If you work in home care, you understand the importance of consistency. Whether you’re an agency operator, case manager, or caregiver, continuity of care should be one of your biggest priorities. There’s plenty of medical literature on this issue in the context of hospitals and other care facilities, but less has been written about continuity as it relates to care provided in the home.
This isn’t surprising – after all, many governments are still struggling to understand the complexities of home and community care. Luckily, these conversations are happening elsewhere – inside home care agencies. Home care teams know from experience that clear communication and thoughtful management result in better client health and quality of life. They know that if care becomes fractured over time, clients will suffer. But ensuring that this doesn’t happen can be a monumental challenge – especially in the home care sector.
This post will look at three major tasks home care agencies should tackle in order to improve continuity of care.
1) Consistent Caregiver Schedules
In this case, we mean consistent for those receiving care. It’s no secret that clients prefer to deal with caregivers they know and trust. And building trust can take time. This is especially true when it comes to private situations. Who wants to take off their clothing to be bathed by a stranger?
We understand the struggle. If you’re in a home care management position, you’ve probably encountered many scheduling challenges. PSW turnover is, unfortunately, high. In some provinces, recent cutbacks to government-funded home care hours are also making it difficult to maintain consistency. That said, sending a different PSW to a client every week reduces the quality of her care. It’s also a surefire way to upset those closest to her. Whenever possible, it’s best to create schedules based on the existing rapport between clients and caregivers.
According to a recent survey, most personal support workers (PSWs) believe their schedules are flexible enough to accommodate clients’ changing needs. Demonstrated flexibility on the part of staff members should be taken into account during scheduling. This willingness to adapt should also be fully appreciated by those who run home care agencies. After all, retaining skilled caregivers helps ensure continuity of care.
2) Encourage Multidisciplinary Learning
In most healthcare settings, the team members responsible for a patient’s care must work together This means more than sharing patient information and playing off of one another’s natural strengths. In many cases, it includes internal training and coaching based on specialized expertise.
This type of collaboration is especially important in home and community care. Home care nurses, PSWs, and specialists often work alone. It’s not always possible to schedule the right caregiver to see the right client at the right time. In order to provide continuity of care, available caregivers must administer the treatments clients need.
Of course, this isn’t always appropriate; not every care professional is qualified to carry out every procedure. But there are many situations when generalist nurses and PSWs can perform simple tasks usually carried out by specialists. Wound care is a great example. It’s estimated that between one-third and one-half of home care clients have wounds care needs. In many regions, the number of wound specialists falls far short of demand.
Unfortunately, due to the nature of home care, in-person training and coaching opportunities are often limited. That’s where technology can help. With the right digital tools, specialists can assess the physical symptoms of clients and coach caregivers through appropriate treatments. The more knowledgeable a caregiver is, the better he can act within his scope of practice to preserve the continuity of care.
Those who operate or manage agencies can encourage multidisciplinary learning by making staff aware of educational opportunities. This encouragement may include providing training materials, advising staff when courses that provide skills upgrades are available, and (when appropriate) looking at technologies that simplify the transfer of knowledge.
3) Streamlining Communication
Every home care service provider knows the value of communication. Without it, caregivers and healthcare professionals simply can’t provide clients with seamless, continuous, and high-quality care. To those on the outside, it seems simple. Record changes in a client’s condition. Alert the right professional when significant changes occur. But the collection, organization, and transfer of data are never simple. It’s something traditional healthcare facilities still struggle with.
There are three types of continuity of care: informational continuity, management continuity, and relational continuity. Informational continuity refers to the timely and accurate exchange of information between healthcare providers. Management continuity refers to the coordination of care across different healthcare settings and providers. Relational continuity refers to the ongoing therapeutic relationship between patients and their healthcare providers.
Unfortunately, in home care, there’s a greater opportunity for errors. In an uncontrolled setting, where only one caregiver is present, mistakes are bound to occur. When multiple service providers have to coordinate, difficulties multiply. It’s inevitable: information gets lost. At best, this situation creates minor annoyances for medical professionals and caregivers. At worst, it can cause serious health consequences to patients.
Consider what happened to Lynn Burkitt, an Alberta woman who suffered after a botched mastectomy. During Burkitt’s recovery, home care staff failed to provide proper treatment due to miscommunication with hospital staff. Unnecessary pain, additional surgeries, and a major deformity resulted. There are steps home care managers and operators can take to prevent these types of errors. Set up procedures for the transfer of information between your agency and outside healthcare institutions or physicians.
What data should your staff always include in a client’s record? When should you ask supplementary questions to obtain information not contained in a record you receive? Technology can also be useful. Of course, electronic health records can greatly improve continuity of care. But often, highly-specific information about a client’s condition or treatment must be highlighted. In these situations, digital tools that facilitate instant face-to-face communication are the answer. These tools can also be used to follow up with clients and family members, increasing adherence to care plans.
Changing Attitudes, Improving Continuity of Care
For in-home care, improving continuity of care will take a lot of effort. Canada’s government is still learning to navigate the shift towards at-home care. Traditional healthcare providers are used to the ways things have been done for decades. As purveyors of a newer model of care, home care providers will have to take the lead.
It’s a position worth taking. Increasingly, patients want to be at home. But without continuity of care, they’ll never achieve the full benefits that home and community care can provide. In many cases, they’ll suffer negative consequences. At every level, those in-home care agencies can work to prevent this from happening.
Feature Image: Myfuture.com