A few weeks ago, CarePlanner gave a talk at the Care Show on Business Challenges and Technological Solutions for Home Care / Domiciliary Care. It was pleasantly surprising to find the theatre was packed full, even as the talk came to a conclusion.

So, it would seem that there’s a real interest in what these business challenges are and how domiciliary care agencies are using technology to address them. In support of this interest, it felt like a blog post was called for.

Firstly, you might ask, how did we come by the insight presented?

Surveying the Domiciliary Care Sector

From June until the end of July 2019 we surveyed 176 different home care agencies – gathering survey responses from 197 individuals with a range of roles and responsibilities.

The survey contained a wide range of questions, the nub of which was to better understand the key challenges and concerns faced by those working in domiciliary care and how technology is helping them to address these.

Full findings from the survey can be found in our Home Care Sector Report 2019 – available for download here.

Business Challenges in Domiciliary Care

We asked respondents to rank their first, second and third biggest business challenges in 2019. You can see a summary of the results below.


Recruiting and Retaining Staff

It may come as no surprise to find that recruitment was the biggest business challenge for 48.5% of respondents. In fact, it was in the top three business challenges for 78.1% of respondents. Furthermore, 80.7% of respondents voted for either recruitment or retention in their top two business challenges

Looking further than just responses to our survey, it’s apparent that vacancies due to recruitment and retention challenges are a huge factor in the current social care crisis.

Skills for Care’s State of Adult Social Care report, published this October, estimates that 7.8% of roles in adult social care are vacant, an average of approximately 122,000 vacancies at any one time. The vacancy rate rose by 2.3 percentage points between 2012/13 and 2018/19. This is expected to rise further still, to at least 580,000 empty posts by 2035.

580,000 is a huge number and deserves some clarification. This is the base case number forecast if the adult social care workforce grows proportionally to the projected number of people aged 65 and over in the population between 2018 and 2035.

This growing number of vacancies is driven by an expanding and aging population, fewer people going into social care roles and the fact that 1 in 3 social care workers leave their roles each year. A recent report by Total Jobs and Care UK indicated that 1 in 3 social care workers plan to leave the industry entirely in the next 5 years. Stark figures.

The topics of recruiting home care staff, and indeed retaining the same home care staff, are worthy of a whole blog post each. But I’ve summarised the findings for how technology can help with each below:

How Technology Can Help Domiciliary Care Recruitment

  • Ask your own staff for referrals to recommend potential carers – check out the Care Friends app to make the referral process really easy!
  • Consider ‘social recruiting’ via social media channels such as Facebook. There is strong evidence to indicate that recruitment through personal connections is more effective and results in higher staff retention rates.
  • Sharing/referencing the Government’s Every Day is Different campaign is made easier via digital channels. The more people exposed to this, the better – it helps to highlight the genuine variety that is on offer in social care roles.
  • Offer flexibility in working hours – care management platforms can remove the headache in making this a reality

How Technology Can Help Domiciliary Care Staff Retention

  • Reduce staff frustrations through using technology to reduce repetitive tasks, improve scheduling and reminders and better allocate carers to appointments which match their skills and preferences.
  • Allow carers to fit work around their own lives and commitments, through greater flexibility in working hours and scheduling.
  • Use staff portals to help staff track their career progress, identify and fulfil learning and development needs, as well as manage their finances and access any perks (widely available through digital HR schemes)

Budgetary Challenges in Domiciliary Care

Working with tight budgets was flagged as the biggest business challenge by 5.7% of the survey respondents. 20.9% considered this to be in their top three (either first, second or third biggest challenge).

The UKHCA estimates that the statutory sector purchases over 80% of all homecare delivered in the UK, so state funding should be the primary focus of financial concerns. Broad findings in the UKHCA report ‘The Homecare Deficit 2018’ indicate a huge disparity between council payments to home care agencies and the expectation of these agencies to pay the National Living Wage. This deficit alone ran to an estimated £402 million in 2018.

How Technology Can Help with Tight Budgets

  • Improve backend efficiency through automation of manual processes – such as invoicing and timesheet production – to reduce office overhead costs.
  • Improve carer scheduling, reduce waiting time between calls and ensure allocated carers always have the required skills/qualifications; preventing waste of each carer’s time and the associated cost of this.
  • Move to electronic systems for scheduling, document management and payment processes to reduce paper, postage and storage costs – as well as improve efficiency.
  • Technology can also be used to help predict costs and achieve required margins. Greater digitisation of internal processes gives insight into costs for recruitment, retention and care delivery. These can be factored in, alongside sector forecast data to help build in ‘margins of error’, when bidding for packages. Using technology to support in this way can reduce the risk of over-stretching resources.

Managing Growth in Domiciliary Care

5.7% of respondents to the survey said that their number one business challenge in 2019 is managing growth. This is perhaps unsurprising when considering that 85.9% of all survey respondents indicated that they expected their business to grow in 2019.

It’s not just the opinion of those responding to the survey which indicates growth; the political climate suggests a greater emphasis on caring for people in their own homes. Combine this with the expectation of social care demands in line with population growth and it’s easy to see why the vast majority of respondents are anticipating growth in demand for their services.

A real-world example highlighting the challenges of managing growth is that of Continuity Healthcare. They grew too quickly and the subsequent impact on organisation and care quality resulted in them being marked down to ‘requires improvement’ by the CQC.

It took Barry Stephenson several months, an 82-step recovery plan and the deployment of a care management solution to steer the agency back on track. The improvement in insight and control afforded by using technology in this way resulted in a dramatic improvement in both workflow management and care delivery.

This was validated by the CQC in May this year, as they raised the rating of Continuity Healthcare to Good. You can see the full Continuity Healthcare case study here.

How Technology Can Help Manage Growth

  • Better visibility – solutions such as call monitoring can really help
  • Increased automation – areas such as invoicing and timesheet generation are prime candidates
  • Better reporting – automatically generating exception reports and seeing at a glance how care quality is being maintained
  • Better scheduling – working with a far larger roster of carers with skills and preferences which can no longer be held in one care administrator’s head!
  • Manage your recruitment pipeline – utilise a CRM system or the functionality of your rostering system to ensure that you have enough new staff working their way through background checks, compliance and training to fill the places left behind by those who – unfortunately – will inevitably leave at some point.

Quality of Care Delivery

Care delivery challenges combined were 7.7% – made up of delivering high enough care quality, missed medications and missed appointments.

Taking these challenges into consideration, alongside statements in a recent CQC report about risks associated with hand-written MAR charts, points to a growing need for digital solutions, such as electronic MARs (or eMARs), in care environments.

“The key contributing factor for administration errors was poor record keeping. We saw that MARs were either not completed, or not completed accurately. Discontinued medicines and incorrect strengths of medicines were sometimes found on MAR charts. These types of errors were more likely when MAR charts were handwritten or included additional hand-written medicines.“ – Care Quality Commission: Medicines in health and adult social care, June 2019

How Technology Can Help Improve Care Delivery

  • Care management software can ensure that only carers with the right set of skills are allocated to each appointment, improving the quality of care delivered.
  • Use call monitoring to track call status and carer location, enabling dynamic rescheduling and notification of service users or family members when unavoidable delays occur.
  • Reduce missed calls through the connection of back-office scheduling to carers via an app, putting their rota in their pocket (with reminders and even directions to their next call). 
  • Integrate eMARs with care rostering solutions, enabling the setting of reminders for medication delivery and require items to be checked off to proceed – massively reducing the risk of missed medications.
  • Reduce the stress of CQC inspections by making sure that your care management software can generate the reports you need to show to an inspector at the correct time.

It goes without saying that quality of care extends beyond simply avoiding delays or giving the correct medications – service users come to value good carers as companions rather than seeing simply the care service being delivered.  Anything carers can do to improve rapport and bring happiness into service users’ lives is hugely valuable. Technology can be a considerable enabler for this, as Adeola from Tech for Care explains below.

“The Emergence and advancements in digital technology have made living better and therefore prolonged life for many adults. More importantly, it has great potential to help home caregivers know their clients. Knowing the clients is vital to quality care and nowadays, there is little or no time for caregivers to know their clients. Digital technology can bridge this gap because it allows caregivers time to know their clients as a person, which will ultimately result in improved clients and caregiver’s satisfaction.” – Adeola Adelakun, Operations Manager at Tech For Care 


So, what can we conclude? The majority of challenges stem from limited resources: many agencies are insufficiently funded to deliver the expected levels of care in the available time.

These challenges will be compounded by projected levels of service user growth in the sector.

Even when the Social Care Green (or maybe White!) Paper arrives, it’s unlikely to provide answers to the funding challenges many home care agencies face today. Much of the discussion around social care funding is around broadening access, rather than paying providers a higher margin.

Change must come from within. The most successful home care agencies will be those who embrace the opportunities offered by technology to increase efficiency, care quality and the diversity of care options for service users.

This was borne out by one final stat I will leave you with, from our survey.

Agencies who were using additional technology to deliver care were three times more likely, compared to those who weren’t, to project a growth of 50% or more in the coming year.