Overhauling Home Care Means Doing More With Less. Here’s How.

Home care is worth getting excited about. It’s cost effective. It’s in line with patient preferences. And it has the potential to provide appropriate support for many chronically-ill patients.

For these reasons, many see home and community care as the ultimate solution to Canada’s healthcare problems. And yet, Ontario – a province that has wholeheartedly embraced this solution – has struggled with care delivery in recent years.

It’s important to recognize that such struggles are inevitable during times of systemic change. Despite public criticism, policymakers are committed to the province’s home care system. But they acknowledge the need for an overhaul.

How long will it take to tackle issues such as long wait times and poor care coordination? For many Ontarians who need more hours of high-quality home care, the answer is, too long.

But there are steps that home care service providers and coordinators can take to help clients now. Low-cost innovation and careful management strategies can make a real difference – today, and tomorrow.

This post will look at Ontario’s home care past, present, and future. We’ll explore ways for those involved in providing care to do more with the resources they have.

The Home Care Landscape – Right Now

It’s no secret that, in recent years, there have been complaints about home care delivery in Ontario.

Numerous provincial and national newspapers – including the Globe and Mail – have printed investigations into the system’s shortcomings.

A troubling 2015 report from auditor Bonnie Lysyk highlighted home care issues such as unequal access to services.

And recently, a panel of home and community care experts penned its own report, which was also critical of the system’s performance. The panel asserted, “[w]e can do better, we need to do better, and we need to change now.”

For many healthcare leaders and frontline practitioners, these sentiments ring true.

If you’re involved in coordinating or delivering home care services, you’re aware of the toll that illness can take on families. You’ve seen the consequences of surging demand. And you probably have valuable insights into how the system can better support patients in the community.

Luckily, policymakers are listening. On the basis of patient feedback and expert recommendations, the government has asserted its commitment to change. A $100 million investment into the sector is proof of this commitment.

These dollars represent a major boost to home and community care. But many home care service providers and coordinators are skeptical. They see recent funding as a drop in the bucket. And they’re right.

The Ontario government will have to offer more financial support to the home care sector as the population ages. At the same time, it’s working hard to eliminate it’s ongoing deficit.

There’s also the question of how best to organize service delivery. In particular, longstanding speculation about the province’s Community Care Access Centres (CCACs) has been a source of some confusion.

Whatever happens, one thing is clear. Moving forward, professionals involved in delivering care will have to make the most of existing resources.

Understanding the Past, Preparing for the Future

As home care services continue to fall short of demand, many policymakers are asking themselves the same question. How did we get here?

Finding the best way forward often requires a close examination of the past. In retrospect, there are are always issues that might have been handled better.

That said, when the needs of patients change as drastically as they have in the last couple of decades, the challenges that government and service providers face are massive.

If you work in healthcare, you’re aware that chronic disease rates are increasing at an alarming rate. Unfortunately, acute care facilities aren’t designed to provide the ongoing support that chronic and complex patients often need.

Chronic diseases are often best managed at home, which is where most patients would prefer to be. And providing care at home is far less costly than most alternatives. It’s easy to see why many view home care as a miracle solution.

On one hand, the province is right to consider the shift from facilities into patient homes a win-win. On the other, overseeing this shift is a massive undertaking. There are unique challenges associated with delivering care in home settings.

From skilled worker shortages to the logistics of travel and long-distance communication, there’s no shortage of home care issues for policymakers to consider.

This, of course, is the problem with wide-scale transformation.

Overhauling the system will take more than dedication. It will take time. Time to fully understand the evolving health needs of Ontarians. Time to discover and work out potential policy kinks. And time to figure out how to best allocate limited funding.

The process is ongoing, but patients need services now. To become efficient enough to meet client needs, providers must be open to new and innovative solutions. It’s not just about adopting the right tools. It’s about adopting a new mindset.

Making the Most of Home Care Resources

Until home care delivery processes are streamlined, issues such as long wait times, insufficient hours for clients, and fragmented care coordination will persist.

These processes can’t be completely fixed overnight. For one thing, the logistics of adequately funding home care during a healthcare transition are tricky. That said, there are actions that providers and coordinators can take to ensure clients receive high-quality care.

Technological innovation has provided cost-effective solutions to challenges in various sectors across the globe. As just one example, urban planners are pulling data from smartphone apps to better understand how cities operate. For both rich and poor cities, this information is solving problems in areas as disparate as energy use and policing.

It just goes to show, tackling big issues doesn’t have to be costly.

Mobile technologies have massive potential to improve home care, since most workers and clients already use them. We’re not talking about big data. We’re talking about the use of apps to improve individual client outcomes. If this usage is well organized, positive outcomes can be achieved on a large scale – for a relatively low cost.

Apps can issue medication reminders for patients, collect and transmit patient health statuses to providers, and do everything in between.

To ensure clients get the exact care they need precisely when they need it, providers need to coordinate carefully.
Imagine a female patient who’s receiving at-home care for a chronic condition. What’s the next step in her health-care journey? Who is the next caregiver or medical professional she’s going to see? Who will require updates afterwards?

For very few healthcare dollars, the right digital tools can help workers share patient health information and care plan updates – all in real-time. Technologies that connect entire circles of care offer the best value.

Mobile apps and digital communication platforms can also maximize the efficiency of each caregiver and healthcare practitioner. In situations where clients don’t require in-person care, nurses and personal support workers can check in remotely via teleconferencing. Using this method, care professionals can see more clients.

By performing video consultations, specialists can also serve more people receiving at-home care.

Today, these technologies are easier to use than ever – even for those who have difficulty with most electronics. Because they can be used on common mobile devices such as smartphones and touchscreen tablets, they’re also widely accessible.

When the use of patient-centred technology is organized to improve workflows, care becomes more efficient. As a result, it has the potential to improve the lives of countless home care patients.

On the Road to Better Care

A revolution in care is on its way. The Ontario government has long been aware of the value of home care – for patients, and for the province. Now, a thorough exploration of service delivery models is underway.

Of course, the challenges associated with home care aren’t going anywhere – especially as the population ages. Working out the logistics will be an ongoing process. In the meantime, low-cost innovation can help service providers make the best of their greatest resources: the professionals who provide hands-on care.

Feature image courtesy of KMR Photography

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

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  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
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The Maintenance Mode
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  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

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Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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