Safety in home care: thinking outside the hospital box.

Rethinking Healthcare Safety for Home Care Canada’s aging population and rising healthcare costs have resulted in an increased number of chronically ill people and heightened demand for acute care. As a result, a growing group of clients is being cared for at home by family and friends, and there has been a 51% increase in home care clients since 1997 (Canadian Home Care Association 2008). Many, if not most, of these home care clients are elderly individuals with chronic health problems or people who require end-of-life care (Canadian Institute for Health Information 2006). The complexity of the cases now handled at home increases the already-heavy pressure on family, caregivers and paid providers, a situation that can create and amplify serious safety issues (Macdonald et al. 2010; Stevenson et al. 2008). These safety threats are not limited to clients. Findings from various qualitative research studies focusing on the experiences and perspectives of those providing care in the home have confirmed that families, caregivers and paid providers can all face significant risks in a home care environment (Lang et al. 2006, 2008, 2009b; Macdonald et al. 2011). However, because home care is so fundamentally different from the regulated and controlled environment of acute care (Lang et al. 2006), improving safety in home care requires a fundamentally different philosophy and approach. The challenge is to rethink our ideas of healthcare safety in the context of home care, and then follow through by developing and applying safety practices for the home. These practices must be clientand family-centred, include safety for providers and, above all, be flexible enough to adapt to an immense range of circumstances. Future qualitative and quantitative research will provide further insight into the impact of the home environment on care for specific populations and will guide the development of strategies to mitigate risks associated with care in the home.