SUMMARY Background Standard 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. Objective To 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. Design Qualitative study, using semi-structured interviews, focus groups and small group interviews. Setting Two demographically similar areas in Nottingham, one served by a specialist home care team, the other by standard services. Participants Twenty-seven service users, 18 family carers, 17 home care workers, 20 health/social care professionals, across both services. Results The specialist service demonstrated greater flexibility and responsiveness to the particular needs and circum-stances 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. Conclusions This 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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