Experiences of homecare workers delivering social care at end‐of‐life: insights from a qualitative multiple perspective study

Social homecare workers (HCWs) play important roles in supporting people with care and support needs who wish to remain at home when approaching end-of-life. Given the difficulties in recruiting and retaining staff within the homecare sector and the challenging nature of end-of-life care, it is essential to understand the experiences and needs of this workforce and to recognise the challenges they face and support they require. This paper reports findings in respect of the experiences of HCWs providing end-of-life care. The data reported here is part of a study which aimed to inform improvements to the quality and sustainability of homecare at end-of-life and to develop training resources. A multiple case study approach was undertaken within three contrasting sites in England, delineated by local authority boundaries and chosen to reflect different demographic characteristics. Semistructured interviews were carried out with 133 participants who included HCWs, managers, clients, carers (families/friends), health and social care practitioners, and service commissioners. Interviews were supported by Pictor, a visual elicitation method used to map networks and relationships. Data were analysed using reflexive thematic and matrix analyses. The findings presented here highlight three themes in respect of HCW experiences when providing care at end-of-life: unique privileges and challenges; relational aspects of care important at end-of-life; and the multiagency challenges and opportunities experienced. Wider factors such as health and social care policy and the care sector environment, both of which influence HCW experiences, were also considered. The findings are discussed in the context of an adaptation of Bronfenbrenner’s Ecological Systems Theory to explore complexity in end-of-life care, and are related to current evidence with suggestions made for policy, practice and future research.