The Way Forward
Our team was keenly aware of evidence suggesting that when health care organizations focus attention on workforce safety, they will improve care recipient safety at the same time. This is perhaps especially true in home care, where the physical, emotional, and psychological safety of care recipients and providers is very much intertwined.
The IHI’s recommendations for improving the safety of care in the home are underscored by five guiding principles:
Principle 1
Self-determination and person-centered care are fundamental to all aspects of care in the home setting. As noted in our report, people receiving care in their homes may not see themselves as “patients.” Care in the home is a delicate balance between respecting the care recipient’s autonomy and prioritizing their goals of care, and mitigating risks presented by the environment.
This can be promoted by providing relevant and useful education to care recipients and families about their condition, treatment, and safety risks; communicating often and effectively; and ensuring that care providers are skilled in assessing what matters to the care recipient.
Principle 2
Every organization providing care in the home must create and maintain a safety culture. While many people in health care know what we mean by safety culture, the general public—including care recipients and their families—likely are not familiar with the concept. Creating such a culture requires the effort and attention of everyone in this setting—and can benefit both providers and recipients. Safety must be embedded
ded in care, not an add-on to care. In a safety culture, care providers, recipients, and family members all feel safe to point out risks, speak up about concerns, and raise questions or ideas to support safe care.
Principle 3
A robust learning and improvement system is necessary to achieve and sustain gains in safety. The key components of such a learning system are leadership that supports and endorses learning, transparency about risks and other obstacles to good care, reliability, improvement and measurement, and continuous learning. Foundational elements include standard metrics for assessing safety and harm, mechanisms for sharing data and best practices, a method of improvement and workers who are skilled and knowledgeable about how to improve, and collaboration among organizations.
Principle 4
Effective team-based care and care coordination are critical to safety in the home setting. Our expert panel identified poor care coordination as a chief clinical problem affecting safety in home care. Home care workers often work alone, but they should communicate with other providers and organizations involved in an individual’s care. Home care agencies and workers can take lessons from the hospice field about coordination of multiple caregivers, and they should be encouraged to test new models of team-based care.
Principle 5
Policies and funding models must incentivize the provision of high-quality, coordinated care in the home and avoid perpetuating care fragmentation related to payment misalignment. Recently announced changes to Medicare will allow Medicare Advantage plans in some states to provide coverage for services such as home health aides and respite for family caregivers. That will come as welcome news to many care recipients and their families. Yet, there is still greater potential for these plans to cover a variety of supports that could be of benefit to care recipients and caregivers, and to cover services related to other social determinants of health that previously might not have met Medicare criteria.
Why Choose Pure Heart
What would the perfect world for home care safety look like? One vision is a scenario in which care recipients and caregivers have access to the necessary resources and supports to ensure that any individual can be safely cared for in a home.
At Pure Heart, our homes; are comfortable and welcoming, Our staff; committed, reliable and respectful and our services, dignified, culturally specific and professional. Call Us: 763-283-5152