• Ian Rothera, Rob Jones, Rowan Harwood, Anthony J Avery, Kate Fisher, Veronica James, Ian Shaw, and Jonathan Waite.
• Nottinghamshire Healthcare NHS Trust, Nottingham, UK. ian.rothera@nottshc.nhs.uk
• Int J Geriatr Psychiatry. 2008 Jan 1;23(1):65-72.

BackgroundStandard home care support for people with dementia has been criticised in statutory inspection reports, and may lead to unnecessary crises, hospital or care home admissions.ObjectiveTo establish whether a specialist multiagency home care service for older people with dementia delivered better quality care than standard services, and how any improvements were achieved.DesignQualitative study, using semi-structured interviews, focus groups and small group interviews.SettingTwo demographically similar areas in Nottingham, one served by a specialist home care team, the other by standard services.ParticipantsTwenty-seven service users, 18 family carers, 17 home care workers, 20 health/social care professionals, across both services.ResultsThe specialist service demonstrated greater flexibility and responsiveness to the particular needs and circumstances of service users and family carers, who were encouraged to participate in routine decision-making and activities. By sharing responsibilities, the specialist service helped reduce carer stress and prevent crises. These outcomes depended on the configuration of the service, including multidisciplinary health and social services input, careworker autonomy and independence, continuous reassessment of clients' circumstances and preferences and the capacity to develop long-term relationships, through careworker continuity. The standard service, which used a task-orientated approach, lacked these characteristics.ConclusionsThis study provides evidence of the benefits of a specialist multiagency home support service over standard home care, in the opinion of service users, carers and careworkers, and defines the operational model that achieves this. Findings confirm best practice recommendations, based on models of dementia care which emphasise respect for 'personhood'.

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