How Home Care Communication Adapts Over Time to Meet Clients’ Needs: A Case Study of Home Care Constellations
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Mount Saint Vincent University
Home care is an invisible, yet essential component of the health care system in Canada (Hewko et al., 2015). It is a complex, interdependent, and interactional process involving clients, families, and home support workers (HSWs) (Shaw et al., 2021) referenced as care constellations in this research. Every home care interaction involves communication (Gustafsson et al., 2021), therefore communication in home care is critical because it facilitates both task-based and psychosocial needs of clients being met (Höglander et al., 2020). Another essential principle in home care is the centrality of the client – namely person-centred care (PCC). Communication is a key component of a PCC approach, yet few studies have focused on communication in home care (Sundler et al., 2016; Kristensen et al., 2015). Using longitudinal secondary data (28 semi-structured qualitative interviews) from the Home Care Pathways Project (Keefe et al., 2020) and framed by person-centred care and critical relational theory, this study examined communication within two Nova Scotian care constellations and how communication adapted over time. An additional research question assessed how and if factors such as societal, structural, political, and historical factors influenced communication within the care constellation. Data analysis of each case was performed using thematic and temporal analysis of the qualitative interviews. A cross-case analysis between the two constellations revealed similarities and differences in the themes. Findings revealed three key themes. One temporal theme was identified in both cases: formal communication processes may or may not meet clients’ needs. Also, in constellation 1, the theme ‘the role of conversations in meeting clients’ psychosocial needs’ emerged and in constellation 2, the theme, ‘communication associated with maintaining independence’ was identified. The COVID-19 pandemic was a contextual factor that negatively impacted the health of both clients. Structural factors including a focus on safety, lack of accountability and time constraints were found to be barriers to client-centred communication. As noted in previous research, as the least powerful members of the caregiving network, HSWs and clients were the most depended upon for communication of clients’ needs (Funk et al., 2022). Implications of the study include recommendations for how to improve the education and training of home support workers as well as policy changes to enhance the delivery of client-centred care at both the organizational and systemic levels. Although specific to Nova Scotia, the findings will be of interest to other jurisdictions looking to improve home care communication within a client-centred care model.