‘What are the training and support needs of homecare workers providing care to people towards the end of life? Insights from case studies in three regions of the UK’

Social homecare workers (HCWs) provide support with activities of daily living in peoples’ own homes. They often lack the training and support needed to provide the personal, social and domestic care that enables people to die at home. Little is known about their support and training needs. We aimed to understand the experiences of HCWs, their clients and family and friends and other professionals involved in community end-of-life care (EoLC) to identify the training and support needs of HCWs. Using a case study approach set across three regions in England, we interviewed 133 participants (41 HCWs; 22 HCW managers; 18 people in receipt of care; 20 family and friends providing care; 32 other health and social care professionals) using in-depth interviews. Reflexive thematic analysis and matrix analysis were used to explore the data within and between case studies, guided by Bronfenbrenner’s Adapted Ecological Systems Theory to understand the wider social, economic and policy contexts in which homecare takes place. We found that HCWs want to provide quality care but often lack the training and support required to enable this in the complex and changeable situation at EoL. We identified four subthemes relating to training and support needs: feeling prepared to deliver EoLC, accessing and availability of training, sources of knowledge and learning, specific learning needs and gaps. There was inconsistency in terms of access to training, quality of content, its accessibility and usefulness and support provided by managers. Our findings highlight the need to improve access for HCWs to training with specific EoLC content. We make recommendations for (i) the development of the structure and content of training materials, (ii) the commissioning and oversight of homecare provision and (iii) how health and social care practitioners can work collaboratively with HCWs in the community.