Home Health staff spoke and we’re listening
Thank you to the more than 100 Home Health staff who found time in their busy schedules to attend one of two Open Talks on Home Health.
Organized in response to a request from Home Health staff, the first installment of the Open Talk series ran August 20 at Robert and Lily Lee Family Health Centre. The second ran September 10 at Pacific Spirit Community Health Centre.
The forums’ goals were three-fold: provide an update on the context that Home Health staff is working in, answer questions, and – above all else – listen.
You’re passionate about what you do
At both sessions, you told us that you care deeply about the clients you support and helping individuals stay well at home. You are delivering care to increasingly complex clients and you expressed concern about the community’s ability to respond in a timely way to all clients, not just focus on the crisis situations; you also expressed concern that the public doesn’t understand the limitations of the care you provide, and that staff are feeling the pressure of meeting the increasing demand.
Your concerns are valid. It remains our goal to work with you to find ways to enable you to provide high quality care to those that need it while creating a system that is sustainable and responsive. We are committed to safely supporting clients to be Home First. At the same time, we need to work collectively to address the demand and create capacity through collaborative work across community, acute and residential care.
“To find our way through this, two-way communication is necessary and will be key to our success,” said Laura Case, Chief Operating officer, One Vancouver. “We must continue the dialogue that these sessions have started.”
Measurement will identify our successes and challenges
A key step involves measurement. We are currently developing metrics to evaluate both our Home Health successes and our challenges. We need to measure our work so we can realign resources where – and if — it makes sense to do so in order to augment our capacity to meet future demand.
“We have hundreds of years of experience between us,” said Vivian Eliopoulos, Chief Operating Officer, One Vancouver. “Together we will find ways to meet our quality indicators as well as create capacity to meet future demand.”
Just last week, we identified through our data that Home Health staff achieved the near-impossible. Since July, we completed approximately 500 overdue RAI MDS assessments. What appeared to be a daunting task was tackled with remarkable teamwork and a commitment to collaboration and on-the-job excellence.
Let’s figure it out together
At the July All-Staff Forum we asked participants for their savings ideas and received more than 100 ideas to explore. We could use more.
Our “ask” arising from these two Home Health Open Talk forums is that you continue to share with us – your ideas for improvement, your thoughts about gaps in care, the systemic barriers you face, and your clients’ ongoing needs.
“Changes will happen client-by-client,” said Laura Case. “We need to know when you encounter barriers to providing the right care for our clients. We need to know what those barriers look like so we can take action to remove them, client-by-client, situation-by-situation. With this kind of open exchange, we can create a system that not only results in high quality patient care, but is also the kind of care that you will be proud to deliver to your clients.”
Feel free to contact us
Whether you work in Home Health or not, we encourage you to share your insights, feedback and suggestions for ensuring patients receive the right care, in the right place, at the right time. Please continue to share your experiences, ideas and feedback with us. Email us at: OneVancouver@vch.ca.
Laura Case
Thank you for your thoughts, Laura. We appreciate that our front line staff are the face of the organization, and that sometimes it’s a tough position to be in.
As Home Health staff, we recognize that you have the relationship with the client and family member and as a result, they will be asking questions of you about their services and changes to their services. As a frontline provider, we do not want you to feel that you are answerable for changes implemented across the provincial healthcare system. We also recognize that information provided in the media is not always timely or aligned with what may be taking place in your particular area of service.
Our intention is to ensure all staff has the knowledge and understanding of changes underway. To that end, we have implemented All Staff Forums as vehicles to support communication and dialogue. In addition to this, if you’d like to feel better equipped, please let us know directly. We’d be happy to create some speaking points – or any other tools you think are necessary — for you to address ongoing client concerns in a thoughtful manner.
Having said this, if questions arise that you are not comfortable addressing, then we would urge you to provide the client with a contact number of your manager or director.
As you know, VCH Home Health staff provides direct health care to clients. To support client needs that are not health-related, the Ministry of Health has implemented Better at Home. This program augments the medically necessary care you provide with services such as house cleaning.
You also raise a valid point about the need for acute and community to work closely — and respectfully — to exchange information pertinent to ensuring positive outcomes for the client when they go home. We are exploring a number of strategies to improve the collaboration and partnership between the two sectors, focusing on the care needs of the client. Home First case conferencing and Ideal Transition Home are just two examples, but we know there are still many opportunities to improve collaboration.
By supporting acute care to “reach out”, and home health to “reach in”, we hope to shorten lengths of stay in acute care – or avoid them altogether – for our elderly population that don’t often thrive in the hospital setting. As you wrote, the notion of planning for discharge upon admission is so very important. We know we must continue to work on improving that practice as we strive for better care.
We will be engaging frontline staff in our efforts to make quality and efficiency improvements, so we may call upon you to further share your ideas. Thank you for taking the time to articulate your thoughts.
Laura Gibson
Hello,
I have some additional comments which I would like to share.
A few weeks ago when I arrived at an 86 y.o. client’s home for an annual review with 2 daughters, one dtr. held a newspaper clipping in her hand. When I informed client & family of decrease in home support (no cleaning or cooking as per VCH guidelines) the daughter with the newspaper said “It says here that the government gave more money to Health Ministry and to United Way for Better at Home.” And went on to ask why I was cutting services which client needs when the government has more money for health care. I have had other clients say “The government talks about Home First and Home is Best but then cut the services which my mother needs”. I am the face of the government and health ministry and VCH when I visit clients. What am I to say???? At your forum you at least gave the information that there is no more money and it will continue to be a situation of making changes to be more efficient. Why isn’t VCH giving this same, more truthful information to media? Instead it is left to front line staff to deliver the news that HSW is being decreased. Clients are only seeing cuts, not efficiencies!
Regarding acute discharge planning to community it seems clear that acute does not understand or have the time or inclination to want to view the client from their home perspective. A couple of suggestions then:
a) have every acute TST, SW and whomever else is in charge of d/c planning, shadow a community staff for one day to see what they are discharging their clients home to;
b) instead of acute phoning community CM or Client Coordinator to ask “How much home support can he/she get?”, call and describe what client NEEDS, then discuss how/whether client’s needs can be met by VCH services;
c) BEFORE acute calls community for d/c planning, have acute collect ALL pertinent assessment information about client’s current ability re ADL’s and IADL’s. Have acute staff trial client at doing ADL’s independently since there may not be anyone at home to take client to toilet, for instance. In my experience the first contact from acute typically is to ask how much service client can get without knowing client’s functional ability – thus the waste of a phone call, my time and acute’s time;
d) if acute does not know what needs to be assessed re ADL’s & IADL’s, have them refer to section H of the MDS assessment. Or perhaps community could devise a template of what is needed to know for discharge planning. I would be happy to be part of developing such a template.
e) I shudder to think what would happen to my caseload, but perhaps consider (and I know it has been talked about many times over the years) having CM come into acute for discharge planning of KNOWN community clients. However if this were to happen there would need to be a process whereby acute would provide client information in a timely manner to such CM so that CM time would not be wasted trying to connect with the responsible acute clinicians or review client’s acute record.
I was taught, way back in the dark ages, that staff need to start discharge planning the day the client enters a hospital. This message seems to have been forgotten but has never stopped being pertinent. Perhaps it is a credo to bring back to the fore!