In response to needs of older adults at the end-of-life and challenges in the recruitment and retention of healthcare providers in home care in the South West Community Care Access Center, a new and innovative model of home care, eShift, has been developed. eShift links unregulated care providers (technicians) providing home care to a remotely-situated Directing Registered Nurse (DRN), through a smart phone application using real-time communication and documentation technology. The DRN monitors and directs appropriate, safe, and effective care provided in collaboration with the technician in real-time, enhancing quality of care delivery for older adults and their family caregivers.
Healthcare providers, care coordinators, and family caregivers indicated that:
Families were reluctant to give up the burden of care, feeling responsible for the care of their palliating relatives. Patients in turn sometimes expressed the desire to only be cared for by family members, limiting the extent of care provided by nursing and technicians staff. Families were often apprehensive about an influx of new health care workers with each increase in the level of care. The desire for privacy contributed to families’ reluctance to accept care, especially overnight; an intimate time for families. This impacted families’ acceptance of eShift.
Intensity of palliative home care, including eShift, was thought to symbolize ‘end of life’ for the patient and family. This further complicated the acceptance of care as patients and family were being offered a service they were reluctant to acknowledge as needed. Families would accept eShift when overwhelmed with exhaustion and were in need of immediate respite care.
Care coordinators reported trying to anticipate eShift demand, knowing that eShift may be initially refused. Care coordinators provided information to patients and families early in the palliative process about eShift as an option for patient palliative care and family respite.
The Care coordinators also saw benefit in “easing in” eShift service, starting with one or two nights a week, to help families build a trusting relationship with the technician.
The Care coordinators carefully monitored patients and caregivers to be able to rapidly deploy eShift when needed. They maintained regular communication with the team including visiting nurses, nurse practitioners, and service provider organizations to anticipate need and ascertain the available resources for eShift implementation.
This project is supported by a team of researchers & led by co-principal investigators:
Lorie Donelle, RN, PhD, Associate Professor, Arthur Labatt Family School of Nursing and School of Health Studies, Western University. email@example.com
Sandra Regan, RN, PhD, Associate Professor, Arthur Labatt Family School of Nursing, Western University. firstname.lastname@example.org
Donelle, L., Regan, S. (2015, December). E-shift, an innovative home care model: Perceptions about patients & family caregivers. Arthur Labatt Family School of Nursing.