Quality control becomes a critical issue as it is often the patient's family that is the major advocate for continuity of care in the home. This puts an additional burden on the family. Communication between the interdisciplinary team (doctors, nurses, physiotherapists) is essential in order to assure a smooth care plan is implemented. After discharge, there has to be an evaluation process that examines services at time intervals during the clients care at home. A recent anecdote from a local hospital that followed up their clients discovered that the homemakers had not been going to the home and that service provision was non-existent.
Case management is essential when the patients require acute illness support and frequent visits are required. It is important to allow independent decision making on the part of all health professionals so they do not have to continually access permission to make decision. For example, with pain control graduated doses may be necessary in order to assist the patient gain the level of control in order to carry out ADL. New structures have to be instituted, such as community advisory panels, in order to oversee the issues in delivery of care. Once there are computers in the home, communication will be easier because clients can access personnel in the hospital settings to communicate their satisfaction or dissatisfaction with services.
Health practitioners need to have advanced training in population health factors, assessment of family dynamics and adequacy of community services. Boblin-Cummings (1998) emphasizes the need for health care practitioner to learn the skills of advocacy such as negotiation, facilitation, and manipulation. In conclusion the skill set necessary for community are very complex as there is not the bureaucratic structure to back up the necessary elements of care. Health care workers have to understand that there needs to be a very close association with the hospital and the community services.
The skill sets needed by the worker in the new millennium include understanding the determinants of health and the ability to work in an environment that does not have as much structure as the hospital setting. One study (Forchuk, 1998) demonstrated that in a psychiatric patient population it was beneficial to use hospital nurses working closely with community services to provide continuity of care for long term psychiatric patients. This intervention required nurses to leave the hospital for periods of time in order to provide collaborative care.
