Domiciliary Care

Please note, this programme of work has been completed and is no longer being updated. The below information is provided for reference only. If you would like more information on this programme, please get in touch. 

Wessex Patient Safety Collaborative (WPSC) is supporting the Domiciliary / Home Care Sector across Wessex by providing resources to help equip carers to manage Hydration in Older People and to implement a standardised common language for managing deterioration.

Hydration in Older People

Health Innovation Wessex (HIW) has worked in collaboration with Hampshire County Council to produce the Hydration at Home Toolkit, which includes an e-learning module. We are delighted that the Hydration at Home e-learning module and Toolkit has been endorsed by the British Dietetic Association.

In 2020, a project team consisting of members from WPSC, HIOW ICS and 5 provider organisations (Caring Hands Domiciliary Services, Crown Home Care, Home Instead [Basingstoke], Ranger Home Care, and Verina Daly Care) including members of the Hampshire Care Association, was established to review and pilot the implementation of the Wessex Hydration Toolkit. A copy of the Project Summary can be downloaded from the Resources tab on this webpage and further details can via obtained via the "Contact Us" link at bottom of the webpage.

Hydration for Older People - the E-learning module

• Developed for Split into four sections:
  1) Define good and poor hydration and explain their impact,
  2) Assess a person's hydration needs to minimise the risk of poor hydration,
  3) Address a person's hydration needs to improve their health and wellbeing,
  4) Assessment
• Takes approx. 40 mins to complete
• Includes an assessment at the end where you can test your knowledge and obtain a certificate
• Can be accessed via computer, laptop, tablet or smartphone

Hydration for Older People - PowerPoint Slides

Cares and Trainers can also access the hydration for older people training materials as a PowerPoint slide deck or a PDF document, both of which can be downloaded from the resources tab on the right of this webpage.

Key Resources

The Hydration toolkit contains numerous resources including:

Staying hydrated as we get older (tri-fold leaflet)

Staying hydrated as we get older (A4 Large Print version) 

Improving your Hydration - Top Tips (A4) (A4 Poster)

Improving your Hydration - Top Tips (A3) (A3 Poster)

Further Information

More information about the Hydration toolkit and associated resources can be viewed at: Hydration at Home Toolkit.

RESTORE2mini domiciliary - supporting Domiciliary Care Providers across Wessex

The RESTORE2mini domiciliary tool encourages carers to look out for, and respond to, 'Soft Signs' of Deterioration in their clients. Using a simple question 'How are you today?' the card includes a series of prompts to support staff to consider possible 'soft signs' of deterioration.

Possible triggers include breathing difficulties; changes in appetite, mobility, consciousness or confused state; bowel or urinary tract problems.

Carers can then raise the alert and communicate their concerns using the SBARD (Situation, Background, Assessment, Recommendation, Decision) communication process.

Developing RESTORE2mini domiciliary

RESTORE2 is a physical deterioration and escalation tool for care/nursing homes co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative and based on nationally recognised methodologies including early recognition (Soft Signs), the national early warning score (NEWS2) and structured communications (SBARD). 

RESTORE2mini was subsequently published, without the NEWS2 component, for care settings preferring to use a "Soft Signs" approach as a pre-diagnostic indicator of concern. The RESTORE2mini domiciliary version of the tool was developed for use specifically in the home care sector. 

A project team consisting of members from WPSC, WHCCG and 4 home care provider organisations (which included 2 members of the regional professional body) ran a six week PDSA pilot of RESTORE2mini domiciliary in the participating care settings. 

Project Aims

1. To improve client outcomes relating to the recognition of, and response to, physical deterioration in the domiciliary care sector.
2. To improve staff confidence relating to the recognition of, and response to, physical deterioration in the domiciliary care sector.
3. To support the professional development of staff as well as the clinical management of clients.
4. To assess the value of the RESTORE2mini domiciliary tool in domiciliary settings.
5. To reduce inappropriate referrals to healthcare services

Perceived Benefits

1. More appropriate care (i.e. in accordance with client’s preferences) (Aims 1&4)
2. Improved local management / prevention of unnecessary hospital visit / admission (Aims 1,4&5)
3. Improved staff confidence regarding the awareness, and use, of Soft Signs / SBARD communication tool (Aims 2&4)
4. Improved staff confidence in recognising and responding appropriately to physical deterioration (Aims 3&4)
5. Greater engagement with clients, families and loved ones (Benefit identified during project)
6. Improved communication between Provider, Primary Care & Hospital staff (Benefit identified during project)

Early signs of physical “unwellness” can be recognised intuitively by physical healthcare practitioners as evidenced by staff saying “I know something is wrong, I just don’t know what”. Even people without training, but who are familiar with someone’s usual behaviour and habits, can often sense a problem resulting in them reporting that the relative, resident or child in their care “just isn’t themselves”.

SBAR (Situation, Background, Assessment, Recommendation) and SBARD (Situation, Background, Assessment, Recommendation, Decision) are easy to use, structured forms of communication that enables information to be transferred accurately between individuals.

SBARD (SBAR+D) is not copyrighted and Wessex PSC have developed an open version in Word format to assist carers wanting either a generic form or a template that they can customise for local use.

The generic SBARD Communication Tool can be downloaded from the Resources Zone on the right hand side of this webpage.

More information about our work relating to SBARD and links to an NHS training video can be found on our SBARD webpage.

All versions of the RESTORE2 tool, including the RESTORE2mini domiciliary and associated resources and implementation materials can be downloaded from the West Hampshire CCG webpage. The WHCCG website contains full information about using RESTORE2 and ordering printed copies of any materials. 

Carers working in domiciliary care settings and family carers supporting someone in their own home, can access a number of tools including RESTORE2 and Soft Signs from the Health Innovation Network to help recognise physical deterioration and take the appropriate actions.

Other resources

• Help at home from a carer (NHS)
  NHS website about Homecare / Domiciliary Care, what it is and how to access it.
• Home care and Covid-19: advice and best practice (SCIE)
  For home care or domiciliary care agencies. Social Care Institute for Excellence's (SCIE) collection of key advice and support about Covid-19.

If you have any questions about the Wessex Patient Safety Collaborative's Domiciliary Care workstream or any other aspects of the Wessex PSC, please contact us via the link