Studies have shown that families of patients who live in their own house prefer the patient to be placed in a nursing home as the discharge destination. Dr. Watanabe's research shows that people prefer to be home if there are adequate services. Saphir (2000) describes Japanese families as relying on the family members for care. If no family caregiver was available families often would purchase services from their personal income. In Japan services are now covered that include ADL, adult day care, medical devices and institutional care. In Canada, in a study done in 1998 the services that were accessed the most were the following, homemaking, followed by nursing care, and to a smaller extent meal preparation and/or delivery. In Canada, there is a disturbing trend of "warehousing" many clients are in institutions where the care is minimal and there is little rehabilitation.
Clients discharged to home with a chronic illness, require support services such as adult day care to relieve the family of the responsibility for short periods of time are essential. Rehabilitation centres can play a major role as an interim centre to increase the patient's physical mobility as well as to bring them to a greater state of health before returning home. Internationally, many people are in the home setting without adequate services and much of the care is absorbed by family members.
At the present time there are very few evaluation methods for community care. It is only now in North America that we are making hospitals be accountable for their outcome measures. It is important as we transfer care responsibility from the hospital to the home that we also build in accountability mechanisms that ensure a high level of care.
11:30-12:30 Lunch
12:30-13:15
The Health Care Worker for the New Millennium
In contrast to the past, health practitioners need to be educated in broad areas such as policy frameworks. For example, in Japan, knowledge of the services covered under the national long term care insurance program is critical in order to access relevant services. The clinician needs to know how to assist the patient in accessing the services in an efficient and effective manner. A systems approach has to be used in order to evaluate the quality of services coming into the home. Often there are different providers from different agencies. Homemaking services can be provided by one agencies and nursing services provided by another.
