Abstract
“Home care” encompasses a range of services designed to meet individuals’ long-term care and support needs in their home setting, thereby promoting independence and delaying admission to institutional care. Addressing concerns about home-care quality is a priority across many care systems, including in England, as reflected in the recent release of the Quality Standard for Homecare for Older People (NICE, 2016). Little is known, however, about how “good” home care – that which is person-centered, well-coordinated, and consistently staffed – is understood and implemented in daily practice, particularly for those with dementia. Drawing from an innovative mixed-methods study undertaken in England in collaboration with a large international home-care provider, the purpose of this symposium is to advance understanding of the structure and content of daily in-home care for clients with mild to moderate dementia. The primary data sources are extensive fieldnotes from one year of participant observation and weekly diary entries maintained by 11 paid caregivers over eight weeks. The first paper will discuss the tensions between autonomy (or “empowerment”) and support in the daily delivery of care. The second paper will describe the emotional labor undertaken by home-care staff, with attention to how their deployment of “tact” to maintain clients’ dignity highlights the inherent conflicts of the paid caregiving relationship. The final paper will draw from the caregiver diaries to discuss the everyday challenges of providing consistently “good” care within broader structural conditions. Implications for workforce development, quality improvement, and commissioning of home-care services will be discussed.