Seniors Matter(s): The future of home care

I hand this article off to my incredible daughter, Kylie Pike.

The future of home care - now is not the time to reduce services

By Kylie Pike

Though this won’t be news to you, the current state of the world is like no other time in history. Exposure to information is immediate and plentiful. Generations, young and old, are accessing copious amounts of information daily. The so-called facts and figures we are exposed to, through various entertainment avenues and social facets, can be overwhelming.

Yet, we still seem to be in dire need of clarity and concise information that is applicable to each of our situations.

Our lives tend to be a moving target when striving to capture wants and needs with changing self-abilities, due to overall health and well-being. Attempting to manage perceptions that really are realities to everyone, and trying to manage priorities that may change and vary between those caring for an individual, can create an extremely challenging situation.

Confusion, anxiety, and a sense of being overwhelmed when trying to help yourself, a loved one and/or being the caregiver for several people, are very common. Sometimes, these negative emotions can seem to be the only guarantee for those in need of and/or providing home care when everything else tends to be changing.

Firstly, there’s the need for reflection. For generations, Canadians have known, or should have known, about the importance of helping your neighbour as well as your family. The sad state of our health-care system, regarding the overall support and one-on-one personal care provided in long-term care, has been widely exposed during the COVID-19 pandemic. Society, through media and information released by our provincial and federal governments, seems to have turned a blind eye to the tragedies occurring in the home-care sector, and yet the cries for help are plentiful.

Should it have taken a pandemic to force us to look closely at the travesties suffered by those in need of personal care? Anyone who has experienced the stress of helping someone diagnosed with an illness or disease, someone who is recovering after an accident, surgery and/or medical treatment, has mobility concerns, is aging, etc., knows the fear and anxiety that often engulf those needing the help, as well as the caregivers.

The aging population is growing at exponential levels in Ontario and will continue to increase over the coming years. Therefore, health-care demands for in-home and community-based care will also rise at an exponential rate.

Access to qualified, experienced and empathetic front-line support workers is – terrifyingly – at an all- time low, despite the increasing demands. Particularly in rural areas, it’s reaching crisis levels. With the rising cost of living, increasing gas prices and the shortage of affordable living options, front-line support workers are leaving the profession or the area completely.

There are additional challenges to encouraging young people to choose this profession, and the educated tend to work in cities. There is also a tragic burn-out rate, as many in front-line health care have been forced to stop working due to their own personal health and well-being. So, as the demands for home care continue to rise, the access to the necessary supports is diminishing, creating a magnitude of crisis.

Home care refers to health-care services that are provided for individuals within their homes. Services are performed via in-home health agencies through regulated and unregulated health-care professionals, including nurses, social-service workers, rehabilitation specialists (such as occupational therapists and physiotherapists), personal support workers (PSWs) and home support workers.

Services can include restorative care, with the intention of providing clients with tools and support for recovery, and range all the way to home-care services that provide palliative or end-of-life care. Home care is ever-changing to accommodate for unique and complex medical needs. This means duties and responsibilities are being shared or are shifting in response to regulated and unregulated health professionals being spread thin.

Tasks that are usually carried out by regulated health-care professionals, such as nurses and physiotherapists, are now the responsibility of PSWs. Yet the demand for PSWs is at an all-time high, so many home-support workers are forced to perform PSWs’ duties. In addition, the role of PSWs has expanded to include care activities previously performed by other various registered health-care professionals. The field and careers of PSWs is not currently regulated and yet, the need and demand for this profession to become regulated is evident.

THE ROLE OF A PSW

PSWs are considered unregulated health-care providers who perform personal and supportive care for a wide variety of clients under the supervision of their regulated employers. As an unregulated position, PSWs have no clear-cut scope of practice, so duties will vary among home-care placements.

Examples of typical duties and responsibilities for PSWs may include:
 

• Assisting with activities of daily living (dressing, hygiene, showering, toileting)
• Mobility assistance (help with transfers and walking assistance to ensure safety and reduce the risk of falls)
• Basic wound and skin integrity care
• Light housekeeping
• Psychosocial care (i.e., respite, companionship)
• Basic medication assistance, prosthetic and brace care

New PSW responsibilities include:
 

• Range-of-motion and home exercise programs
• Bowel and bladder care (ostomy and catheterization)
• Tube feeding
• Oxygen administration
• Application of topical medical creams
• Assistance with inhalers and drops
• Skilled wound care
• Donning/doffing compression stockings
• More in-depth prosthetic and brace application

PSWs are expected to complete the duties for which they’ve been trained during their certification courses. For PSWs to legally and ethically take on additional tasks, which are usually assigned to regulated health professionals, there needs to be a specific form of delegation of these services. Delegated services are to be highly-routine, repetitive activities that can be completed with training and appropriate supervision.

However, it is becoming more common-place for PSWs in certain home-care placements to take on non-traditional client-care activities. This is typical of those working with individuals who have extremely complicated plans of care and medical histories. Although it may be cost-effective and save time to push these additional activities onto the PSWs, there needs to be a consideration for intervention effectiveness and safety of the patients, as well as the PSW.

The roles of home-care workers encompass individuals who typically have years of experience as a health-care aide or nurses’ aide (both professional titles that do not currently exist, but they did a few decades ago) or experience as a primary caregiver for a loved one (child with complex medical needs and/or a spouse, friend, neighbour, aging parent, etc.).

Attempting to navigate the health-care system can be overwhelming. Trying to advocate for yourself or a loved one, when there are numerous agencies and individuals to communicate with, is daunting. Having so many questions and concerns that tend to multiply the more we learn, can be emotionally draining and completely encompassing. It can be terrifying. There needs to be a better way, no matter how complex.

This does not overshadow the need for celebration. By almost any standard, there is no better place to live than Canada. Few countries make outstanding health care available to all. Even fewer seek to accommodate so much diversity, whether it be language, ethnicity, faith, creed and sexuality. It is why millions stand in line for the chance to become Canadian. They choose Canada because we are open, tolerant, curious, and humble.

Is there room for improvement in the home-care sector? Absolutely. As Canadians, I hope we humbly appreciate all that we have and yet work together to provide solutions and rally to help those in need and those who tend not to be able to advocate for themselves.

HOW TO GET HOME SUPPORT

The place in life where someone needs home-care support can vary significantly, so whenever possible, speak to your family physician or call Home and Community Care Support Services (HCCSS), which was previously known as the Local Health and Integration Network (LHIN) and the Community Care Access Centre (CCAC).

If you feel that you or your family member needs health-care support at home, school or in the community, HCCSS can open the door to a world of options and opportunities.

Anyone can make a referral on your behalf – a family doctor, friend, family member, even you. The first step is to call 310-2222, which will automatically direct you to your local home and community care office (no area code required) – or you can call the number for an office close to you by visiting healthcareathome.ca/southwest/en/Contact-Us or call 1-800-811-5146.

Let the office know you are making a referral for services. The helpful staff may ask some questions to better understand your needs. Then, you will either be connected with a care co-ordinator, or be referred to the program or service that may be right for your needs.

RESOURCES
 

• www.southwesthealthline.ca
• www.ontario.ca/page/homecare-seniors
• https://healthcareathome.ca/southwest/en
• www.cno.org
• ontariopswassociation.com

Kylie Pike owns Rural HomeCare and lives in Ripley with her family. She has worked on both the front lines and administrative avenues of home care for more than 20 years. Learn more at www.ruralhomecare.ca.