Domiciliary Care

Section 01Service definition

Domiciliary care is the delivery of personal care and daily living support inside the service user's own home, structured around scheduled visits ranging from short calls to extended support.

It is distinct from live-in care (continuous presence), reablement (time-limited and goal-focused) and supported living (housing separated from support). Commissioners penalise responses that conflate these models.

Support typically includes personal care, medication prompting, nutrition and hydration, continence and mobility, and integration with community health.

Section 02Typical client cohort

Older adults with age-related needs, working-age adults with physical and sensory disability, adults with dementia or long-term conditions including diabetes, COPD and heart failure, and people requiring support after hospital discharge.

Referrals come from local authority social work teams, hospital discharge coordinators, community health teams, and self-funded private placement.

Section 03Commissioning and procurement context

Local authorities commission through Frameworks (dominant), Dynamic Purchasing Systems, block contracts and spot purchasing.

NHS Integrated Care Boards commission for hospital discharge and CHC packages.

Lot structures are typically geographic (district-by-district), with separate cohort lots for complex needs and dementia.

Section 04Core service requirements

Visit scheduling reliability, continuity of carer arrangements, electronic call monitoring data, missed visit management, medication and eMAR compliance, safeguarding routes, workforce capacity, and outcome-focused care planning.

Specifications increasingly require providers to evidence how care contributes to maintained independence, reduced hospital admissions and personal goal achievement.

Section 05Regulatory and compliance framework

CQC registration for the regulated activity of personal care, with assessment against the five key questions (Safe, Effective, Caring, Responsive, Well-led).

Care Act 2014, Mental Capacity Act 2005, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regs 9, 12, 13, 17, 18). Section 42 safeguarding duties apply.

Section 06Key operational challenges

Workforce shortages and retention pressure, travel-time density particularly in rural lots, missed and late visit recovery, evidencing continuity, agency dependency, eMAR adoption, and data flows into commissioner reporting.

Section 07How we approach this setting

We translate visit scheduling systems, ECM data and rota design into evaluator-grade evidence. Every paragraph maps to a scoring criterion. Generic care language is replaced with named systems, named roles, dated case examples and quantified outcomes.

Section 08Typical starting points we handle

First-time bidders entering local authority frameworks, scaling providers expanding into adjacent districts, established providers improving from Tier 2 toward Tier 1, providers without packaged digital evidence (eHM, eMAR, DSCR).

Section 09Outcomes achieved

Framework entry under PCR 2015 and Procurement Act 2023, multi-lot district expansion under tiered banding, and Tier 1 upgrades following CQC rating refreshes.

Section 10Related case examples

The case studies below match this care setting and demonstrate the operational evidence base behind successful submissions.

Section 12Where this applies

Local authority adult social care commissioning, NHS hospital discharge and CHC pathways, and joint commissioning across health and social care footprints.