of someone’s home.

However, while care at home is needed by a lot of people, the standards of care, and how safe it is may vary. This has led us to ask, what does safe care look like, and how can we make home care safer for everyone?

2. The Hidden Risks of Home-Based Care

Good care is not just about completing daily tasks, it should also be about helping people to live well, safely, and with dignity. That means that care should be personal and meets each person’s needs and preferences.

We know that carers and care organisations are doing their best to do this, and within our research, we do not want to blame anyone for doing their work but want to understand more about what can be done to make sure that care at home is safe and suits the people who need it.

Social care is under increasing pressure as there are not enough carers, and they need to help more and more people at home. Carers can find the role difficult and without thanks, often asking for more support and training, within a job that can be emotionally and mentally tiring. In England, about 8.3% of all carer roles were vacant in 2023-2024, which means about 131,000 vacancies, and home care has the highest number of unfilled jobs (Skills for Care, 2024; House of Commons Library, 2024).

Carers may carry out a range of tasks in people’s homes, from physical tasks such as lifting or moving,supporting physical and mental health conditions and coping with challenges on a daily basis, often with different support from their employers or occupational health compared to other healthcare workers (Taylor, 2006; Shemtob and Asanati, 2022). Carers can also face pressure to do the work quickly, and problems with staffing levels at their place of work may mean they have to balance the quality of care, safe care, and their own wellbeing (Lewis et al., 2023). This may lead to missed or rushed visits, medication issues, exhaustion, poor mental health, and a lack of trust and connection between families and care providers. This creates the question: how can care at home be organised so that it is safe, meets people’s needs, and supports the wellbeing of carers?

3. Introducing SAFE@HOME

All of these issues led us to develop the SAFE@HOME study, focusing on safety and helping people to make their own choices, known as autonomy, for everyone receiving care at home.

Our research been funded by the National Institute for Health and Care Research (NIHR), and we hope to understand what safe care means for older people at home, while also supporting what matters most to each person who needs the care.

We will be hearing from people who have, or used to have, home-based care in Wales, as well as their families, and carers. We want to know more about their thoughts about care, any concerns they have had about home-based care, and their ideas for safer care.

Previous research has recommended that homecare and healthcare services should work together, and that more help is needed to help carers to work and stay in this important job role (Malley et al., 2023). Our research will also ask healthcare and social care workers across the United Kingdom (UK) about what helps or prevents safe care, wanting to learn more about the training they have had, and how to support links between health and social care.

We want to:

• Know how safe care or unsafe care at home care has been described and understood within journals and reports.
  
  
• Look at reports written by home-based care providers like carers to learn about the commonly reported problems, wanting to know about what happened, and what prevented safe care from being given.
  
  
• Hear from social and healthcare professionals, paid and unpaid carers, and people who receive care, about what they think safe home care is and what is needed for people receiving care to feel safe at home.

4. Why This Research Matters?

This study was inspired by the government’s priorities and reports that have asked for safer home-based care. A House of Lords committee focussed on social care recognises we need to know more about safe home care, calling for more support and more choice for disabled adults and older people. They also say we need to help social care to provide a robust, cost-effective, and ongoing service (House of Lords Adult Social Care Committee, 2022).

Despite knowing how important this is, unsafe care is not well understood and there has not been a lot of home-based care research in the UK, meaning that more studies are needed urgently in this area (Malley et al., 2023).

5. Sharing What We Learn

Once we have carried out our research, we want to bring together the different groups of people involved in home-based care. This will include carers, social workers and the professionals who fund and organise home-based care, to share what we have found and then to work together, thinking about how to make the care safer.

We want to create practical solutions and guidance to help improve home-based care for older adults who need this care. We will share our findings in lots of ways to support this change and will share what we learn from this study on our study website, and write about it in our study report, and in academic journals. 

6. A Shared Responsibility

As the people in the United Kingdom are living longer, this work has never been more urgent. Our SAFE@HOME study aims to understand how people can feel comfortable, safe and valued in their own homes and that how carers can be helped to support this.

By learning from carers, families, and the people that they support, we want to understand what safe home-based care should look like and know where and how this might be achieved for people who need care in their own home.

References

• House of Commons Library (2024) Adult Social Care Workforce in England. Research Briefing CBP-9615. London: House of Commons Library.
• House of Lords Adult Social Care Committee (2022) 'A Gloriously Ordinary Life': Spotlight on Adult Social Care. HL Paper 99. London: UK Parliament.
• Hussein, S., Ismail, M. and Manthorpe, J. (2022) 'Exploring resilience in UK-based domiciliary care workers before and during the COVID-19 pandemic', International Journal of Environmental Research and Public Health, 19(23), 16128. doi: 10.3390/ijerph192316128.
• Lewis, R., Plant, R., Carder, G., Cordery, S. and Adams, N. (2023) 'A Day in the life of a home care worker in England: A human factors systems perspective', Applied Ergonomics, 113, 104111. doi: 10.1016/j.apergo.2023.104111.
• Malley, J., Towers, A.M., Collins, L., Sandhu, S., Cass, S., Brady, L.M., Beadle-Brown, J. and McGill, K. (2023) 'Research priorities for homecare for older people: A UK multi-stakeholder consultation', Health & Social Care in the Community, 2023, 5621059. doi: 10.1155/2023/5621059.
• Read, R. and Fenge, L.A. (2018) 'What does Brexit mean for the UK social care workforce? Perspectives from the recruitment and retention frontline', Health & Social Care in the Community, 27(3), pp. 676–682. doi: 10.1111/hsc.12689.
• Shemtob, L. and Asanati, K. (2022) 'Why workforce health should have a place in UK care reform', Occupational Medicine, 72(4), pp. 213–215. doi: 10.1093/occmed/kqac039.
• Skills for Care (2024) The State of the Adult Social Care Sector and Workforce in England, 2024. Leeds: Skills for Care.
• Taylor, B.J. (2006) 'Risks to home care workers: Professional perspectives', Health, Risk & Society, 8(3), pp. 239–256. doi: 10.1080/13698570600871695.
• Turnpenny, A. and Hussein, S. (2022) 'Migrant home care workers in the UK: A scoping review of outcomes and sustainability and implications in the context of Brexit', Journal of International Migration and Integration, 23(1), pp. 23–42. doi: 10.1007/s12134-021-00807-3.

Authors

Mr. Saptarshi Putatunda

Data Manager

School of Medicine 

Division of Population Medicine

Cardiff University 

Dr. Joy McFadzean

Study Manager and Clinical Lecturer of Patient Safety

School of Medicine 

Division of Population Medicine

Cardiff University 

Ms. Meghan Hamilton

Research Assistant

School of Medicine 

Division of Population Medicine

Cardiff University 

Dr. Nick Hodson

Academic GP Registrar

School of Medicine 

Division of Population Medicine

Cardiff University 

Miss Marie-Clare Hunter

Public co-applicant

SAFE@HOME study

Dr. Samuel Li

Clinical Research Fellow

School of Medicine 

Division of Population Medicine

Cardiff University 

Dr. Sophie Marsh

Academic GP Registrar

School of Medicine 

Division of Population Medicine

Cardiff University 

Ms. Melissa Meindl

Research Fellow

School of Medicine 

Division of Population Medicine

Cardiff University 

Dr. Dylan Pritchard

Academic GP Registrar

School of Medicine 

Division of Population Medicine

Cardiff University 

Professor Andrew Carson Stevens

Chief Investigator and Professor of Patient Safety

Division of Population Medicine

School of Medicine 

Division of Population Medicine

Cardiff University 

Contact details: Safeathome@cardiff.ac.uk

Registered at: https://www.isrctn.com/ISRCTN16548878

Funding statement

This study/project is funded by the National Institute for Health and Care Research (NIHR) ID:161525. ​
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The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study have no role in study design, data collection, data analysis, data interpretation.