This study reviews the ‘real world’ potential (i.e. efficacy and effectiveness) of restorative approaches towards home care for frail older adults. Such approaches aim to go beyond traditional home care goals of ‘maintenance’ and ‘support’ towards improvements in functional status and quality of life. Our review of the literature included searches of health and gerontology databases as well as ‘grey literature’ across Australia, the UK and the USA. We provide an initial overview of the efficacy of a range of single component restorative interventions, including occupational therapy, physical therapy, health education and social rehabilitation. In order to answer questions about the overall efficacy and cost-effectiveness of restorative home care provision, we also review the nature of in-house programmes across the three nations as well as the evidence base for such programmes, particularly when they have been compared to home care ‘as usual’. A range of positive outcomes has emerged, including improved quality of life and functional status and reduced costs associated with a reduction in the ongoing use of home care services postintervention. Questions remain about which components are most beneficial, which clients are likely to receive the greatest benefit, and the appropriate intensity and duration of such interventions.