Abstract
Background: Availability of high-quality integrated home and community care is essential to providing older adults with more opportunities to age in their communities. However, health human resource challenges continue to pose a barrier to expanding home and community care capacity. Skill gaps, where differences exist between employer expectations and the skills the workforce possesses, can result in negative outcomes for both providers and patients including moral distress, missed care and turnover. These challenges are complex, with many contributing factors such as pay inequity, working conditions, and increasing client complexity. Workforce stabilization efforts aim to ensure the availability, retention, and well-being of providers, to protect care capacity in the community. While macro (system) level policy changes are necessary to address systemic issues, these take time and funding attention. To support sustainability of the integrated care workforce now, meso (organizational) and micro (point-of-care) level initiatives which recognize and prioritize improving provider experiences can be undertaken at the organizational level.
Approach: We undertook three applied research studies using the Participatory Research to Action (PR2A) Framework to address cross-disciplinary home and community care workforce capacity related to recently updated integrated care competencies relevant to mental health, use of standardized comprehensive assessment tools and integration of unregulated provider contributions in team-based care delivery. Common across studies was our commitment to a learning health system model and authentic engagement of experts-by-experience representing the lenses of client, caregiver, provider and health system decision-maker. These experts-by-experience were involved in working-group style learning communities and provided end-to-end input on the research from study design, through data collection, data analysis and prototyping. All studies involve a discovery phase where literature review and primary data collection through key-informant interviews and/or workshops led to defining key opportunities for solution-oriented idea generation in co-design workshops and prototyping of new point-of-care solutions.
Results: The end goal of each of these studies is implementation-ready knowledge products that have been pilot and feasibility-tested to support outcome and impact measurement and meaningful scale and spread. We will share details about three such emerging knowledge products including, ‘The Mental Health Conversations Initiative’, the ‘Holistic Needs Report for Goal Oriented Care’ and the ‘Observe, Coach, Assist and Report Practice Toolkit’ and how their design, testing and implementation considers and leverages both the challenges and opportunities in the current health system to bolster provider experience, competence and inclusion in home and community care.
Implications: Tangible, practice-based solutions co-created with end-users can support workforce stabilization through of the application of updated integrated care competencies necessary for the delivery of home and community care. End-to-end participatory research- ensuring providers are actively engaged in identifying urgent challenges, co-developing actionable solutions, and evaluating meaningful change- was imperative to generating solutions that respond to real and urgent challenges and that are feasible to implement in a strained health human resource environment. We argue that workforce stabilization is fundamental to health system transformation. Strengthening the home care workforce must be a priority to ensure aging Canadians receive high-quality care where they prefer—at home.