Most home care staff are lone workers, calling house to house, helping people who very often live by themselves. Lone working adds to health and safety risks, for both the home care worker and the service user.

HIQA’s December 2021 Home Care Regulation Research Paper reported Canadian evidence showing 13.2% of home care clients were exposed to adverse events (such as a medication errors or falls), and that 33% of these were preventable. Adverse events were often due to the actions and decisions of service users, their family and friends and of home care workers.

HIQA also reported increased risks to home care workers, quoting evidence showing the presence of environmental hazards in 91% of homes that home care workers visit. Such hazards include trip risks and clutter, heavy loads, dogs and vermin.

Regulation can address lone worker risk. Regulation can achieve this by strengthening the governance of home care organisations. This means establishing a management team, including clinical professionals who are accountable for the quality of their service. Unlike regulated nursing homes and hospitals, there is no onsite nursing station in someone’s private home. Regulation can ensure that 24/7/365 assistance is available from the home care organisations' management team to home care workers and service users who want to escalate a query or concern.  

Home care providers must be held accountable for delivery of high-quality carer training and development, carer supervision in the workplace (which means regular visits by care management to a client’s home when a carer is providing care), and carer competency assessment. Regulation must require care organisations to employ health care professionals with sufficient qualifications and experience to ensure delivery of high-quality care and focus on preventative measures to maintain a service users physical and mental well-being. Regulation can require care managers discuss and agree care plans with service users, allowing more responsibility and autonomy to flow from the commissioner of care to the service user, as clinical outcomes can be balanced with service user goals.  Such experienced health care professionals can also integrate with a service user’s wider healthcare team, ensuring accurate information flow and assisting in multi-disciplinary team decision making.

Regulation must recognise the unique working environment that home care operates in, and balance these risks by improving provider governance, improving safety for all whilst allowing choice and control for service users.