Monday, May 18, 2015

Pilot project for self-directed home care –a dismal mistake

That is my belief.   Currently there is a cap of at-home nursing care visits per month: 120 visits. They are raising this to 150 visits per month. The Minister added $5 million in new funding for home care. The biggest barrier to getting home care is the lack of experienced, competent workers: from personal support workers (PSWs), to nurses, and physicians who will make house calls. The next barrier are the budgets that limit the number of visits. Next, the biggest barrier is the lack of regulation and training for PSWs. Poorly trained PSWs make the news. Unregulated PSWs who slip under the radar can go from employer to employer.

In the Ontario system, there is a packet of money for various home care supports: primarily PSWs who provide assistance with daily living (ADL: cleaning, housekeeping tasks, meal prep, bathing clients, keeping them dry and clean). There are also nurses who provide wound care, manage the case, and keep on top of medications. When a change is needed in medications, for those who are palliative or unable to go to the physician, they will phone the doctor and request different medications.

Families tell me that they have difficulty in coordinating care: juggling support from various
agencies, keeping on top of medications, doing errands. The agency employee (e.g., PSW or nurse) with the home care contract (e.g., Bayshore Home Health, Red Cross, VON) will phone the family and let them know when they will be over, which day and time. There is no choice, as they are swamped with work, the transportation issue, going between clients home, is complex, especially in rural Ontario. Imagine forcing client's and caregiver to phone these for-profit agencies themselves. This is what the CCAC Charge Nurse is paid for: to coordinate care.

Clients who qualify for home care are now going to have to search out an agency, and create a contract themselves. For those who qualify for nursing visits, or support with ADLs, they are still going to have a hard time finding someone to come. As it is, some families qualify for a PSW to come weekly to bathe a loved one, and hire someone to do house cleaning. This is what people with money do for themselves.

A Canadian pilot project that would give patients or their caregivers money to spend on the home health services of their choosing. Details were scant on the government’s plans for experimenting with “self-directed care,” an approach that Health Minister Eric Hoskins said is already working well for some parents of autistic children who have been given the flexibility to spend public funds on the programs they believe are best for their children. 

Pilot project to give cash to Ontario patients for 'self-directed' home ...

The Globe and Mail-May 13, 2015
In a bid to respond to a blistering report on home care in Ontario, the ... give patients or their caregivers money to spend on the home health ...

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