A significant number of our seniors in Newfoundland and Labrador live in housing often referred to as personal care homes.
Personal care homes are homes for those who do not need nursing home care, but who can no longer live in their own homes.
However, unlike nursing homes that are publicly funded, personal care homes are businesses that are privately owned and run.
Despite being private businesses, they are regulated by the provincial government to ensure that each personal care home is run safely, especially in regards to health care for their residents.
Conducting research to make a difference
Our research group at Memorial’s Faculty of Medicine, through the auspices of the Primary Healthcare Research Unit, received a Medical Research Foundation grant to examine the delivery of health care in personal care homes.
In this study, we surveyed government, personal care home operators, family physicians who serve the homes, emergency department staff and the presidents of the two personal care home associations in the province.
Due to budgetary and time restrictions, we could not examine all of the regional health authorities of the province and thus it should be noted that some of our findings may not necessarily be applied to other regions.
Seeing is believing
As a family physician, I have extensive experience treating residents in nine different personal care homes in this province since 1986.
The impetus for the study was my impression that health-care policy developed by the provincial government did not necessarily include significant input from others within the health system.
“As a family physician, I had no formal means to recommend changes that could improve health-care delivery in personal care homes.”
I found that, as a family physician, I had no formal means to recommend changes that could improve health-care delivery in personal care homes.
For example, I noted that residents were frequently transported to the hospital emergency departments without any prior health professional screening and that the typical lack of an accompanying resident advocate led to frequent repeat emergency department visits.
I also noted how policy was implemented varied from home to home; this was often confusing to me as a physician who served several homes. For example, different government case managers for the homes that I served could have different directives about certain aspects of medication dispensing.
Although all of the personal care home players were dedicated to providing the best health care for the residents, I found that we all worked independently, with varying degrees of collaboration.
Breaking down silos
As a result of our study, several recommendations were made, including improving access to family physicians, co-ordinating care between personal care homes and the emergency departments, increasing the monitoring of residents’ level of care, improving personal care home access to existing resources, such as the N.L. Health Line, and re-examining how medication was dispensed.
Other needs noted were improving the communication of resident health information to family physicians and improving access to recreation programs to personal care homes.
However, the key finding of the study was the need for a model of health-care delivery that better addressed the public-private relationship between the government and privately owned and run personal care homes.
This finding influenced all of our other recommendations.
Currently, the primary goal of government for personal care homes is to ensure they all follow the Department of Health and Community Services’ regulations that are clearly essential for resident safety.
However, the regulatory work is so prominent and time-consuming, there is little room left for government to help personal care homes to provide health-care needs to their residents.
“The enforcement of government regulations often causes an antagonistic relationship with the personal care home operators.”
These needs include the provision of adequate family physician coverage, adequate medical care for residents recovering from severe illness or the day-to-day supervision of residents’ health-care needs.
Also, the enforcement of government regulations often causes an antagonistic relationship with the personal care home operators, which may be a barrier to health-care delivery.
Private vs. public
Another key barrier is that personal care homes are private businesses that provide a financial return for their operators.
The provincial government understands that personal care home operators deserve a fair return for their service, but rightly does not want to be involved in enhancing their profits at the expense of the public purse.
This prevents the use of more public resources which, if available, could provide better long-term health results for residents.
As one example, it may be cost-effective for government to provide nurse practitioners to supervise multiple personal care homes that have difficulty or cannot obtain fee-for-service family physician coverage.
Change the hierarchical model
When I and my colleagues meet with and discuss the matter with government representatives, there is a clear understanding that more needs to be done to address the issue of health-care delivery in personal care homes.
There needs to be a more collaborative approach between government personal care home operators — and other players such as physicians and the emergency departments involved in providing care to these homes — rather than the current hierarchical model.
“The threat of a personal care home being deemed “non-compliant” for not following a government regulation by “the letter” is still a prominent feature of government/personal care home interaction.”
Despite measures by government to improve communication at the administrative level, it is not always reflected in the day-to-day interaction at the ground level in a number of areas.
The threat of a personal care home being deemed “non-compliant” for not following a government regulation to “the letter” is still a prominent feature of government/personal care home interaction, instead of working together to solve challenges in an affiliative way.
Our research group believes that the time has come for the development of a new model for this special subset of elderly Newfoundlanders and Labradorians.
It is critical that this new model addresses the challenges that now exist as a result of government health agencies in a public system regulating personal care homes that are run as private business.
Elderly residents of personal care homes with their medical needs are often caught in the middle of this current relationship and deserve a better model of health-care delivery.