Home-based care: barriers and facilitators to expanded personal support worker roles in Ontario, Canada

Abstract

To accommodate the increasing demand for home care in Ontario, Canada, some care tasks traditionally performed by regulated health professionals are being transferred to personal support workers (PSW). However, this expansion of PSW roles is not uniform across the province. Between December 2014 and April 2015, barriers and facilitators to expansion of PSW roles in home care were explored in a series of 13 focus groups. Home care staff identified seven categories of factors affecting the expansion of PSW roles in home care including: communication and documentation; organization and structures of care; attitudes and perceptions of the expanding PSW role; adequate staffing; education, training and support; PSW role clarity and variation in practices, policies, and procedures. Addressing barriers and promoting facilitators at the funder and employer levels will enable the provision of safe, effective, and equitable care by PSWs.

Challenges and Barriers Faced by Home Care Centers: An Integrative Review

“…They must be aware of numerous training strategies, should continuously develop them, and recognize available social resources (52,54,55). Unfortunately, this infrastructure is missing and due to a shortage of nurses, economic problems, and the introduction of cheap manpower, sometimes even people other than nurses are employed to provide home care services (4,6,9,12,16,18,21). The presence of these ineligible individuals and their improper care will lead to people's mistrust of nursing and care (23,37).…”

“…Non-application of standard and integrated methods for home care nursing services (7,(9)(10)(11)(12)(13)(14)(15)(16)(17) (13, 18) (12, 15, 16, 19) -Lack of basic protocols and coherent standards for home care services -Absence of clear guidelines to introduce the duties and responsibilities of each member of a home care team as well as the patient and his/her family during the caring process at home -Absence of standards, guidelines, and monitoring mechanisms for home care providers Deficiency in intra-and extra-organizational communications (4-6, 9, 12-15, 17, 18, 20-28) -Absence of communication between nursing schools and home care centers -Lack of registration and identification systems for licensed home care providers and nurses working in these centers to closely monitor their work -Defective and discontinuous communication between a medical team, caregivers, and patients -Inadequate communication between private and public sectors -Ineffective communication network between those in charge of home care centers, home care nursing providers, the police, and the municipality -Absence of coordination, cooperation, and proper communication among the entire members of a home care team (i.e. nurses, social workers, physical therapists, occupational therapists, speech therapists, and those in charge of home health aides) to care for a patient at her/his home -Deficiencies in planning for as well as the system of referring a patient from hospital to home care centers and vice versa -Inadequate exchange of information between hospitals and home care providing centers -Inappropriate inter-professional cooperation such as lack of proper access to specialists in diverse fields of health and home care as well as lack of coordination between implementation of clinical care and patient paperwork -Lack of knowledge of and, hence, non-application of the capacity of other organizations such as marketing agencies, medical equipment providers, and so forth to improve home care services -Absence of coherent teams with strong nursing leadership in an organization to plan for the promotion of care based on needs assessment, derived from the reports on care services which have been provided so far by home care centers.…”

“…-Inadequacy of professional female nurses to provide home care services -Assignment of home care services to those who are not nurse and are, thus, incompetent in providing home care -Difficulty of employing, training, and preserving skillful and experienced nurses at home care centers -Quitting the home nursing occupation due to working pressures caused by the absence of official and financial supports Absence of legal and security supports (5, 14, 16-18, 22, 26, 35, 38, 40, 41) -Absence of formal and legal supports for nurses -Security problems for a nurse both on his/her way to a patient's home and at the patient's home Economic problems (4, 5, 7, 10, 12-15, 17-19, 21, 22, 24, 29, 30, 32, 34, 36, 39, 40, 42) - -Society's lack of trust in health specialists other than physicians -Difference in the culture and language of the patient versus the caregiver Ignoring ethical issues (5,7,12,16,18,26,28,41) -Families' making direct and informal contacts with nurses and caregivers instead of calling authorized home care centers which are qualified to send licensed nurses to a patient's bedside -Families' demand of nurses to do tasks, such as changing clothes, other than those defined for their profession…”

The evolving role of the personal support worker in home care in O ntario, C anada

“…However, PSWs are frequently the first provider to visit service users in their homes, often with limited information about the service user's care needs. This situation often results from scheduling issues and limited availability of RHPs and supervisors (Saari, Patterson, Killackey, Raffaghello, Rowe & Tourangeau, ). Delays in the development of care plans and identification of necessary added skills by PSW supervisors can result in needed care going unfulfilled or PSWs making independent decisions regarding care (Sharman et al., ) based on the inappropriate application of previously learned knowledge to new service user situations (McBride et al., ).…”

“…Furthermore, due to variation in documentation, direction and support for delegation to PSWs across health regions in Ontario, PSWs working in adjacent health regions may be required to know and follow different guidelines regarding the care they provide (Saari et al, ). Approved added skills in one region may not be approved in an adjacent region and the same may be true across service provider organisations.…”