Home safe home
Home health care is the best-kept secret in the health-care system, according to Stuart Cottrelle, president of the Ontario Home Health Care Providers' Association. It's a failing that frustrates him, because it means so many frail, often ailing elderly people, are going without the care they need.
"There are thousands of people needing help who are not getting it," Cottrelle says. I constantly hear, "I wish I would have heard about your services when . . ."
One of the things we assume (as a society) is that we will get whatever help is available and appropriate when it comes to home care, but that doesn't happen because it's a scarce resource and as an industry we are doing a bad job of communicating," he says. "We are not visible. Institutions are."
Home health care is new to Canada, he adds. "Other countries like England, the U.S., Holland and Sweden practise it at the front end. We have not been trained that way. Our health-care system is based on acute needs - it's not set up for the typical chronic-care Canadian who needs home health care. (In Canada) we do the more expensive things, not the less expensive.
"By the time someone calls us they are totally bewildered by the system," says Cottrelle, who has been in the industry for 20 years and is also president of Bayshore Health Group, a national network that provides nursing and home support services.
"They think they need 24-hour nursing care, but once we assess (their situation) we find they only need a few hours. And when they do get home care they are amazed, because they had no idea it existed and. . . at the small amount they need."
Home care is absolutely vital, Cottrelle adds, because it allows people to avoid other more expensive elements of the health-care system like institutionalization.
"If we do not have a strong home health-care system, we're allowing frail people to become more in need. We're putting them at risk and all of a sudden we have to move to a higher level of care like a nursing home."
An accident or stroke is often the catalyst.
"A lot of times, when (elderly) people repeatedly end up in emergency rooms, it's because they're in failing health and require ongoing help, or have had a fall. They have no personal support or they haven't been eating properly, they become weak and dizzy and before you know it they have an accident and end up immobilized and need long-term care."
What often happens, says Mary Plaudis, director of customer service for Bayshore HealthCare, is that a person in failing health will pretend nothing is wrong, rather than go to a nursing home.
"They try to hide the fact they are having problems. Never mind that they haven't eaten in four days," she says. "They'll say, ?Don't tell my daughter because I don't want to go to a nursing home.' But they are aware they need help so they end up searching through the Yellow Pages looking for nursing care."
For those who do connect with home care, they often find that even the most basic help - assistance with grooming or meal preparation, for instance - will go a long way toward keeping them healthy and able to manage.
"Home care is an (attractive) alternative to traditional hospital or long-term facility care," Plaudis says. "It's flexible and empowering; it preserves independence."
Sometimes a neighbour may become aware something is wrong and call social services, but most often it's a hospital discharge planner who arranges for home care.
Referrals are made through the patient's area Community Care Access Centre, government-established agencies that serve as gatekeepers to a host of funded health-care services that include personal home care, nursing, occupational and physiotherapy and homemaking services.
The agency will send someone to assess people who are sick, elderly or physically disabled, then arrange for care through agencies, organizations and facilities that have contracts with them. "Clients always do better in their own homes, especially if they have family (nearby)," Plaudis says. "It's familiar to them and they are more comfortable. They heal more quickly (after an illness or injury) and they have more independence."
Simple modifications, such as a raised toilet seat and grab bars in the tub, may be all it takes to allow someone to remain at home with a little help.
But it's the caregivers themselves who really make the difference: holding a hand, listening, encouraging, bathing, dressing, tidying up, preparing a hot meal, changing a dressing. They are the supporting arm on a stroll around the neighbourhood or a visit to the doctor or grocery store. They are also the decoders of the health-care system, often making things happen with a single phone call.
They can be a personal support worker or homemaker, a nurse, a
physiotherapist or even a companion. They can visit a couple of
times a week or every day; for a few hours or around the clock,
at home, in a long-term care facility or retirement residence, or
even a hospital. Their qualifications range from a few weeks training
to master's degrees.
Personal support workers must take a nine-month course from a community college to become qualified. They are trained in all aspects of personal care and may specialize in areas such as palliative care or dementia.
Home support workers are another category of home health-care providers.
They cook, clean and do laundry, but not personal care. As they
gain experience, they can assume more responsibilities, such as
basic grooming and dressing or assisting with outings.
When it comes to specialized care, home-care nurses run the gamut from treating skin rashes and bedsores to changing catheters to co-ordinating the entire care plan.
"The nurse is the hub of what happens," says Shirley Egger, manager of Clinical Practice of Nursing for Bayshore HealthCare in Hamilton. "Along with the case manager from the CCAC, she organizes the other disciplines."
"If a person is having financial problems, she would contact the social worker, who can then help the client apply for benefits or arrange for power of attorney. She would communicate with doctors to find solutions for problems like incontinence or bowel problems. She is also the teacher, showing people how to monitor their blood sugar levels or helping them with nutrition.
"We work closely with the occupational therapist to make sure (seniors) are safe and not leaving burners on. We make sure (seniors) can complete the acts of daily living - so we may have to take the fuses out of the stove, for instance."
There are two types of home-care nurses - visiting nurses (funded by the CCAC) who may spend from half an hour to two hours in the home, and shift nurses, usually paid for privately or by an insurance company, who may spend from four to 12 hours in a client's home, or stay with them in hospital or a long-term care facility for a period of time.
Until January this year, Egger was a front-line nurse herself. One of her clients was an 86-year-old woman who was in heart failure most of the time.
"I went once a week at first, for about a year, then every day and sometimes twice a day near the end to make sure she was OK," Egger says. "We had many conversations with her doctor. And we also kept her daughter posted."
Egger says that home care allowed the woman to remain comfortably in her home until her death, which was important to her and her family.
"When I met the family at the funeral home, they were so appreciative," Egger says. "That's what's important. That we made a difference."