Research and analysis

Extreme cold temperatures in domiciliary care: executive summary

Updated 31 July 2024

Background to the research

In the UK mortality is significantly higher during the winter months (December to March) than in other seasons. Excess mortality attributed to cold is significantly higher than that attributed to heat, and cold-related mortality is a considerable health burden, particularly in deprived areas. There is also an appreciable increase in risk of mortality during extreme cold for people aged 65 and above across a range of studies and settings. People with long-term conditions are also more vulnerable (1).

While the focus of this research was on people receiving care, carers themselves are also at risk during periods of cold weather alerts. So the aim of this study was to explore both the client and care worker risks as well as general preparedness for cold weather, with a view to identifying mitigations and incorporating these into advice and cold weather planning.

Methodology

The UK Health Security Agency (UKHSA) commissioned Discovery Research, an independent research agency, to carry out this study to understand the attitudes and actions of social care practitioners working in domiciliary care during winter months as well as their experiences of planning for cold weather. A qualitative approach was used to explore the research objectives.

Key findings

Risk perceptions of cold weather

Domiciliary carers had an accurate idea of what to look out for and understood what actions they should be taking to support the health needs of their clients. They identified where some adults receiving care were at more risk from the cold than others and these considerations were built into their preparations.

Planning and preparedness for cold weather

While preparations for cold weather were commonplace, the extent to which plans were formalised as opposed to carers carrying out behaviours they felt were ‘common sense’ was variable. Larger care organisations had more formal plans than the smaller organisations.

Impact of sudden cold weather

Dealing with the impacts of sudden cold weather was a key issue facing the sector. Enabling the safe and efficient transport of carers to clients’ homes in the context of disruption to travel routes was a particular challenge. Activating full community support involving local authorities, a network of care organisations in the area and local charities was felt to be the best course of action to ensure all clients were seen but this was not happening consistently across local authorities.

Impact of increased energy cost

The cost of energy was a particular issue in the winter of 2022 to 2023. Some clients turned their heating down or off, so risking their health, while others left it on continuously, so risking getting into financial hardship. Carers also found this situation difficult to manage and were unsure whether they could or should intervene. They were also keen to ensure they knew how clients could take advantage of the financial support available to them.

Wellbeing and vulnerability

Poor mental health and feelings of isolation were a concern for many clients, particularly during prolonged periods of cold. Some domiciliary carers also felt isolated and unsupported over the course of the winter months and did not feel their personal needs were always considered by their employer.

Information needs

The research identified 3 areas in which information could be improved for domiciliary carers:

1. More tailored and practical formal guidance from UKHSA.

2. Information to enable consistent coordination and communication within agencies and local authorities.

3. Greater clarity about what information to provide to clients to ensure they are getting all the support available.

Reference

1. ‘Adverse Weather and Health Plan: Supporting Evidence 2024’