Home care nursing is a specialized area of nursing practice in which the nurse provides care in the client’s home, school or workplace or other community settings. Individuals who receive nursing care today often have more acute and complex needs and an increasing amount of their care is provided in the home.
In the home setting, the nurse brings caring activities that generate trust and collaboration for both the care of the client and the maintenance of health of the other family members. The nursing process applied to home care includes assessment, nursing diagnosis, planning for care, intervention and evaluation. These processes are often more complex given the nature of the setting, the additional variables influencing the client and the family, and the need for integration of community health nursing concepts.
Home care nursing practice is complex requiring independent decision making, a diverse knowledge base in order to manage the care of patients with a broad array of diagnoses across the lifespan and the health-illness continuum. The home care nurse requires:
Personal Support Workers (PSWs) are the largest class of workers in the home care system. PSWs complete a standardized training program enabling them to provide care and assistance to clients of all ages, and their families/caregivers, with tasks of daily living, personal care and hygiene, restorative/activation activities and home management activities.
Typically, PSWs provide care that clients could be expected to perform by themselves if they were physically and/or cognitively able. Their activities are supportive and non-medical in nature.
PSWs provide for the comfort, safety and well-being of their clients, and also demonstrate sensitivity and respect for those in their care. The PSW’s positive attitude, abilities and approach are critical to the health of the people they support.
PSWs spend the greatest amount of time, as compared to the other members of the health team, with the client. They are often the first to alert the health care team to subtle changes in a client’s condition and through their close relationship with the client have insight into their needs.
Within home care in Ontario, dietitian services are grouped with the therapies. Registered Dietitians (RD) are regulated health professionals who are “expert in food and human nutrition”.
Registered Dietitians work individually with people of all ages focusing their skills, professional knowledge and expertise on optimizing client nutrition intake; individualizing food intake to meet specific nutrition, dietary and/or functional needs; promoting overall health and well-being; and maintaining client independence.
The Registered Dietitians’ knowledge of nutrition, sources of funding reimbursement, and support technologies positions them to improve client care in a cost-effective manner. RDs are important members of the home care.
Physiotherapy is a primary care, autonomous, client-focused health profession dedicated to improving quality of life by:
Physiotherapists are primary health care professionals with a significant role in health promotion and treatment of injury and disease. They combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability. Physiotherapists encourage clients to assume responsibility for their health and participate in team approaches to health service delivery.
A PTA is someone who provides care under the direction and supervision of a physiotherapist. They may have been trained in a college program or learned on-the-job. PTAs are not regulated and they do not have a protected title. PTAs may also be called rehab assistants, therapist assistants, support personnel. An individual is only a PTA when a physiotherapist is accountable for treatment (a physiotherapist is assigning and supervising care).
Occupational Therapists (OTs) provide assessment, treatment and education to enable clients to safely participate in daily activities of self care, work and leisure in their homes and community. OTs services include:
OTAs may work under the supervision of the Occupational Therapist to support the client in achieving their goals.
Speech Language Pathologists (SLPs) provide comprehensive assessment, education and a functional, life participation approach to home-based community therapy for adults with communication and swallowing disorders. SLPs services include:
Within home care in Ontario, social work services are grouped with the therapies. Social work is a regulated profession “concerned with helping individuals, families, groups and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their own resources and those of the community to resolve problems.”
Social workers specialize in working with people, families and communities whose needs are high and whose resources to meet those needs are compromised or depleted. At the individual level, social workers assist with the management of issues ranging from depression, dealing with marriage problems or family breakdown, living with chronic or debilitating health conditions, recovering from trauma, or facing a life issues.
Mediate and facilitate multicultural environments and diversity.
Home care infusion pharmacy is a specialized area of pharmacy practice where patients are able to receive infusion administered medications in the client’s home, school, workplace or other community settings such as clinics. Individuals who receive infusion pharmacy medications administered by nurses often have more acute and complex needs, and an increasing amount of their care is provided in the home and in community.
A physician from hospital or in community will provide the pharmacy with a medical order or prescription for a patient to receive infusion medication. Ontario Health atHome (formerly HCCSS – Home & Community Care Support Services) will arrange for the pharmacy to deliver the medication, infusion equipment and related medical supplies to be delivered to the patient’s home, work or to a clinic setting for administration by a home care nurse. The pharmacy coordinates with the home care nurse to ensure all required medication and supplies for infusion to be administered safely. Patients receive education about who to contact in case of questions regarding medication, or administration process.
Infusion pharmacies approved under government-funded programs must meet NAPRA standards for dispensing highly complex medications safely in a clean room environment. The pharmacy must be licensed for dispensing complex medications, infusion equipment and supplies and pre-qualified for servicing through Ontario Health atHome (formerly HCCSS – Home & Community Care Support Services) in Ontario.
A Respiratory Therapist is a regulated health professional who monitors/assesses and treats individuals with breathing difficulties. Respiratory Therapists are experts in:
They provide care in hospitals, long term care and home care settings; they must be registered with the College of Respiratory Therapists of Ontario.
Respiratory therapists provide many services to patients in their home including:
An efficient and effective home care system appropriately utilizes and collaborates with all members of the broader health care team to achieve value and to assist Ontarians who wish to receive care at home and remain independent. These include:
Family physicians are integral members of the health care team and are critical for the medical support they provide to all clinicians in the home. The strong linkage between family physicians and home care practitioners enhances the ability for individuals to remain independent at home for as long as possible.
Pharmacists have unique expertise in medication management. They are responsible not only for the procurement and dispensing of medications, but also for their safe and effective use in the prevention of disease and the promotion of health and wellness. As a medication expert, the pharmacist makes an important contribution to the home care team by serving as a resource for the increasing numbers of medications prescribed to seniors in particular.
