Care Closer to Home: Elements of High Performing Home and Community Healthcare Services

A Rapid Review Prepared for the Canadian Foundation for Healthcare Improvement
Executive Summary

In Canada, as in other countries, there is considerable interest in shifting care out of institutions into home and community settings to better meet the needs of a growing population of older adults living with complex conditions. The aim of this report is to summarize and assess the review literature (e.g., systematic reviews, scoping reviews, etc.) in order to identify key attributes that are associated with high-performing care provided closer to home.

The results of our rapid review suggest that improvements in functional capacity are more likely through long-term interventions and programs that offer a variety of support options (i.e., education and case management). Similarly, multi-component individualized care from a multi-disciplinary team of providers is associated with delayed need for institutional-based long-term care and reduced hospitalizations. Satisfaction as an outcome received mixed results. However, satisfaction appears to be improved with interventions offering a variety of support options that are tailored to individual needs. Whether or not interventions were able to achieve cost savings was unclear. In cases where costs were reduced compared to usual care, it seemed to be a result of reduced service utilization and increased reliance on lower-cost supports, such as unpaid caregivers and technology. The impact of programs on well-being and quality-of-life were also mixed.

We were able to identify seven core elements that appear to support the success of interventions that attempt to provide care closer to home. Next steps could involve assessing the extent to which care models offering such care incorporate the following seven elements:

  1. Long-term planning (lasting several months) that includes frequent and/or regular visits with consistent care providers.
  2. Incorporate support for both paid and unpaid caregivers. These supports include education on disease/condition management, and psychosocial supports (i.e., formal counselling or informal through online or in-person support forums).
  3. Offer a range of program options and delivery methods. These elements should include social supports, e.g., transportation to group-based activities to reduce social isolation, and self-management supports that provide coaching and education in collaboration with a variety of other supports (i.e., a part of multi-component interventions).
  4. Approach care planning and decision making in collaboration with the client and caregiver to be sure supports are individualized to meet each person’s unique needs and goals.
  5. Standardized clinical guidelines and protocols to support care coordination, to smooth care transitions, and to inform healthcare provider decision making.
  6. Access to 24/7 support through technology (e.g., virtual visits, telephone).
  7. Inclusion of well-integrated multi-disciplinary care teams.