Monday, January 11, 2010

Issues in Home Care

While many with strong family and friends, and good support systems, with strong values, an education and money to buy help, these people can often stay at home well into their twilight years.
Women, essentially caregivers for many old, disabled and failing, can manage their loved ones and keep them in dignity.
Others, without the financial  means or physical strength to care for themselves, end up in poverty, in tragic situations.

These are a few of the issues, as I see it, in Home Care and the government policy of the Aging At Home Strategy.

*Treating a patient as a single person, when caregivers are often ill, frail seniors, or working adult children. They cannot be expected to take up the slack of the needs of a patient. Caregivers are afraid to demand that their loved one stay in the hospital, or find Alternate Levels of Care (ALC).

*Patient Navigators: we desperately need these. The cancer society has them, as do Alzheimer's Societies with their FirstLink program. But ordinary folk, without the means or knowledge to get around the system, lack of transportation to doctors appointments, or orphan patients without a family doctor, are at high risk. This tend not to be middle class families, with money to pay for prescriptions and extra care.

*primary care staff misunderstanding PHIPA vs, FIPPA, and denying family members info, decision-making powers, or respect. Despite families begging for help Case Managers, and visiting nurses, keep evaluating using their 'capacity' tests, and do nothing. The client appears to pass the capacity test and refuses to move to ALC.

*Front line workers: Nurses, Personal Support Workers (PSW), Health Care Aides

  • Nurses are regulated. There are ways and means to improve their delivery of care. They are accountable and have training requirements.
  •  PSWs are unregulated, not necessarily trained, not necessarily having any certificates, or understanding of geriatrics, yet they deliver intimate care to failing loved ones. There are some fabulous workers, who have helped my late parents through their palliative care at home and in LTC. But others move from place to place, being fired and rehired, carrying superbugs, if they don't understand the mysteries of Superbugs or infestations (scabies), and some abuse clients, or steal, sometimes through manipulation. They develop inappropirate sexual relationships with clients. Others do not have anyone behind them and cannot refuse to work in homes in conditions like this. Some abuse their clients. YouTube videos prove this. There are several groups that have organized to represent PSWs: PSW Canada, PSW Network of Ontario. God Bless them all. They seek to improve the delivery of Home Care services to aging seniors, and the disabled.
  • Nurses who test a patient for being sentient, and allow them to live in filth (see photos). They deny the reality of a situation and refuse to admit a client to hospital.
  • Hospital discharge staff who send patients home to live in horrible conditions, with unresolved addictions, inability to manage ADLs, let alone IADLs, incapable of doing their banking, with no transportation, and inadequate support.

*Volunteers crossing over the line: enabling clients to continue living in unsafe, unsanitary conditions, and do not inform the proper authorities (Health Department, CCAC, the police, physicians, Case Managers) and continue that slippery slope to assist 'friends' with ADLs and IADLs, until they are doing everything for the client. The client's family wants the client to admit that they need help, and to permit this to happen. My parents were in this situation. I had no idea that they were unable to cope with their daily needs until I moved 430 km to assist them. By then it was too late. Mom died 6 weeks after I arrived. No one had told me about her issues, by then she was afraid to ask for supports, or to have assistance in her home. She was afraid we would move her out of her home, and she feigned good health and lied to her Case Manager. Patients with dementia are fairly good at faking mental health.

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