Wednesday, October 24, 2012

Dying at home -it is not pretty and it is not for all families

Dying at home -it is not pretty,
and it is not for all families.
There is much in the news about how much care loved ones receive in home care services. The conflict arises when family members confuse the amount and type of services with the treatment of a loved one. One family protested when Home First, emergency discharge care, was cut after a month. (This is the protocol for Home First - 30 days emergency care, until a different arrangement can be made.) The issue arises when a client wants to die at home, a family doesn't have the resources to keep 24/7 watch, and they demand 24/7 services. We cannot afford it. There are reasons we have group care settings, such as long-term care (LTC), as it is less expensive than putting a full-time nurse or PSW in a home.

However, what happens when a family is unable to provide the 24/7 care, through extended friends and family? They complain to CCAC and demand more care. Many of us burn out, trying to fil a role for which we were not trained.

Many are doing well in LTC
How does CCAC determine the level of care a client receives?

It is up to CCAC case managers in Ontario to determine the level of care a client receives at home, and the way they prioritize case loads and clients is using MAPLe. The Method for Assigning Priority Levels (MAPLe) is a tool used by health care professionals to prioritize clients’ needs and to appropriately allocate home care resources and placement in long-term care facilities.

Some care recipients and families
cannot manage caring for a loved one at home
Protocols are determined by the budgets and must not be confused by this Bill of Rights, which outlines the human rights of care recipients. They must be treated with dignity and respect, they must be dealt with professionally, and their privacy must be respected. But healthcare does not have the funding for unlimited services at home.
And, yes, there are issues in being in hospital. It depends upon your needs.


One senior making a choice
Home Care and Community Services Act - a bill of rights
The BIll of Rights outlines the way in which clients are treated. It does not outlines how much caregiver support a family receives, this varies with local needs, the range of services they are able to provide. CCAC is simply a Transfer Payment Agency. They will hire for-profits, like Bayshore Home Health (who earned $425 million in profits one year), and this Bill of Rights simply ensures that outside providers treat patients with dignity, respecting their culture.

Complaints about these three issues can be appealed further if someone is not satisfied with the CCAC's response to the complaint. This appeal is to an independent tribunal called the Health Services Appeal and Review Board (HSARB).

Bill of Rights for Ontarians Receiving Home Care
Individuals who receive services through a CCAC have a Bill of Rights which is part of a law called the Home Care and Community Services Act. A service provider shall ensure that the following rights of persons receiving community services from the service provider are fully respected and promoted:
           1. A person receiving a community service has the right to be dealt with by the service provider in a courteous and respectful manner and to be free from mental, physical and financial abuse by the service provider.
2. A person receiving a community service has the right to be dealt with by the service provider in a manner that respects the person’s dignity and privacy and that promotes the person’s autonomy.
3. A person receiving a community service has the right to be dealt with by the service provider in a manner that recognizes the person’s individuality and that is sensitive to and responds to the person’s needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors.
4. A person receiving a community service has the right to information about the community services provided to him or her and to be told who will be providing the community services.
5. A person applying for a community service has the right to participate in the service provider’s assessment of his or her requirements and a person who is determined under this Act to be eligible for a community service has the right to participate in the service provider’s development of the person’s plan of service, the service provider’s review of the person’s requirements and the service provider’s evaluation and revision of the person’s plan of service.
6. A person has the right to give or refuse consent to the provision of any community service.
7. A person receiving a community service has the right to raise concerns or recommend changes in connection with the community service provided to him or her and in connection with policies and decisions that affect his or her interests, to the service provider, government officials or any other person, without fear of interference, coercion, discrimination or reprisal.
8. A person receiving a community service has the right to be informed of the laws, rules and policies affecting the operation of the service provider and to be informed in writing of the procedures for initiating complaints about the service provider.
9. A person receiving a community service has the right to have his or her records kept confidential in accordance with the law. 1994, c. 26, s. 3 (1).
For more detail about what these rights mean, see CLEO's publication Home Care Bill of Rights.

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