A standardized process in the electronic health record to identify and recruit family and other unpaid caregivers of Veterans for a caregiver survey study (Preprint)

BACKGROUND Most efforts to identify caregivers for research use passive approaches like self-nomination. We describe an approach where the EHR can help identify, recruit, and increase diverse representation of caregivers. OBJECTIVE Few health systems have implemented systematic processes to identify caregivers. We aimed to evaluate an electronic health record (EHR) algorithm for identifying Veterans with caregivers. METHODS We identified initial cohorts of Veterans likely to need supportive care from friends or family based with pre-defined EHR referrals for home and community care. Veterans were contacted assess whether the Veteran had an unpaid caregivers; unpaid caregivers were then contacted and offered enrollment in a caregiver survey. We compared Veteran characteristics from the EHR across these referral, screening, and recruitment groups using descriptive statistics and logistic regression models. RESULTS Of 12,212 Veterans identified through EHR referrals, 2,134 (17.4%) were selected for screening and 1,367 (11.2%) answered phone screening; 813 (60%) of those screened had a caregiver, and 435 (53%) caregivers participated in a survey. Married veterans had increased odds of having a caregiver (adjusted OR 2.63 [95%CI 1.65-4.24]) or had an adult day health care referral (adjusted OR 3.06 [95%CI 1.38 – 7.76]) or a respite care referral (adjusted OR 2.21 [95%CI 1.45-3.44].) Caregivers of Veterans with dementia had increased odds of participating in the survey (adjusted OR 1.78 [95%CI 1.20-2.65]). CONCLUSIONS The EHR algorithm process is systematic, resource intensive, and imperfect. Sixty percent of successfully screened Veterans had an unpaid caregiver. Implementing discrete caregiver fields in the EHR would support more efficient systematic identification of caregivers. CLINICALTRIAL ClincalTrials.gov Identifier: NCT03474380.

A SHARP Response: Developing COVID-19 Research Aims in Partnership with the Seniors Helping as Research Partners (SHARP) Group

COVID-19 has disproportionally impacted older adults, and has highlighted many issues, including extreme deficiencies in Canadian long-term care homes and gaps in home and community care services for older adults. In recent years, there has been a push towards better patient and family engagement in health system research, and with the onset of the pandemic, engaging older adults in research and policy planning is more important than ever. In this article, we describe the Seniors Helping as Research Partners (SHARP) approach to engagement with older adults as an example of how partnerships that engage older adults in the development of research aims and processes can help to ensure that future research meets the needs of older adults. SHARP members highlighted a number of areas for future COVID-19 research such as improvements to long-term care, enhancing access to home and community care, and a focus on aging and social isolation.

PP41 British columbia emergency health services assess, see treat and refer palliative clinical pathway

Background/Research ObjectivesParamedic services have experienced a steadily increasing demand from palliative patients accessing 911 during times of acute crisis, and not wishing subsequent conveyance to ED. Early data indicates that many of these patients are NOT already connected to palliative care teams.To address this demand and to connect patients to care, BCEHS introduced the Assess, See, Treat and Refer (ASTAR)-Palliative Clinical Pathway. Objectives are to reduce patient conveyance to ED, reduce hospitalizations and improve patient care through referral after non-conveyance.InterventionParamedic activation of the ASTaR Palliative Clinical Pathway results in referral of non-conveyed palliative patients to local Home and Community Care teams and BCEHS paramedics. The referral occurs within 1-6 hours of paramedic contact and follow up occurs over the next 24-48 hours by telephone. This referral action provides safe, effective, patient-centred care for non-conveyed patients, and also fills a gap for connecting patients to local palliative care teams.ImpactA retrospective case review of 183 cases was conducted. Symptom improvement was achieved in 70% of cases, the ED non-conveyance rate was 19%, and the time on task when palliative patients were treated at home and not conveyed was 37% less (52 minutes) than if palliative patients were transported (82 minutes). All 183 patients were connected to either the local home and community care team or BCEHS Rural Advanced Care Community Paramedics (RACCP).Lessons LearnedPalliative patients frequently call 911 for help during acute crisis events and many of these patients do not wish conveyance to ED. The introduction of the ASTaR palliative clinical pathway provided safety netting and referral to appropriate care teams.

Policy and Practice Note: Policy, Safety, and Regulation with Regard to Ontario Home Care Clients and Personal Support Workers

In light of COVID-19 and elevated concerns for the health of older Canadians receiving care, this Policy and Practice Note explores the confluence of the current home care policy landscape and the organisation of personal support worker (PSW) work, and highlights the need to consider governance of PSW work generally, and in-home and community care especially. PSWs are currently not professionally regulated, nor is there a central site documenting location, education, or any form of verification of the PSW workforce. Home care PSWs often provide physical care in isolated settings with no in-person supervision. In home and community health care, complaints about PSWs can be scattered among different service providers or client files not linked to or searchable by PSW name. This policy note explores how these factors and the currently unregulated status of PSWs affect home care safety in general as well as in the context of COVID-19, Ontario’s decentralised home care system, and efforts towards professional regulation.

Workload, workplace violence and harassment, and well-being of personal support workers in home and community care

Demand for home and community care services has continuously increased in Canada and elsewhere in the last few decades due to aging of the population and healthcare policy changes shaped by budgetary limitations. As a result, home and community care organizations are having trouble hiring adequate numbers of healthcare workers to meet the escalating demand, the result being increased workload on these workers. Another stream of literature has shown that care recipients and their family members, frustrated with the limited ability of healthcare workers to provide adequate care because of increased workload, might resort to violence and harassment. Bringing these two streams of literature together, we examined the relationships among three variables : workload ; workplace violence and harassment ; and well-being of personal support workers (PSWs). Using structural equation modeling, we analyzed a 2015 Ontario-wide survey of 1,347 PSWs employed in the home and community care sector. The results indicate that workload is negatively associated with extrinsic and intrinsic job satisfaction, and this relationship is mediated by violence and harassment and by stress. Specifically, workload is positively associated with violence and harassment at work, which in turn is positively associated with stress, which in turn is negatively associated with extrinsic and intrinsic job satisfaction. Our study contributes to the literature by examining the impact of a work environment factor, workload, on the well-being of PSWs. This approach makes it possible to expand the current literature’s focus on psychological processes at the individual level to a more contextual approach. Furthermore, the results have important implications for home and community care organizations as well as for the healthcare sector in general. The well-being of PSWs is critical to retaining them and to ensuring the quality of care they provide their clients. Thus, their workload should be lowered to a more manageable level to help minimize the violence and harassment they experience.

Assessment, Allocation, And Management Of Home And Community Care Services For Medically Complex Children : A Case Study

This study examines the experiences of CCAC Care Coordinators when assessing, allocating, and managing medically complex children who require home and community care services. A case-study design was implemented, employing a focus group with seven Care Coordinators and an analysis of the 14 Local Health Integration Networks (LHINs) Integrated Health Service Plans (IHSPs) across Ontario. Three major findings arose from the study. First, families are experiencing increased levels of burden related to the child's care responsibilities. Second, there remains a health human resource shortage of individuals with a specialization in paediatrics in the home and community sector. Third, Care Coordinators function as street-level bureaucrats when allocating publicly funded services without the use of a standardized assessment tool. Ultimately, a model of care needs to be implemented supporting a balanced approach to assessment, utilizing standard assessment tools while providing a means for Care Coordinators to utilize their expertise in allocating services.

Assessment, Allocation, And Management Of Home And Community Care Services For Medically Complex Children : A Case Study

This study examines the experiences of CCAC Care Coordinators when assessing, allocating, and managing medically complex children who require home and community care services. A case-study design was implemented, employing a focus group with seven Care Coordinators and an analysis of the 14 Local Health Integration Networks (LHINs) Integrated Health Service Plans (IHSPs) across Ontario. Three major findings arose from the study. First, families are experiencing increased levels of burden related to the child's care responsibilities. Second, there remains a health human resource shortage of individuals with a specialization in paediatrics in the home and community sector. Third, Care Coordinators function as street-level bureaucrats when allocating publicly funded services without the use of a standardized assessment tool. Ultimately, a model of care needs to be implemented supporting a balanced approach to assessment, utilizing standard assessment tools while providing a means for Care Coordinators to utilize their expertise in allocating services.

Improving Access to Home and Community Care: An Analysis of the 2017 Health Accord

In 2017, the federal Liberal government confirmed the new Canadian Health Accord, which included a targeted transfer of $6B over ten years to the provinces and territories to improve access to home and community care services. Although there were previous federal initiatives aimed at enhancing home and community care services, challenges remain. Many Canadians cannot access home care, and a high burden of care is placed on formal and informal caregivers. These challenges partly stem from an unregulated home care sector and a societal undervaluing of the caregiving role. In 2016, federal, provincial, and territorial governments met and established home and community care as a Canadian health priority. Funding was agreed to in principle from 2016 to 2017 and finalized from 2017 to 2019 through a series of bilateral agreements. The targeted transfer appears to be boosting investments in the home care sector and fostering collaboration across jurisdictions. However, it is unclear whether there have been improvements in access to home and community care.