The meaning of ‘quality’ of homecare for older people: a scoping review

Abstract Background How quality of care in homecare for older people is understood is important, because it influences how quality in homecare is delivered, improved, regulated and measured. We conducted a scoping review to summarise the meanings of homecare quality for key stakeholders and identify measures of homecare quality. Methods We searched four databases (CINAHL, PsycINFO, ASSIA and Social Care Online) for peer-reviewed literature from high-income countries, and websites of major UK organisations for grey literature, published between 2016 and 2023. Articles were included if they reported views of any stakeholder on quality of care in the context of homecare for older people (aged 65 and above). Data were summarised using a qualitative content analysis approach to identify key dimensions of quality. Results Overall, 93 articles from 16 countries were included. Research focussed on understanding the views of four groups: older people, family carers, care workers and service providers. Homecare quality is understood as a multi-dimensional concept. We identified four dimensions: (1) relationships and continuity of care; (2) bespoke care; (3) organisational and structural aspects of care; and (4) understanding of quality as a measurable construct. Notable gaps in the literature include a lack of evidence on how older people form and articulate their preferences for homecare; a lack of consensus on care quality measurement; and a lack of focus on optimal models of care provision within existing budgets. Many crucial perspectives were absent, including owners of homecare organisations, inspectors and assessors involved in regulation of homecare services, and the legal or advocacy professions. Conclusions There is a wealth of evidence about how homecare quality for older people is understood. These understandings are largely consistent across different constituencies and countries. It is less clear how this shared vision of high quality homecare might be realised within existing systems.