Integrated Domiciliary Care Pathways: Working Alongside Community Health Teams
Integrated working is frequently requested in contracts, but it can fail in practice when roles, information flow, and escalation routes are unclear. Domiciliary care often sits at the centre of daily risk management, yet providers may have limited influence unless integrated pathways define who does what, when, and how evidence is shared.
This article complements homecare service models and pathways and connects to time-critical coordination in hospital discharge and reablement homecare, where multiple agencies must act on the same information without delay.
What “integrated pathways” mean in homecare delivery
In operational terms, integrated domiciliary care pathways describe how the provider:
- Coordinates day-to-day work with community nursing, therapy, and primary care
- Shares relevant information safely and promptly
- Escalates deterioration or risk through agreed routes
- Documents decisions so accountability is clear
Integration is not a meeting. It is a repeatable workflow that staff can follow during visits, supported by governance that tests whether it is working.
Key design features of an integrated homecare pathway
1) Clear role boundaries and delegated tasks
Where homecare staff support health-related tasks (for example prompting medication, supporting dressings awareness, or monitoring simple observations), the pathway should define what is delegated, what training is required, and where the boundary sits. Ambiguity here creates risk and inconsistent practice.
2) Standardised escalation routes
Frontline carers need clarity on who to contact for different types of change. Good pathways distinguish between:
- Immediate risk: urgent health escalation or safeguarding action
- Emerging change: same-day review and referral to community teams
- Planned review: routine updates through agreed points of contact
3) Shared information that is usable
Professionals do not need long narratives. They need concise, consistent observations with dates, times and specifics. Integrated pathways often include a short “structured update” format so staff can summarise change clearly.
Operational Example 1: Integrated pathway for wound care support and monitoring
Context: A person has a leg ulcer managed by community nursing. Homecare provides daily support with hygiene, comfort, and monitoring for deterioration.
Support approach: The integrated pathway clarifies homecare’s role: observation and escalation, not clinical intervention.
Day-to-day delivery detail: Staff follow a prompt list during visits: pain level, dressing integrity, swelling, odour, heat, or leakage. They record observations consistently and notify the community nurse via the agreed route when thresholds are met (e.g., increased pain or visible leakage). The manager reviews entries weekly to ensure escalations happened appropriately and that staff are not attempting tasks beyond competence.
How effectiveness/change is evidenced: Evidence includes consistent monitoring notes, timely escalation records, and outcome logs (nurse review arranged, treatment adjusted, deterioration avoided). Audit trails demonstrate safe boundaries and clear accountability.
Operational Example 2: Integrated pathway to prevent hospital admission during deterioration
Context: A person supported after discharge begins showing breathlessness and fatigue during routine visits. There is no emergency event, but the pattern suggests deterioration.
Support approach: The pathway treats pattern recognition as a trigger for early health escalation, aligned with discharge support principles.
Day-to-day delivery detail: Carers record observable indicators (breathlessness on exertion, reduced appetite, reduced mobility) and complete a same-day alert to the supervisor. The supervisor compiles a concise chronology and contacts the agreed health point of contact. Visits are temporarily adjusted to support hydration, pacing and safe mobility while awaiting review. If risk increases, the pathway clarifies when emergency services are required.
How effectiveness/change is evidenced: Records show early escalation, professional response, and changes to the plan. If hospital admission occurs, the provider can evidence that deterioration was identified and acted on promptly, supporting defensibility and learning.
Operational Example 3: Integrated therapy pathway to improve functional outcomes
Context: A person is working with OT/physio to regain confidence with transfers and stairs. Homecare visits are frequent but time-limited, creating risk of “doing for” rather than enabling.
Support approach: The pathway aligns homecare routines with therapy goals so daily visits reinforce progress.
Day-to-day delivery detail: Therapy recommendations are translated into practical prompts for carers: how to set up the environment, how to cue safely, and what to record. Staff document progress markers (e.g., transfer completed with supervision rather than assistance). Supervisors review progress weekly and flag plateaus to therapists for adjustment.
How effectiveness/change is evidenced: Evidence includes consistent records of enablement-focused support, measurable progress markers, and documented professional feedback loops. This supports commissioning outcomes and reduces long-term dependency.
Commissioner expectation: integrated pathways reduce duplication and delay
Commissioner expectation: commissioners expect homecare providers to coordinate effectively so care is not duplicated and risk is not missed between services. Integrated pathways should demonstrate timely information sharing, clear escalation practice, and measurable impact (reduced failed discharges, improved stability, fewer avoidable crises).
Regulator / Inspector expectation (CQC): safe systems, clear accountability
Regulator / Inspector expectation (CQC): CQC will scrutinise whether the provider works safely with other professionals, especially around delegated tasks, information sharing, and escalation. Inspectors expect evidence that staff understand boundaries, that decisions are recorded clearly, and that people are protected from harm caused by fragmented working.
Governance and assurance that strengthens integrated delivery
- Multi-agency communication logs: track contacts, responses and outcomes
- Delegation and competence checks: confirm training and supervision for any delegated elements
- Pathway audits: sample cases with deterioration and test escalation timeliness
- Learning reviews: refine prompts and thresholds based on what cases show
Why integrated pathways matter
Integrated domiciliary care pathways make coordination real: staff know what to observe, who to contact, and how to evidence decisions. This strengthens outcomes, protects people through clearer escalation, and demonstrates maturity to commissioners and CQC.