Tuesday, December 16, 2008

Home Care

I heard the news item re: supposed improvements to home care by the (new!) Ontario Health Minister, David Caplan.

This is ridiculous. The Minister is going to demand that patient safety and performance statistics are available for potential clients.
You don't fatten a cow for market by weighing it.

The issue is not with knowing which agencies perform well, it is in finding well-trained, dependable ethical staff. Our Personal Support Workers (PSW) have only a 14-module course to undertake the care and treatment of our seniors. Day Care teachers are required to have an ECE degree in better schools. Why is this not different? Poorly performing individuals go from agency to agency and stain the entire group.

The presumption, just like EQAO scores, is that seniors and family members can shop around for better home care like parents do with schools. The myth is that families can afford better agencies. You are limited by your income. Most families rely on CCAC to deliver extra support. These folks have limited budgets.

LTC homes already have reporting standards. Family members are afraid to report for fear of retribution on their loved ones. There is little that is done or can be done, without more, better trained staff. There is a huge shortage. It is criminal that our seniors get limited care. This impacts on chronic diseases that only exacerbate and result in comorbidities and early deaths.

We need a system whereby we can track those who cannot perform their duties well. We need them to be trained, educated and a mentoring system to train each other. We need a support network that lauds best practices.

We need more staff, and a higher budget for CCAC to deliver services to seniors in their homes. "Quality indicators" will not result in better performance. We need more staff, there is a huge shortage. Excellent Personal Support Workers (PSW) are hired by better-paying institutions, with better benefits. We don't need so many Transfer Payment Agencies, as we need more quality staff.

There is a back-up of seniors in hospitals who need to be discharged to home or LTC. Without supports in place, nurses to change bandages, take blood work, and do Primary Care, patients discharged to home get into trouble.
  • Those with diabetes have poor circulation and end up with gangrene. Those without transportation cannot get groceries.
  • Those without family members to provide support with ADL, or IADL, are unable to keep a senior home and healthy.
  • Those without resources are taking care of frail spouses.
  • Those at home may have undiagnosed dementia and simply cannot cope or keep their spouse healthy and clean.
We can insist that a senior gets up to date health care. We need to better monitor paitents discharged too early, theoretically to free up hospital beds.
You can ensure that they have transportation, nutritional care, access to day away programs or respite care for caregivers.
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