Complex Care vs Domiciliary Care: What’s the Difference in Practice?

The terms complex care and domiciliary care are often used interchangeably. On paper, they can even sit under the same regulatory heading. In practice, they are very different models of care, designed for very different needs.

For case managers and deputies, understanding that difference is critical. It affects outcomes, risk, family confidence, and ultimately whether a package stabilises or quietly unravels.

This article explains the distinction clearly and calmly, focusing on what actually happens day to day rather than labels.

What is domiciliary care in practice?

Domiciliary care is best understood as time-and-task support.

In its traditional form, it involves:

• Short visits, often 15–30 minutes

• A focus on basic daily tasks such as medication prompts, meals, and personal care

• Rotating staff supporting multiple service users across a day

• Limited clinical complexity

• A “check-in” model rather than continuous presence
  

This model works well for people with stable needs who require light-touch support to remain at home safely. Continuity is helpful, but not structurally essential to the model.

Domiciliary care is not lesser care. It is simply designed for a different purpose.

What is complex care in practice?

Complex care supports individuals with advanced, long-term needs, often neurological or clinically complex, where outcomes are directly linked to who provides care and how consistently.

In practice, complex care typically involves:

• Long shifts, waking nights, or 24/7 packages

• A small, consistent core team of support workers

• Service users with neurological conditions, acquired brain injury, physical disability, epilepsy, or behaviours of concern

• Clinical interventions such as PEG feeding, tracheostomy care, catheter care, respiratory support, and seizure management (read about our Clinical Care)

• Deeply personalised support plans informed by risk, behaviour, and clinical guidance
  

The defining feature is continuity. The same people, day after day, learning how the individual communicates, responds, and progresses.

This consistency is what enables real outcomes, such as:

• Reduced behaviours of concern

• Increased independence

• Re-engagement with the community

• Families feeling confident enough to step back, rest, or even go on holiday again

These are often major milestones, not minor improvements.

Why continuity changes everything

One of the clearest dividing lines between domiciliary and complex care is staffing structure.

In domiciliary care, staff rotate. In complex care, staff own the package.

That difference matters because:

• Behavioural stability improves when support is predictable

• Physical deterioration is spotted earlier by familiar staff

• Documentation becomes meaningful rather than tick-box

• Families stop needing to cover shifts or micromanage care

In neuro-focused packages especially, outcomes often improve within weeks, with significant gains over six to twelve months once a stable team is embedded.

Where confusion starts: CQC registration and labels

Many complex care providers, including Thriving, are registered under the domiciliary care category with the Care Quality Commission. This causes understandable confusion.

The key point is this:“Domiciliary” is a classification of setting, not complexity.It simply means care delivered at home, rather than in a care home or medical facility.

The category is broad, and the industry has evolved faster than the language used to describe it. Problems arise when the label is mistaken for the operating model.

CQC registration alone does not indicate:

• The complexity a provider specialises in

• The depth of supervision and review

• The experience level of staff

• The provider’s ability to manage behavioural or clinical risk

What matters is what the provider actually does, and what they do well.

Oversight and accountability: what changes in complex care

As care becomes complex, everything becomes more detailed.

Compared to traditional domiciliary care, complex care requires:

• More in-depth care planning

• Higher-risk and more dynamic risk assessments

• Regular, structured reviews

• Robust incident and escalation processes

• Clear accountability to families and case managers

Provider responsibility increases significantly. So does the impact of getting it wrong.

The hidden risk of “cheap” complex care

One of the most common failure points occurs when complex care is delivered at domiciliary-style rates.

If complex care is priced the same as standard domiciliary care, there is usually a reason. In practice, what’s missing is often:

• Continuity

• Experienced staff

• Proper supervision

• Sustainable staffing
  

The result is rarely immediate, but it is predictable:

• Increased staff turnover

• Behavioural escalation in neuro packages

• Physical issues being missed

• Rising stress for families

• Escalation back to the case manager
  

This is often driven by budget pressure and time pressure, particularly around urgent discharges. What looks cost-effective early on can quickly become unstable.

A simple way to frame the difference

For many case managers and deputies, these three statements tend to resonate:

1. Complex care isn’t about intensity. It’s about consistency.

2. The risk isn’t higher rates. It’s higher failure.

3. Cheap care often becomes expensive care.

Understanding this distinction makes it easier to challenge providers, set expectations, and protect long-term outcomes.

A note on Thriving’s approach

Thriving is CQC registered under domiciliary care because we deliver care at home. However, we do not operate a traditional short-visit domiciliary model.

Our service is structured, staffed, and governed specifically for complex care, with a focus on:

• Neurological and physical disability support

• Experienced Clinical Care when needed

• Long-term continuity

• Experienced support teams

• Robust oversight and accountability

When reviewing providers, the most useful question is not “Are they domiciliary or complex care?” It is “What are their strengths, and do they match this person’s needs?”

That question usually tells you everything you need to know.