Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed.
RÉSUMÉL’article examine où les personne agées peuvent chercher l’aide pour prendre soin d’un parent avec démence et les facteurs associés à leur identification des services de santé et de soutien communautaires comme des sources d’aide. Les auteurs menées des entrevues téléphoniques, à l’aide de numérotation de chiffres aléatoires, de 1,152 adultes âgés de 50 et plus dans la ville de Hamilton. À déterminer les sources de soutien, plus 37 pour cent des répondants a identifié leur médecin, 33 pour cent a identifié un soutien informel comme la famille et voisins et 31 pour cent a identifié des services de santé maison. Seulement 18 pour cent a identifié des services de soutien communautaires. Participants femmes ayant des niveaux plus élevés de scolarité étaient plus susceptibles d’identifier leur médecin comme une source de soutien. Savoir où trouver renseignements sur services de soutien communautaires était associée à une probabilité accrue de mentionnant des médecins et des services de santé maison comme sources d’aide.
Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.
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