In anticipation of Vancouver’s All-Staff Forum, we received questions about Home is Best (HIB) and what it means for our shared patients/clients and each other. Today, we share our answers to the last of the questions we received.

If you couldn’t join us for Vancouver’s All-Staff Forum, the webcast is available for viewing and full coverage of the event can be read here.

If you have a question about Home is Best (or other work-related topics), we welcome your email at OneVancouver@vch.ca.

Today’s answered questions

Q. When you say “Home is Best isn’t always best for everyone”, can you please elaborate?

A. Our aim is to provide the right level of care in the right setting at the right time, which is why you might hear us say that home is generally best. We want to acknowledge that for some people their conditions are such that they do require the intensity of service offered in other care settings, such as residential or acute care. Each client is assessed on an individual basis with the intention to provide the most appropriate care in the right care setting.

For some people — for example, frail seniors — home is the safest place to recover from illness or injury, and manage chronic conditions. In hospitals, frail elders with chronic conditions are at higher risk for falls, delirium and infections. They’re also at risk of becoming overmedicated or deconditioned because they’re in bed too long.

For other people, acute care in a hospital setting is the most appropriate level of care to ensure best outcomes. For example, a senior who’s broken her hip requires at least some time in hospital for surgery.

And, then, for some people, community services and the support of family and friends are no longer enough to live at home safely. For those who require intermediate or extended care, or perhaps dementia care, residential care facilities provide the right level of care in the right setting.

Q. How is the Home is Best philosophy different from current practice?

A. Actually, in many ways, it isn’t different. Our Home is Best (HIB) philosophy presumes that, with the appropriate supports, the comfort and familiarity of home is often the best place to recuperate from an illness, to manage long-term conditions and to live out final days. To some extent we have always embraced this philosophy, and strived to support individuals and families to receive the care they require in the community. The change is that we’ve created a frame and focus for our goals, how we can best achieve them, and how we’ll evaluate our outcomes.

Having said that, we are, on occasion, challenging each other’s long-held assumptions, refining programs and services to better meet patient/client needs and preferences and breaking new ground with new initiatives.

Take ED iCARE, for example. This collaboration between Vancouver community and acute teams is helping frail seniors with chronic conditions return — and remain — home from the ED, avoiding unnecessary hospital stays. This initiative recently won a 2015 HEABC Top Innovation Award. To learn more about this remarkable acute/community collaboration with positive patient outcomes, read this VCH News story. To meet a patient/client who’s benefitted from ED iCARE and the support of community’s Quick Response Team, watch our new video: Home is Best: Leo’s Story.

We should also add that HIB is a work in progress. As our aging population grows, we’re in a time of transition as we develop new and better ways to create linkages between acute and primary care, to improve access to diagnostics and community services and to manage chronic conditions and end of life

Q. Have other health care networks used this philosophy and what have they learned?

A. B.C.’s Ministry of Health sets out a strategic direction to guide all health authorities in the province, and the ministry’s direction includes supporting seniors’ independence and helping them live in their own homes for as long as possible. So, yes, we’re in good company.

Home is Best is a work in progress and while the health authorities — including our respective physicians, staff and administration — will learn from each other, we also need the partnership and collective wisdom of families, communities and family physicians. We are also learning from government, too.

B.C.’s Seniors Advocate Isobel Mackenzie recently completed a comprehensive review of what seniors want and identified many learnings, including:

• seniors want to age as independently as possible in their own homes and in their local communities
• seniors want housing options and be engaged in their plans
• caregivers require support such as adult day programs and respite to enable them to care for loved ones at home

The Seniors Advocate’s most recent report — “Seniors Housing in B.C., Affordable, Appropriate, Available” — summarizes these and other conclusions and sets out 18 recommendations.

Q. How cost-effective is HIB compared to other models of care?

A. While the costs of acute care and residential care are higher than the costs of delivering care and services in the community, cost is not the driving reason for Home is Best. Helping clients, and especially frail seniors, return and remain home is about quality of care and quality of life.

For many frail seniors, home is the best place to be unless their condition — for example, a broken hip — requires inpatient care. With the appropriate supports, home is the safest place for these patients to recover from illness or injury, and manage their chronic conditions. In hospital, frail elders with chronic conditions are at higher risk for falls, delirium, infections, etc.

It’s also important to recognize that returning and remaining home is the preference for many patients. Patients generally prefer to resume their lives in the comfort and familiarity of their own home, and for many this means being nearer to family and friends. At home, frail seniors have the best chance to regain strength and independence. Helping patients achieve the goal of living at home honours their preference while enhancing patient outcomes.

Q. Sometimes the relationships between professional staff and families can be difficult because staff see themselves as the experts teaching or educating the families. Often, the professionals have absolutely no idea what it is like to live every day with a person with a mental, physical or addiction illness especially because the professionals only have a few minutes or hours of contact maybe a month and don’t have the long term commitment or history. Professionals can have ideas about what the families should be doing or have done in the past that are inaccurate, unreasonable, and or moralistic. How much emphasis is there on promoting a more mutually collaborative relationship?

A. We believe quality care is best achieved when patients/residents/clients, along with families and friends, become partners in care with us — and we’ve declared our commitment to this partnership publicly.

“Partners in Care” is our commitment to providing patient-centred care. The statement of expectations and responsibilities captures how members of the public can expect to be treated while they are in our care, as well as our expectations of the public.

By clearly stating what patients, staff and others who interact within VCH can expect from each other, we aim to ensure that relationships are helpful, considerate and safe. In this way, we will be most effective in developing plans of care that meet patient/client needs and contribute to positive outcomes.

We take pride in the fact that our physicians and staff strive to work in partnership with patients/clients every day, and sometimes under difficult conditions, but we also acknowledge that fulfilling our expectations and responsibilities is a work in progress. Balancing meeting professional standards with being responsive to individual client needs is a challenge and while we may not always get it quite right, we hope this doesn’t get confused with a lack of commitment to deliver quality care collaboratively.

We remain as committed as ever to delivering patient/client-centred care and services and, indeed, our collective efforts to help clients remain in the comforts of their own homes reflect this commitment and honour the preference of many frail seniors.

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