Safety Strategies for Care in the Home

Abstract

Patient safety has evolved and developed in the context of hospital care. The understanding we have of the epidemiology of error and harm, the causes and contributory factors and the potential solutions are almost entirely hospital based. Safety in home care is likely to require different concepts, approaches and solutions. Safety in this context has however been barely addressed and yet care provided in the home will soon become the most important context for healthcare delivery.The term 'home care' can encompass a variety of residential settings in which people are cared for by family, nurses and other professionals. In this chapter we use the term in a more restricted way to refer to the care of people in their own home, with varying degrees of informal and professional support. We focus on people with illnesses, usually chronic conditions, who are either living independently or being supported in their own homes by family or professional carers. Much healthcare is already delivered in the patient's home and this form of provision is growing rapidly. The benefi ts of home based care have been widely discussed, but the risks have not been fully articulated. In this chapter we fi rst briefl y summarise the background to the expansion of home care and then consider the nature and challenges for patient safety and the strategies that might help us manage risk in the home. An Ageing Population and the Expansion of Home CareMore than 20 % of citizens in developed countries will be over 65 in 2020. These people, while enjoying better quality of life than previous generations, will suffer from a variety of long term conditions. As we discussed earlier, patients with cancer, heart disease, dementia, renal and respiratory disorders may now live for decades with their disease. The most common causes of disability however are due to sight and hearing disorders which affect very large numbers of people and are particularly pertinent to safety in the home. As well as an absolute increase in the numbers of older people, there will also be a considerable relative increase. The socalled 'support ratio' -the ratio of people of working age to those over 65 -will

Addressing safety risks in integrated care programs for older people living at home: a scoping review

“…Fewer programs addressed risks related to people's social and physical environments as evidenced by program activities and interventions. However, as the number of people receiving care and support at home keeps rising, risks related to, for example, people's socio-economic conditions, their home environments, and increasing caregiver responsibilities, are becoming more prominent [24]. Addressing such risks is especially important since older people themselves also express that such concerns influence their ability to age in place [20,25].…”

“…Data were extracted on the general characteristics of the integrated care program (i.e., country, setting and target group, goals, and how programs address the elements of integrated care), and on the safetyrelated intervention components of the program (i.e., the risks addressed, and the interventions and activities used to address them). These safety-related components were categorised into five domains of safety risks, which were defined based on the principles of Lau et al's framework for health-related safety and additional literature [18][19][20][21][22][23][24]. The domains included client functioning, client behaviour, social environment, physical environment, and health and social care management (see Fig.…”

“…Cognitive impairments and depressive symptoms were addressed less often. For client behaviour, there was somewhat more variation [18][19][20][21][22][23][24]). This figure presents the five domains that were used to categorise the safety risks and interventions identified in the included studies across the programs in the types of risks addressed.…”

“…1). However, older people encounter limitations in multiple domains of life, which could also pose risks to their ability to live safely and independently at home [18][19][20][21][22][23][24][25]. This implies a need to look at older people's safety at home from a broader perspective.…”

“…Lau et al (2007) [23] proposed a model for health-related safety that extends beyond the institutional settings and includes a wide range of risk factors in multiple domains of life. Following the principles of this model, risks relate to older people's health and functioning (e.g., physical or cognitive decline), their lifestyle and behaviour (e.g., dietary intake, self-care, medication adherence), their social or physical environments (e.g., social isolation, caregiver burden, hazards in the home) and the health and social care they receive (e.g., medication errors, communication failures, fragmentation of care) [18][19][20][21][22][23][24][25][26][27]. This wide range of risks could lead to a multitude of problems that challenges people's ability to live safely at home, and could ultimately result in emergency department visits, (re) hospitalisation, institutionalisation and mortality [23].…”