‘We're the Eyes and Ears… out There’: A Qualitative Exploration of the Perceptions and Experiences of Polypharmacy Amongst Home Care Providers

INTRODUCTION: Polypharmacy is often managed at home by older people and those involved in their day-to-day care. Home care workers are well placed to play a crucial role, but there is little research in this setting. This study aimed to explore experiences and perceptions of polypharmacy amongst providers of home care. METHODS: We conducted qualitative interviews with 15 home care staff from five for-profit home care providers in three regions of England. Data were analysed thematically. RESULTS: We identified three overarching themes: (1) managing medications within a fragmented care system, (2) decision-making and autonomy and (3) client and family expectations and emotional burden of home care work. People providing home care services were striving to support older people with medications with limited training, communication or authority. The emotional toll on the home care workers was considerable. CONCLUSION: Home care supports an ageing population to live and be cared for, close to home. There are potential benefits to the management of polypharmacy, of better integrating home care into the broader health and care system. Clarity over roles, appropriate channels of communication and enhanced training are required. PATIENT OR PUBLIC CONTRIBUTION: Individuals with lived experience of home care services contributed meaningfully throughout the study. They advised on the development of the topic guide to ensure that interview questions were relevant, acceptable and reflective of real-world home care experiences. At the mid-point of data collection, public contributors reviewed insights and provided feedback on whether additional issues or perspectives should be explored in subsequent interviews. Following completion of data collection, they were also involved in discussing the preliminary findings and ensuring that the interpretation accurately reflected the experiences of those using and or accessing the service.