In late 2015, the Canadian Patient Safety Institute, the Canadian Home Care Association and the Canadian Foundation for Healthcare Improvement launched the Home Care Safety Falls Collaborative. Organizations providing care in the home participated in a series of online virtual meetings and received individualized coaching and support to prevent falls in the home. Teams from the Canadian Red Cross, Eastern Health, Saint Elizabeth Health Care, VHA Home HealthCare and the Winnipeg Regional Health Authority participated in the six-month Collaborative. In this article, The Canadian Red Cross shares their key learnings from the Collaborative.
The Canadian Red Cross (Ontario Community Health & Wellness programs) used a two-prong approach in setting the goals they wanted to achieve as it relates to the Home Care Safety Falls Collaborative. One of their measures focused on a specific targeted client population at high risk for falls and the other was to develop a service planning tool related to the outcome of the InterRAI Community Health Assessment (CHA), which is a standardized tool that is a mandated requirement of all Ontario community support service programs.
"The Service Planning Tool helps frontline workers to identify action items that engage both the client and the caregiver in the care process, and promotes the understanding that clients and/or their caregivers have a responsibility to be actively involved in their care," says Jody Hales, Director of Quality Assurance & Risk, Canadian Red Cross Community Health & Wellness programs. "It is not just about providing a service; the client and/or their caregiver need to be engaged, and take on a role of responsibility as it relates to their own well-being."
In developing and evaluating the Service Planning Tool, one of the key findings was that many caregivers are a family member or significant other of the client, who work outside of the home and therefore are most often not present for the client's assessment (assessments are done during the regular work day, most often when the caregiver is working).
"That was quite a finding for us," says Hales. "Even though we are a 24/7 service, our supervisors work nine to five, Monday to Friday and are on-call for emergencies, we don't plan after-hour home visits and we may need to consider that. We need to understand our client population; you can't put everyone into one basket."
This pilot project was affiliated with the Canadian Red Cross assisted living and attendant care programs in Cornwall, Ontario focusing on the use of the InterRAI Community Health Assessment (CHA) tool. This involved using the electronic validated assessment tool (as mandated in Ontario), where information is auto-populated into clinical assessment protocols (CAPs), which help identify specific risks to each individual client, which in turn, informs the care planning process.
"One of our key findings was with connectivity issues at the point of care, being in the client's home – connectivity was very sporadic," says Hales. "This led to the completion of a provincial survey which identified that connectivity was a huge challenge across the province, not only in outlying areas, but in apartment buildings, basements suites and other geographic areas. Before you employ anything electronically, you really need to conduct foundational work to determine its feasibility and identify what effect it will have on both the provider and the end user."
The connectivity issues resulted in the Canadian Red Cross supervisors and care coordinators having to print off the forms and manually completing them during the assessment at the point-of-care, then returning to the office and entering the data electronically (where there was good connectivity) which in turn would then auto-populate the risks for each specific client – clinical assessment protocols (CAPs). The supervisors and care coordinators would then travel back to the client's home to discuss the identified risks to inform the care planning process, in collaboration with the client. It is a huge, time-intensive process that requires duplicate effort resulting in additional workload. The Canadian Red Cross is now looking at options to address the identified connectivity challenges.
Another key learning was related to client engagement. Understanding what is important to the client, rather than relying on worker perception. The Canadian Red Cross had a client representative join their Falls Collaborative team.
"Our client representative was invaluable," says Hales. "She reviewed existing support documents and provided open and honest feedback. What was really interesting and important was to be cognizant of the level of information that we are providing. It is critical to understand our audience when delivering information. We must make it relevant and understandable for our clients and caregivers. We need to identify what is most important to our end user - our clients and focus on that."
Jody Hales explains that they don't service just one client population. "As a service provider, it is vital that we understand the unique needs of all our client populations and although it is predominantly the senior, frail population that most often uses our services, we also have an attendant care population -servicing adults with physical disabilities."
"Our quality improvement work is a continuous process," says Hales. "You can't just develop something and leave it. You need to engage clients, their caregivers and our frontline staff – those that are using the tools to ensure they continue to be relevant and responsive to the needs of our client population(s). We recognize that clients and their caregivers are critical partners in their plan of care. As we move forward with our client/caregiver engagement journey, our commitment is to creating the best possible client experience in partnership with our clients, families and the broader community."