Around 12,500 agencies and 100,000 personal assistants provide domiciliary care in England, yet no one has systematically compared the costs and benefits of different homecare arrangements against each other or against residential care. This matters because the social care system is under enormous financial pressure, and policymakers lack the data to know whether public money is best spent on agency visits, live-in carers, or directly employing a personal assistant. The researchers will recruit 800 people receiving agency care, 800 who employ their own personal assistants, 250 in housing-with-care schemes, and 400 unpaid carers. They will measure quality of life, carer wellbeing, labour market participation, and downstream health service use. If the research succeeds, it will give the government and local authorities hard evidence on which homecare options deliver the best outcomes per pound spent. Care providers will receive benchmarking reports showing where their services fall short. Individual care purchasers will have clearer information to make their own choices. The findings could reshape how public budgets are allocated across the entire social care sector, potentially shifting resources from care homes toward more cost-effective home-based support.
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Background Social care in England comprises a range of service and support options. Care home services remain important but various forms of domiciliary care have become a growing part of the sector. Domiciliary care is provided by about 12,500 largely private or voluntary agencies, and about 100,000 personal assistants (PAs). Provision can be either through care visits or live-in care and can differ in quality and price. People have diverse support needs and preferences; accordingly different care options will be suitable or acceptable. Aims Our main aims are to: Evaluate the cost-effectiveness of domiciliary care services and the wider effects on families outcomes (e.g., carers quality of life and labour market attachment) and health care demand, considering differences in intensity of care, source of funding, and individual characteristics. Assess the cost-effectiveness of domiciliary care as compared to residential care and housing with care as well as between modes of care (i.e., homecare by agencies vs. PA employment). Methods We will conduct a primary data collection on domiciliary care services. People receiving home care from an agency (800) or in housing with care scheme (250) will be recruited via providers, with the support of provider associations and local CRNs. Recruitment of PA employers (800) will be supported by Skills for Care and the contacts they use for annual survey. We further aim to collect data from 400 unpaid carers. Working with social research specialists at Ipsos, bespoke survey questionnaires will be administered via post, telephone, or interview. Questionnaires will be co-developed with public research advisors with experience of social care services. Data on care home residents will be ensured through collaboration with a NIHR project, currently piloting a minimum data set of care homes residents (i.e., the DACHA study). We will use a production function approach to assess the effects of care inputs on ASCOT quality of life outcomes. To identify causal effects, we will collect and control for a range of relevant confounders (e.g., demographic characteristics, underlying needs, unpaid care, house suitability and adaptations, care provider characteristics, etc.) and employ instrumental variable techniques to account for endogeneity of care intensity. We will also consider statistical matching techniques to ensure comparison between groups with similar characteristics, including care needs. Timelines for delivery The study will be over 3 years, with the primary data collection planed in months 1-20 and data analysis and dissemination of findings in months 21-36. Impact and Dissemination Our research findings are anticipated to help policy makers in setting public budgets and developing guidance to encourage homecare options as well as inform practice, especially individual care purchasers and care commissioning decisions. Academic outputs will be submitted to academic journals and presented at conferences. Non-academic outputs, including case studies and blogs, will be co-produced with our public research advisors and jointly presented at community of practice workshops, provider associations annual conferences, and events of the care recipient community. Benchmarking reports will help participant care providers identify aspects of their service where improvement would make most difference to their clients.
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