Tag Archives: home care

Interim Report: Home Care Nursing Health Human Resources – Building and Sustaining a Quality Nursing Workforce

Posted on by mkoh

Research Team

Diane Doran, RN, PhD, FCAHS
Dan Laporte, Research Manager, NHSRU
Sang Nahm, Data Analyst, NHSRU
Laureen Hayes, Research Officer,
NHSRU Roshan Khan, Research Officer, NHSRU

Executive Summary

Ontario faces enormous health care challenges driven by realities that include: a shortage of nurses, an aging workforce, issues in inter-professional care, advancing technologies, increasing patient complexity, and a need for chronic-disease management. Underlying all of this is a recognized concern about the available supply of the nursing workforce and projected shortages of Registered Nurses in Canada of almost 60,000 full-time equivalents (FTEs) by 2022 (Tomblin Murphy, 2009). Effective strategies are needed to address the impending nursing shortage, particularly in sectors such as home care and Long-Term Care (LTC), where demand for health care is expected to increase and where disparities in nursing services supply and demand have been the most glaring. Furthermore, new possibilities in service delivery are being created, through the Ontario provincial government’s Aging at Home (AAH) strategy (MOHLTC, 2009), which emphasize community-based partnerships and an integrated continuum of services. Researchers, home care nurses, nurse leaders and policy makers need to work together to generate the evidence required to support the goals of effective chronic disease management and improved outcomes for Ontario’s diverse population.

This study was designed to generate evidence about effective strategies for recruiting and retaining home care nurses and sustaining home care nursing capacity, in order to meet the health needs of Ontario’s diverse population. It is the researchers’ intention that the findings of this study will assist with creating solutions for attracting nurses to under-resourced areas by improving the prospects for rewarding, long term employment for home care nurses through the creation of policy change. A second goal of this applied research project is to inform policy decisions, through valid research, about effective strategies for optimizing the utilization of RNs and RPNs in community practice settings.

The primary objectives of the study currently underway at the Nursing Health Services Research Unit (NHSRU) are to:

  1. Determine how decisions, on the utilization and allocation of Registered Nurses (RNs) and Registered Practical Nurses (RPNs), are currently being made in Ontario home care provider agencies; investigate the feasibility of, and provide input into, the development of an RN/RPN Utilization Toolkit for the home care sector.
  2. Compile a detailed demographic profile of nurses working in the home care sector and identify areas of concern/strength related to current trends in the home care nursing workforce.
  3. Evaluate the unique challenges of attracting and retaining early, mid and late career nurses to the home care sector and describe factors or policy initiatives that may be instrumental in attracting new graduates to community nursing as an employment choice.

To date, researchers have completed a detailed demography of visiting home care nurses working in Ontario, and are in the process of administering surveys to a stratified sample of 900 early, mid and late career nurses in this sector.  Concurrent with the survey administration, interviews with a sample of home care (HC) decision makers are being conducted by NHSRU staff. Interview questions have been developed to address issues associated with the allocation and utilization of RN/RPNs in Ontario’s home care settings.

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Aging at Home

Posted on by mkoh

This summary highlights findings from a study investigating the workforce profile of community healthnurses and public health nurses, and presents sugggestions for aging at home strategies. The research study is funded by Canadian Health Services Research Foundation; Public Health Agency for Canada; Health Canada (First Nations &Inuit Health Branch, Health Human Resources Strategy Division, and Office of Nursing Policy); British Columbia Ministry of Health (Nursing Directorate and Communicable Diseases &Addictions Prevention Branch); Nursing Health Services Research Unit (McMaster site) and Vancouver Coastal Health.

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The Effectiveness and Efficiency of Home-Based Nursing Health Promotion for Older People: A Review of the Literature

Posted on by rkhan

Author(s): Markle-Reid, M ., Weir, R., Browne, G., Roberts, J., Gafni, A., & Henderson , S.

Publication: Medical Care Research and Review, 2006 Oct; 63(5): 531-69

Abstract: Despite the large potential role that community nurses have in providing individualized health promotion to older people, there is a lack of consensus in the literature regarding this role’s effectiveness and efficiency. This article presents a literature review and synthesis of 12 randomized controlled trials selected from 344 published studies on preventive home visitation programs for older people. The findings suggest that a diversity of home visiting interventions carried out by nurses can favorably affect health and functional status, mortality rates, use of hospitalization and nursing homes, and costs. Further research is needed that focuses on the outcomes of quality of life, mental health, social support, caregiver burden, the acceptability of intervention, and specific subgroups of clients who benefit most. Findings also indicate the need for a theoretical foundation, increased emphasis on health-promotion strategies, and more research using a more complete economic evaluation to establish efficiency.

The nature of safety problems among Canadian home care clients: evidence from the RAI-HC Reporting System.

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Author(s): Doran, D.M., Hirdes, J., Blais, R., Baker, G.R., White, N., Pickard, J., & Jantzi, M.

Publication: Healthcare Quarterly Vol. 12 Special Issue 2009.

Abstract

Objective: The objective of this study was to assess the burden of safety problems among Canadian home care (HC) clients.

Methodology: The study methodology involved a secondary analysis of data collected through the Canadian Home Care (HC) Reporting System, which utilizes the RAI-HC© assessment tool. The study sample consisted of all home care clients who qualified to receive a RAI-HC assessment from Ontario, Nova Scotia, Winnipeg Regional Health Authority, and Yukon Territory for the 2003 -2007 reporting period.

Key Findings: The majority of HC clients were in the 75+ age range, female, living with someone else, and cognitively intact. The incidence of new fall was 11%; unintended weight loss 10%; new emergency room visit 8.3%; new hospital visit 7.7%; decline in cognitive performance 5.7%; urinary tract infection 1.9%; deterioration in pressure ulcer 1.8%; new pressure ulcer 1.7%; pneumonia 0.9%; new bowel problem 0.8%; dehydration 0.7%; and caregiver decline 3.3%. Homecare clients presented with multiple risk factors, such as polypharmacy, living alone, and no recent medication review. These risk factors were differentially related to potential adverse outcomes. For example, the odds of emergency room visits increased with history of two or more falls (OR=1.2), cancer diagnosis (OR=1.2), receiving anxiolytic medication (OR=1.2), receiving antidepressant medication (OR=1.4), and polypharmacy (OR=1.5). It decreased with lower self-reliance (OR=0.9) and activities of daily living (0.8).

Conclusion: The RAI-HC© assessment tool provides valuable information about adverse outcomes and risk factors for Canadian home care clients. New fall and emergency room visits were among the most frequent adverse outcomes. Many of the safety risk factors are modifiable but require client behaviour change, health provider behaviour change, and health system policy change. Policies should be developed to encourage best practice related to risk mitigation.

Identification of Safety Outcomes for Canadian Home Care Clients: Evidence From the RAI-HC Reporting System Concerning Emergency Room Visits

Posted on by rkhan

Author(s): Doran, D.M., Hirdes, J., Poss, J., Jantzi, M., Blais, R., Baker, G.R., & Pickard, J.

Publication: Healthcare Quarterly Vol. 12 Special Issue 2009.

Abstract: Problems of patient safety have been well documented in hospitals. However, we have very limited data about patient safety problems among home care clients. The purpose of this study was to assess the burden of safety problems among Canadian home care clients using data collected through the Resident Assessment Instrument – Home Care (RAI HC), and to explore the role of age and patient safety risk factors in explaining variations in adverse outcomes, with a particular focus on emergency room visits. The study methodology involved a secondary analysis of data collected through the Canadian Home Care Reporting System. The study sample consisted of all home care clients who qualified to receive an RAI HC assessment from Ontario, Nova Scotia and Winnipeg Regional Health Authority for the 2003-2007 reporting period. There were a total of 30,396 cases with a paired intake and 12-month follow-up assessment available for analysis. New falls, unintended weight loss, new emergency room (ER) visits and new hospital visits were the most prevalent adverse outcomes. A history of falls, a cancer diagnosis, polypharmacy, receiving an anxiolytic medication and receiving an antidepressant medication were associated with an increased risk of ER visits, while low self reliance and limitation in activities of living were associated with a decreased risk of ER visits. Understanding clients’ risk profiles is foundational to effective patient care.

“What’s In, What’s Out”: Stakeholders’ Views About the Boundaries of Medicare

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Authors: Raisa Deber and Brenda Gamble

Publication: Healthcare Quarterly. 2007;10(4):97-105.

The Canada Health Act requires that provincial insurance plans provide universal coverage without copayments for all “medically necessary” services delivered by hospitals and doctors, but allows care delivered by other providers in other locations to fall outside of the boundaries of medicare. Discussion about the sustainability of medicare at both the national and provincial levels has called for the revisiting of these boundaries. The M-THAC (Medicare to Home and Community) Research Unit attempted to clarify the areas of consensus and controversy as to what key stakeholders thought should be “in” or “out” of Medicare. Using a non-experimental, cross-sectional design, a self-administered survey (in both English and French, constructed in consultation with our partners) was distributed between January and April 2002 to policy elites of key stakeholder groups. The results are based on 2,523 responses. Much of the current “debate” is mired in discussing issues where consensus already exists. We found strong support for in-hospital care. However, there is considerable resistance, across all groups, to full funding for similar services in private clinics or in the home, and almost no support for full funding for non-medical home-based services. The vision of many policy elites remains heavily linked to the current system of guaranteed public funding only for acute care in hospitals or by physicians. Successful reform will need to address, rather than assume, a broader view of healthcare.

Health Promotion for Frail Older Home Care Clients

Posted on by rkhan

Accepted by: Journal of Advanced Nursing (2006)

Authors: Markle-Reid, M., Weir, R., Browne, G., Roberts, J., Gafni, A., & Henderson, S.

Background: An aging population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for post-acute care. For frail older people with chronic needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on-demand rather than a proactive system of care.

Aims: This study aims to evaluate the six-month comparative effects and expense of a proactive nursing health promotion intervention in addition to usual home care for older people compared to usual home care services alone.

Methods: Two-armed, single-blind randomized controlled trial of older people > 75 years and eligible for personal support services through a home care programme in Ontario, Canada. Subjects were randomly allocated to either the usual home care (control) or the nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education regarding management of illness, coordination of community services, and empowerment strategies to enhance independence.
Results: Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared to providing nursing services on-demand, resulted in better mental health functioning (p = 0.009), a reduction in depression (p = 0.009), and enhanced perceptions of social support (p = 0.009), at no additional expense from a societal perspective.

Conclusions: Home-based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of healthcare. The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care.

Seniors at Risk: The Association Between the Six-Month Use of Publicly Funded Home Support Services and Quality of Life and Use of Health Services for Older People

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Authors: Markle-Reid, M, Browne, G, Weir, R., Gafni, A., Roberts, J., & Henderson, S

Publisher: Canadian Journal on Aging, 27(2), 207-224, 2008

Key Messages: This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support services for more than 1 hr/week; these seniors had higher rates of depression and cognitive impairment, lower levels of physical and emotional functioning, and less effective coping styles than those who used fewer services. Cognitive impairment explained 17 per cent of the variation in use of home support services. At 6 months, use of home support services for more than 1 hr/week by seniors with higher levels of need was associated with lower cost of use of health services and lower levels of improvement in health status. These findings suggest the need for further research to identify efficacious ways of providing home support services to this population to enhance their health status using available resources.