St. Joseph’s Home Care: Bringing Creativity and Innovation to Senior Care

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Kim-Ciavarella-thumbWith a steadily increasing number of seniors entering retirement and seeking long-term care, the home-care industry is a rapidly growing sector of health care, not only in the United States but also in Canada.

St. Joseph’s Home Care is independently incorporated, but falls under the umbrella of St. Joseph’s Health System, which spans the continuum of care from hospitals to home care to long-term care.

As St. Joseph’s Home Care in Ontario builds its niche within the marketplace, the organization is developing creative ways to meet patient needs in a cost-efficient manner.

Focusing more on what patients want

Like the United States, Canada is also seeing baby boomers enter their retirement years. As a result, there is an increased demand for senior-oriented services.

St. Joseph’s Home Care President Kim Ciavarella said her organization has been studying the care models employed by Great Britain and Scandinavian countries, both of which have had large elderly populations for many years.

“The literature available repeatedly states that home care is the most cost-effective way of providing care, as long as there is access to primary care,” she said. “Most patients would prefer to be cared for in their own homes rather than in an institutional setting.”

Evidence related to client outcomes in the home-care sector is limited, but what is available has demonstrated that people recover better when they are content and in a comfortable environment. Ciavarella said one of the most frequently overlooked aspects of providing quality home care is listening to patients.

She gave an example of one 82-year-old patient who was referred to St. Joseph’s. She had received a home assessment that determined she needed personal care and assistance with bathing; such assistance could be provided at great cost three times per week by a personal support worker.

However, when the St. Joseph’s care coordinator came out to see her, it was concluded that this woman was more than capable of bathing herself if a grab bar was installed. The grab bar would cost a total of $30, a solution that saved money and eliminated the need for the personal support worker. Furthermore, the client was much happier because she was able to maintain her independence at home.

“We assume what patients want in many cases, but we need to start listening,” Ciavarella said.

Additionally, falls are one of the key factors that result in loss of independence for seniors, and St. Joseph’s began a falls prevention initiative that included education for care teams and patients, along with conducting home assessments and removing slipping and tripping hazards.

Ciavarella said they have seen declining fall rates since implementation, and the rate of falls for St. Joseph’s Home Care clients is below the provincial norm.

Building relationships and breaking down silos

Although health care in Canada is funded by the government, individual organizations are not seeing budget increases and are facing many of the same fiscal constraints as their American counterparts.

Being part of a larger system allows the home-care division to build a close relationship with the hospital, which is both a necessity and an advantage in reducing costs across the entire health-care system.

Ciavarella said the board of directors and executive team for the three St. Joseph’s organizations in the city of Hamilton–which include an acute-care and research hospital and divisions for long-term care and home care–is under the same governance and management structure.

Last year, all three organizations adopted a joint five-year strategic plan that will transform how they work together by breaking down barriers, using research to inform and innovate the path of clinical excellence, and engaging their people, both staff and patients, within the process.

“We are uniquely positioned to offer the continuum of care and advocate at a higher level than just home care,” Ciavarella said. “We want to break down traditional barriers in healthcare.”

One major initiative is a pilot program that spans the entire health system. The Change Foundation released a paper in June 2009 about people’s experiences receiving home care after being hospitalized.

The report found 37 areas of improvement and noted that “I Don’t Know,” which is the title of the report, was the most commonly heard phrase from patients when asked what was happening next in their care journey.

Ciavarella said St. Joseph’s took that report and mapped a new model of care from the patient perspective, looking at what patients value in the health-care experience. The map, which included all steps from the pre-op visit at the hospital to being discharged from home-care services in the community, was 50 feet in length and had 92 steps.

“With 92 steps, it’s no wonder why patients’ information was getting lost and the follow-up could take days ,” she said. “We were able to cut that process by a third initially and continue to refine the process today with feedback we receive from patients and staff involved with the program.”

For the pilot program, the system focused on patient-population groups, such as short-stay surgery and chronic diseases. Each patient who presents to a St. Joseph’s hospital with one of these conditions is assigned a coordinator for their entire episode of care.

Ciavarella said the system saw a reduction in hospital length of stays and readmissions and home-care visit times were cut in half. She added that the program has worked best for the short-stay surgery population, and patient satisfaction has been extremely high.

St. Joseph’s Home Care will continue to look for ways to collaborate with the hospital and develop new models of care oriented around meeting the needs of the new group of seniors who will be seeking home-care services.

“We have to break down the silos in health care,” Ciavarella said. “We have one patient, and when we focus on the patient and quality, we will get better outcomes and better efficiency.”

-by Patricia Chaney

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