Strengthening workforce capacity in Canadian home care: Aligning personal support provider practices with the OCAR framework for team-based care

Background: High quality, accessible home care is essential for supporting people to live and age in their communities, and a strengthened integrated care workforce is needed. While Personal Support Providers (PSPs) provide most home care services, their potential contribution to home and community teams is often unrealized. A framework to structure PSP practice can contribute to role definition and enable integration.

 

 Developed in 2015, the Observe, Coach, Assist, and Report (OCAR) framework describes the role of PSPs in team-based home care, supporting interdisciplinary communication and a culture of respect for diverse knowledge, skills and expertise. The objective of this study is to explore, synthesize, and compare evidence of, and opportunities for, alignment of current PSP home care practice with OCAR activity types.

 

Approach: We are leading a three-phase multiple case study, guided by the six step Participatory Research to Action (PR2A) Framework. Cases include two home care organizations in Ontario, Canada. The ‘Readiness’ step of PR2A was completed during grant development, involving an environmental scan to confirm current OCAR relevance. We report phase 1 findings, addressing the ‘Discover’ and ‘Define’ steps of PR2A. Data collection included semi-structured interviews and an elicitation of practice documents from interview participants—a purposively sampled group PS providers, managers, professional practice and operations leaders, and clients (older adults) and caregivers.

 

Framework analysis was employed to map the data from interviews and documents within and across cases to describe PS practice and identify alignment of current practice with OCAR activity types at micro, meso, and macro levels of the health care system; noting similarities and differences across interview perspectives. We also described interaction of PS providers with other health and social care providers and examined how practice and resources contribute to team-based community care to consider how OCAR can support such approaches.

 

Results: Twenty diverse participants were interviewed (7 PS providers, 8 PS managers and leaders, 2 clients, and 3 caregivers); most interview participants were women age 25 years and older, with age distribution varying by case. Twenty-eight documents, including charting and communication templates, policies, and educational materials, were reviewed. Patterns in PS practice and alignment of OCAR activity types with practice components including communication, documentation, education, governance, and mentorship, were identified, with emphasis on facilitators and barriers associated with the application of each of the activity types. Findings from key informant interviews and practice guidance documents that describe the alignment of OCAR with PS practice in the two cases will be reported in an OCAR Landscape Report (expected March 2026).

 

Implications: Findings will form the knowledge base for the ‘Develop‘ step of PR2A, where we will co-design an OCAR PS practice toolkit with experts-by-experience. The toolkit will then be pilot tested with the two cases, completing PR2A’s the ‘Deliver’’ and Measure steps. By co-designing and deploying more inclusive home health workforce strategies that value and integrate PSP contributions in a team-focused approach to care, this study can support positive provider experience, job satisfaction, and worker retention, ultimately improving the equitable delivery of home and community care.