Experiences of delivering social homecare at end-of-life: insights from a qualitative study drawing on multiple perspectives

Social homecare workers (HCWs) play an important role in supporting people with care and support needs who wish to remain at home as they approach the end of life. However, the experiences of these HCWs have been neglected within policy and research, leaving gaps in knowledge regarding the challenges they face, and the support needed. Given the difficulties in recruiting and retaining staff in the home care sector, a better understanding of the experiences and needs of this workforce is essential. This paper reports on the findings of a multiple case study, using semi-structured interviews carried out with 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. 133 individuals participated across three sites in England chosen to reflect different demographic characteristics. Data were analysed using reflexive thematic analysis in NVivo 14.The findings presented here highlight three themes in respect of HCW experiences: the unique privileges and challenges of providing care at end-of-life; the relational aspects of care important at end-of-life; and the multi-agency challenges and opportunities experienced at end-of-life, with the wider factors such as policy and the care sector environment which can influence HCW experiences at work also considered.The findings are discussed in the context of an adaptation of Bronfenbrenners Ecological Systems Theory to explore the different levels operating in the community care network, and are related to current evidence with suggestions made for policy, practice and future research.