Home care safety report at odds with new directions at OACCAC

By now every Ontarian has heard how hospitals are unsafe. Patients are told the shorter the stay, the less risk, in order the help them understand the need to vacate their bed long before they feel physically able to go home.

The problem is there has been very little study to determine risk in alternative settings, including home care. Just because a hospital stay poses risks, it doesn’t mean home care or other settings are necessarily safe.

This summer the Canadian Patient Safety Institute released its first pan-Canadian home care safety study.

If anything, the report underlines the difficulty in even assessing risk in this environment, pulling data from multiple sources – not all of it consistent from province to province. The authors note that home care safety issues are only beginning to be addressed in healthcare literature.

Depending on where the data is drawn from, annual rates of adverse incidents can vary from 4.2 to 13 per cent of Canadians receiving public home care.

An adverse incident is defined as an injury caused by medical management or complication rather than by the underlying disease itself, and one that results in an adverse outcome.

The report notes that it is a challenge to take care to private places: “People’s homes, both apartments and houses, are rarely suited to the provision of safe healthcare. Homes of the chronically ill are often run down. They become cluttered, dirty and poorly maintained environments. Icy walkways, halls blocked by wheelchairs and walkers, and cramped spaces with little room for treatment-related equipment are common safety hazards in the home care context.”

Not surprisingly injurious falls and medication-related incidents top the list of hazards at home. The report’s analysis concludes that among adverse events in home care, 56 per cent are preventable. That’s higher than the 37 per cent preventable adverse event rate in Canada’s acute care hospitals.

“Many of the safety issues identified are related to system design, slow administrative processes, shortages of staff and equipment, and poor communication that lead to a lack of continuity and coordination of care.”

Ontario’s turbulent world of contract home care could very well be what the authors had in mind when they noted “lack of coordination of and turnover of staff often affects the reliability of service and poor communication makes workers feel isolated and lacking in support.”

While Ontario is presently testing a further fragmentation of the case manager’s role, the report instead calls for a case manager “quarterback” capable of not only coordinating the care team, but also linking to other caregivers, such as primary care providers, pharmacists, and institutional care providers. The authors also stressed the importance of standardization of care processes at a time when the OACCAC is heading in the opposite direction, suggesting they can incentivize “innovation” on the part of contract agencies.

This is particularly surprising given the OACCAC had a representative on the study panel.

The report also notes that the lack of support for non-paid caregivers is creating additional stress on the health system. These unpaid caregivers are often also elderly spouses or retired children.

“Family and friends looking after a seriously ill person at home reported that the work is difficult, stressful, and draining. In the face of increased demands on their time, energy, and emotions many unpaid caregivers have to cut down their own work hours or even quit their jobs.”

The report estimates the rate of caregiver distress at 6 per cent.

“If the needs of the caregivers are not adequately addressed the clients are at risk for re-admission to acute or LTC (long-term care) facilities at increased cost.”

The report notes that the cost to replace unpaid caregivers across Canada would be about $25-$26 billion annually. Therefore it is no surprise that the study team calls for greater caregiver support.

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