“We Only Own the Hours”: Discontinuity of Care in the British Columbia Home Support System

Abstract

Le présent article utilise le concept de continuité des soins pour examiner les effets de la structuration du système de santé sur les travailleurs et le personnel du programme de soutien à domicile de la Colombie-Britannique (C.-B.). Ce programme dessert principalement les personnes âgée fragiles vivant dans la pauvreté, et il permet d'obtenir de l'aide pour des tâches comme le bain, l'habillement, et la toilette, et offre aussi un soutien social et relationnel spécial aux clients isolés. En présentant des données qualitatives tirées de groupes de discussion et d'entrevues avec des personnes assignées au soutien à domicile et des clients de la région métropolitaine de Vancouver, nous indiquons comment la précarisation et l'intensification du travail, dans un contexte d'un niveau accru d'acuité et de complexité des besoins des clients, ont réduit la continuité et la qualité des soins. Le présent article parle de la façon dont la restructuration du secteur du soutien à domicile en Colombie-Britannique a réduit le nombre total de personnes bénéficiant de soins dans le cadre du système, perturbé la continuité des soins, et compromis la qualité. ABSTRACTThis article uses the concept of continuity of care to examine the implications of health-system restructuring for workers and staff in the BC home support system. Home support primarily serves frail seniors living in poverty and has the potential to provide assistance with tasks like bathing, dressing, and toileting, as well as offer social support and relational care to isolated clients. Through presentation of qualitative data from focus groups and interviews with home support workers and clients in the Greater Vancouver area, we demonstrate how the casualization and intensification of work in a context of increasing client acuity levels has diminished both continuity and quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, and compromised quality.

The space between: using ‘relational ethics’ and ‘relational space’ to explore relationship-building between care providers and care recipients in the home space

“…A chief criticism often leveled at home care services is that they are fragmented and uncoordinated (Martin-Matthews et al, 2013;Sharman et al, 2008). In addition, when provision is driven by a concern with efficiency over quality of care, clients are more likely to be subjected to multiple care providers as dictated by scheduling, rather than preserving worker -client relationships through regular and consistent care providers coming into the home.…”

“…In recent decades, client caseloads have increased in size and complexity across Canada. There is growing awareness of the need to improve the home care system for frail seniors to foster quality of life, and also to reduce unnecessary hospital visits (Cohen, 2012;Sharman et al, 2008). In British Columbia (BC), evidence suggests that the provision of home and community care services decreased by 14% between 2001 and 2010 even though client complexity and need for care have increased (Cohen, 2012).…”

“…In British Columbia (BC), evidence suggests that the provision of home and community care services decreased by 14% between 2001 and 2010 even though client complexity and need for care have increased (Cohen, 2012). At the same time, changes to home care policies have widened the gap between service continuity and quality of care, and raised concerns about the ability of these services to support vulnerable older adults to age in place (Sharman et al, 2008).…”

“…In the Canadian context, as in other jurisdictions, burgeoning costs and the resultant restructuring of health care systems pose challenges for the provision of adequate home care services for older adults and families in later life, despite a growing awareness of the importance of these services (Canadian Institute for Health Information, 2011; CloutierFisher & Joseph, 2000;Sharman, McLaren, Cohen, & Ostry, 2008). Some of the most significant challenges in the home care sector in recent decades have been in the form of funding cuts and policy shifts (e.g., an emphasis on home care for post-acute older populations rather than for chronic, long-term service users).…”

“…Some of the most significant challenges in the home care sector in recent decades have been in the form of funding cuts and policy shifts (e.g., an emphasis on home care for post-acute older populations rather than for chronic, long-term service users). Cuts and policy shifts have ultimately affected the availability, accessibility, and form of this care for older adults and disabled persons (Canadian Institute for Health Information, 2011;Martin-Matthews, Sims-Gould, & Tong, 2013;Sharman et al, 2008).…”