Program not being used effectively, hospital reviewer concludes
Despite criticism in a recently-released report, the Home First program is being well used by Health Sciences North, according to the North East Community Care Access Centre's senior director of client services.
However, Frankie Vitone said Home First is still a relatively new philosophy, and said there's definitely “room for growth.”
“Remember, our original focus was on the frail, elderly patient, but Home First should be a reality for everyone,” she said.
“Here in Sudbury, we are working with our HSN partners on a daily basis to ensure that people of all ages receive the right care in the right place by the right provider.”
The Home First program sees patients discharged from hospital with enhanced home care supports so they continue to improve in a comfortable environment, minimizing the need for readmission. This in turn frees up more beds at the hospital. The program was launched by the North East CCAC in August 2010.
It was hailed as one of the solutions to the ongoing ALC patient crisis.
“We recently marked the 1,000th client who went 'Home First' from hospitals in the northeast,” Vitone said.
“And perhaps more importantly, 68 per cent of these clients remain in the community for longer than 90 days without readmission to hospital.
“The Home First philosophy will play an increasingly important role as we continue to work with both our acute care and community partners in building the care and services necessary to meet each client's needs.”
In the report detailing his peer review of Health Sciences North, Hamilton Health Sciences CEO Murray Martin said there was “varied responses to the question 'Has HSN adopted the Home First philosophy?”
He also said there's “pervasive scepticism among HSN staff and physicians with respect to the availability of community infrastructure and resources.”
Additional concerns were raised by physicians and various HSN and CCAC stakeholders about problems surrounding recruitment and retention of personal support workers delivering Home First services.
There's also “evidence of practices within HSN that do not align with Home First,” Murray said, including the fact that many more patients are designated as being destined for long-term care instead of their homes.
He also said he's concerned by the “messaging provided to patients and families regarding to the program.”
We recently marked the 1,000th client who went 'Home First' from hospitals in the northeast.
senior director of client services, North East CCAC
When asked if part of the issue with the program is a lack of funding, Vitone said the North East CCAC could always do with more funding.
“Of course, we realize the health-care system is under tremendous financial pressure. That's why we work so closely with our partners to come up with innovative solutions to specific challenges in our community.”
Murray also said the lack of a 24-hour, daily Home to Wait program was commonly cited as one of the deficits of Home First in the region.
Home to Wait programs support hospital discharge with appropriate supports while planning and waiting for transition to long-term care.
The North East CCAC does provide this type of care for palliative patients in the last month of life, Vitone said.
“If we receive direction to offer this level of care to a larger population, then we will either shift our existing resources to meet that demand, or work with enhanced funding specified for this purpose.”
To solve the issues he outlined in his report, Martin recommends a “re-launch” of the Home First program.
This would involve a review and education of Home First principles and available CCAC supports with hospital and CCAC stakeholders, physicians and front-line workers.
Martin also recommends a review of service provider capacity concerns and a review of requirements to implement Home to Wait 24/7 programming.
Health Sciences North board chair Russ Boyles said the hospital will be having a lot of discussions with the North East CCAC about this subject in the near future.
“Together, we basically have to re-launch the program,” he said.
“I don't think it's right to say it's all the CCAC's fault because they don't provide the support. That's not true. They've got financial issues, too. Home care is the one growing area that the government is supporting and trying to expand, but is it expanding quickly enough?
“There are things in the hospital we should be doing in relation to Home First, too. So together we're going to tackle that.”
Vitone echoed Boyles' comments.
“The review just came out on Tuesday morning,” she said.
“We're going to continue to work with our care partners and our community partners in terms of looking at different strategies to ensure we're getting as many clients home and in community venues as we can.”