In developing this position paper, the Seniors Task Force of Public Interest Alberta describes what we think a satisfactory Home Care program should look like. Some of what we advocate is similar to the Home Care program that Alberta Health Services claims to be offering; unfortunately, that offering is not being delivered in anything like a consistent manner in Alberta and its scope and effectiveness is not being properly evaluated.
The purpose of this paper is to outline the scope and essential elements of an effective and economically viable Home Care system that enables frail seniors and the disabled to remain in their own homes as long as possible, thereby reducing the need for institutional care and relieving the pressure on the health care system, particularly emergency rooms and acute care hospital beds. The opportunity to maximize their independence by staying in their homes was recognized in the Alberta government’s Continuing Care Strategy and is clearly what most seniors prefer.
An effective Home Care system needs to be community based and a fully integrated part of the whole health care system so that all care providers know the latest assessed and diagnosed needs of the patient they are serving and what other services have been and are scheduled to be provided by other care providers. Corporate delivery is incompatible with this model.
Scope
To the extent economically feasible, an effective Home Care system has to provide the comprehensive services necessary to ensure the optimum level of physical and mental health of those whom it serves in both urban and rural areas. These services include:
- All medical, paramedical, nursing and personal care services necessary to keep the patient safe and well in their own home.
- Day programs and companionship to support socialization.
- Therapeutic services including mental health counseling and referrals.
- Post-operative and rehabilitative care.
- Wellbeing counseling.
- Respite care where the family is involved in
- Palliative care.
Additionally, an effective Home Care System should provide those domestic and other outreach services not provided by community services, such as:
- Transportation for health related appointments and other necessities.
- Home cleaning, laundry and home upkeep.
- Assistance with shopping and meal preparation.
- Snow removal and yard maintenance.
Quality of Care
A key element in the quality of Home Care is the existence of a sufficient number of care workers with the communication skills and training required, and that those workers are adequately compensated to ensure there is a high degree of continuity in the care provided. The delivery of quality Home Care requires that:
- There is adequate screening of all potential care workers to ensure that they have the aptitude and communication skills necessary.
- There is a progressive series of training programs establishing the qualification of all workers so that those qualifications can be matched to the assessed and anticipated care needs of individual patients.
- There is a compensation scheme that recognizes levels of training, covers all time and travel required to perform the work, and encourages further training, thereby establishing home care as a valued occupation.
A second key element in the quality of care is the establishment of standards of care and the monitoring of those standards to provide for the following:
- Annual or more frequent re-assessment of patient care needs with the establishment of specific and realistic goals for improvement of health.
- A formal appeal process for contested assessments of patient needs.
- Development of procedures for assessing progress in the attainment of health goals.
- Periodic audits of the quantity and quality of care provided by the recipients of care (patient and family or their authorized decision makers).
- A monitoring process that records and reports all adverse incidents with public access to those reports, while protecting the privacy of patients.
Case Management of Home Care
Direct responsibility for the management of effective Home Care should be in the hands of Case Managers who are employed by Alberta Health Services and who have reasonable caseloads. Case Managers should have direct authority to supervise the work of all Home Care workers delivering services to patients in their care, whether the workers are employed by a public, voluntary or private-for-profit agencies, and to require appropriate training or the replacement of workers not providing satisfactory care (following the process in a collective agreement). Case Managers should also have the authority to determine and implement the level of care that is required.
The roles and responsibilities of Case Managers should include the following:
- Monitoring the work of, and maintaining good communications with the Home Care workers assigned to patients in their care.
- Ensuring that materials and equipment are in place to secure the safety of the patient and a safe working environment for the care providers.
- Ensuring that all changes in the condition or needs of patients in their care are brought to their attention.
- The responsibility for calling other health care providers to provide services, when necessary.
- Liaising with hospitals, PCNs, FCCs, physicians, nurses, LPNs, physiotherapists, pharmacists and social workers involved with the patients in their care.
- Keeping Home Care workers and the families or their authorized decision makers fully informed of changing circumstances of patients in their care.
- Keeping the patient and family fully involved in decision-making and informed of all services available from AHS and the community.
Administration and delivery of Home Care
Home Care must be a comprehensive and fully integrated service that is universally available on the basis of assessed needs. The delivery of Home Care services should be administered on a community-based model involving Family and Community Social Services, municipal organizations, cooperatives and other community organizations to ensure continuity and transparency, in accordance with provincially set standards.
All agencies providing Home Care should be regulated and, where publicly-funded services are provided under contract, those contracts shall be fully transparent.
Funding of Home Care
The cost of Home Care delivery should be borne by government to the extent required to ensure that all health care services are provided without charge to the patient.
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