Protecting Patients at Home

Brown, Lynn (2017) discussed issues in long-term care which leave people
vulnerable. Privatization and short-staff front-line workers were mentioned as
factors that detract from quality care, resulting in faster deterioration of
residents.
In 2016 a Bill known as the Time to Care Act passed the first reading. It is
an amendment to the Long-Term Care Homes Act (2007) stating that each
resident will have at least four hours daily of hands-on nursing & personal
support services averaged across residents.
Connection, SaultOnline.com Vol. 2 ISS 2 January 16, 2017, p 10.
This is a positive step for long-term care facilities but it is uncertain whether
it is applicable to home settings. What is certain is the present state of
insufficient home care. Instead of 4 hours as per the new Bill, individuals
receiving home care typically have 30 minutes daily. Disgruntled workers are
acutely aware that tasks cannot be completed on chronically ill individuals in
this minimal time so cut corners. It stands to reason that home care settings
are not equivalent to long-term care facilities. Special regulations and
legislation tailored to protect individuals receiving home care is needed.
Home settings cannot be lumped together into long-term policies. It is like
suggesting apples and oranges are the same.
1. Everyone seems to blame private agencies, but even when the system
and agencies work, it does not work. A private home care agency
allocated 1.5 hours for my sister in the morning. It is generous on the
part of this agency, but few workers work the entire time. They either
arrive late or leave early, signs of stress, burnout, and scheduling
conflicts. In addition to contending with our own stress from caring for
an extremely ill loved one, we often become sounding boards for
workers experiencing high levels of stress and job dissatisfaction. Care
has become careless.
Excellent workers assist my sister, focussed on quality, holistic care.
Unfortunately, this is the exception rather than the norm. Solutions are
needed. Possibly workers could:
2. Remember, home care is a clinical setting, as professional as if it were
a hospital or long-term care facility. Professional boundaries are
important including punctuality, working the entire shift, keeping self-
disclosure to a minimum instead of maximum. Personal problems are
best addressed with trained professionals.
 In-service workshops reinforcing professional boundaries to help
caregivers deal more effectively in a home setting may be helpful. A
home environment is more intimate than a long-term care facility by its
very nature. This makes it easier for workers to overstep boundaries. A
loosening of professional intimacy is to be expected and savoured, but
there are lines professionals must not cross. These are crossed too
often such as workers bringing their own personal problems into the
home.
3. Home-care settings are more isolated than long-term care facilities.
This brings unique problems without an avenue to presently address
them. As an example, workers triggered by circumstances in the home
cannot support each other over a coffee break like workers in a
hospital setting. Instead workers converge on the road or end of the
driveway. It is understandable but undesirable. We do not like having
our home a parking lot of unresolved issues.

4. Sometimes, workers are not aware they are reacting to issues in the
home, but it is obvious to those receiving care. As my sister became
sicker, some workers would pull away, ill-equipped to deal with loss.
Sometimes, they were unable to remain in the present because they
had not fully dealt with their past. The isolation of a home setting fuels
this kind of behavior, letting issues go unnoticed so workers are unable
to receive the support needed to enhance their professional roles.
Sometimes the issues have nothing to do with the home environment,
but workers bring their own concerns into the home. They tell us No-
one in the agency is listening.
A hot line, a neutral professional or an organization is needed where
home care workers can voice concerns in a safe manner without fear of
repercussions is needed. It is equally as important that workers are
reassured issues will be addressed and resolved. Workers are afraid to
stir up the pot by bringing issues to the attention of supervisors
because job security and promotions may be jeopardized. Also,
workers are reluctant to discuss issues with supervisory staff,
suggesting they are not responding in a timely and effective manner.
Unfortunately, issues hidden away cannot be solved. The end result is
a lack of results.
5. Even if people are dying and nearly dead, they are more than a
physical shell of a body. Regardless of the appearance of the body, it is
essential for workers to remember that a person is present, a person
with emotional and spiritual needs. Caring for the ill is a primary
 motivating factor for workers called to the health professions, but the
caring is not showing through, not shining through.
In-service workshops or education emphasizing holistic care are
necessary. The current focus is geared toward meeting basic
physiological needs with lesser regard for the emotional aspects of a
person. For example, some workers race to bathe my sister quickly
then leave early instead of performing other essential tasks such as
feeding her. Basic care, neglecting emotional care, neglecting
intellectual stimulation is the norm. Even some essential basic needs
are not performed optimally, especially dental care which is often
haphazard. However, research demonstrates that oral health is linked
to health in the entire body including the heart and brain. We often
remind workers to perform all tasks because my sister cannot speak.
Hopefully, individuals receiving home care are able to speak for
themselves so they have a better chance of having needs met. But
face it, sick people are vulnerable and at the mercy of others.
Safeguards are needed.

6. Continuity of care eliminates chaos. A continual flow of different

workers coming to the home for the same patient is not desirable or
efficient. It is not good for patients in the home who develop bonds
with certain workers. It is not desirable for workers who feel more
comfortable in certain homes.

Matching workers to specific homes would be empowering. They will

know the routines inside and out. This would increase efficiency.
Workers could memorize routines, know where supplies are located
and perform tasks with ease. A win-win instead of a spin- spin with the
influx of different workers. When new workers come into our home, we
have to educate them as to the location of supplies and personal
items. It takes time. It is tiring for them, tiring for us. Some workers
shared that people refuse to let them into their home. I understand.
Sometimes it is better to lie in bed uncared for than to receive this
type of care

Making workers part of the matching process would be ideal. Having

workers refuse assignments to homes where they feel physically or
emotionally unequipped to care for the patient makes sense. When
hesitant workers arrive, they rarely perform all tasks anyway.
Continuity would address this. Workers who shine in our environment
would select our home or be assigned to us.
 7. Workers must be fully trained for the functions they perform. Personal
support workers must be trained and signed off to use equipment. In
December a worker with 30 years experience came into our home but
was not signed off to use a mechanical lift. Either sign off this worker or
send another worker. My sister had a bed bath instead of a shower.
This strips away care from a person who has had so much stripped
away.

It may be necessary for nurses with less experience to be paired with

more experienced nurses. My sister was left with a full bladder in
December because a nurse was unable to catheterize her. Patients
cannot be left in situations which could be potentially life threatening.
A home is not like a hospital or long-term care setting where there are
other staff with whom to consult.

8. It was suggested by workers who truly have best interests in mind to

keep my sister in southern Ontario or Sudbury where more funds are
allocated. We have contemplated relocating. More in the Sault is
needed. More funding. More help. Our residents are every bit as
important as the resident in other more densely populated cities.
I have been writing a journal highlighting the stresses and strains of home-
care and issues on both sides of the fence. Workers who are allowed
insufficient time as well as insufficient training have exacted a toll. I asked
workers to step forth, but they always caution me not to use their name
when they share frustrations, fearful job security will be compromised. I
understand their concerns. It must be difficult being employed in a system
without a neutral support where concerns can be aired. Presently, there is an
inordinate amount of fear without a way to voice concerns in a positive way
so issues can be addressed, improved or resolved. It is the vulnerable and ill
at home who suffer in silence without a voice, without a choice.
Essentially, four choices confront us all.
1. Keep health
2. Long-term care
3. Home-care
4. Euthanasia, depending on ethics, beliefs, laws
But when sickness arrives, it arrives and we need safeguards to protect the
sick. This article touches upon the ramifications of sickness, the difficult
choices people must make about either keeping someone at home or placing
them in a long-term care facility. Both choices have an incredible cost to the
human spirit. It is true a person is most comfortable in the home, lives longer
in the home and this is preferable. But the situation must be improved so
individuals can remain in their home longer. Policies to lessen suffering
instead of increasing suffering must be enacted by taking an in-depth look at
the current situation.