How safe are Canadians who are receiving home care services?

Historically, this has been a very difficult question to answer. While patient safety has been well documented in acute care settings, it remains a new and limited focus of research in home care.

There are many unique patient safety issues that exist in home care. These include the physical context and variability of home environments, the very crucial role of informal caregivers (including family members, friends and others who provide unpaid assistance), and the varying characteristics and needs of the clients.

There are currently 900,000 Canadians receiving home care, and this growing number has significant implications on the health and safety of not only those who are cared for, but also the health and safety of informal caregivers.  These individuals, many of them elderly, may provide up to 75 per cent of the care needed in the home, and they, like the family members or friends they are helping, may have differing levels and types of care needs.

There is, however, some hope on the horizon.

For the past four years, a research team co-led by Dr. Diane Doran, professor at the Faculty of Nursing at the University of Toronto, and Dr. Régis Blais, professor at the Department of Health Administration at the University of Montreal, have been working on an important study that aims to answer the question: how safe is home care in Canada?

This timely study, entitled “Safety at Home: A Pan-Canadian Home Care Safety Study,” promises to greatly improve our understanding of the prevalence, magnitude and risk of patient/client safety incidents in home care settings across Canada. For the first time, we will possess real insight into the incidence of harmful incidents and some of the contributing factors, as well as recommendations to enable meaningful change.

“The existing literature on the safety of home care in Canada is still vague,” says Doran. “This study, which took place across several provinces and territories in Canada, provides evidence about the nature of safety concerns for home care clients and their families. For example, it is developing evidence about such issues as the prevalence of injurious falls, medication related events, caregiver distress and mental health related events. It also examines variation in different types of events for subpopulations of home care clients such as those with diabetes and dementia.”

What’s really special about this work, however, is that once it has been published, it is not destined to sit on a shelf. Rather, the Canadian Patient Safety Institute and its partners have committed funding that will ensure the recommendations contained within the research will see the light of day. In collaboration with the research team and our partners, we are planning to create tools and resources informed by this research, and specific to home care and put them in the hands of those who can use them to improve the safety and quality of home care in Canada. This includes a partnership with VON Canada to capitalize on previous Safer Healthcare Now! work and develop tools aimed at clients, family members and care providers to make care safer in the home. In partnership with Accreditation Canada, we’re also reviewing the existing Required Organizational Practices for home care organizations and providers.

This research has important implications that need to be acted upon. We believe that the findings and recommendations, and the tools and resources that will be developed as a result, can have a meaningful impact on the quality and safety of home care in Canada. We are committed to ensuring that policy makers, home care organizations and caregivers are given the knowledge and tools to help them make a positive difference in the safety of home care clients.

This research is funded by the Canadian Patient Safety Institute in partnership with the Canadian Institutes of Health Research (Institute of Health Services and Policy Research, Institute of Aging, Institute of Musculoskeletal Health and Arthritis and Institute of Circulatory and Respiratory Health); The Change Foundation, the Canadian Foundation for Health Improvement, the Nova Scotia Health Research Foundation and the Quebec Ministry of Health and Services.