How does the delivery of paid home care compare to the care plan for clients living with dementia?

Abstract

Many people living with dementia choose to remain in their own homes, supported by home-care workers, who provide care that is specified in care plans. We explored how care plans of clients living with dementia, compared with ethnographic observations of home care they received. In a secondary, reflexive thematic analysis, we reviewed care plans for 17 clients living with dementia and transcripts from 100 h of observations with 16 home-care workers delivering care to them. Our overarching theme was: Care plans as a starting point but incomplete repository. Clients' care plans provided useful background information but did not reflect a wealth of knowledge home-care workers built through practice. Two sub-themes described: (a) Personcentred care planning: whether and how the care plan supported tailoring of care to clients' needs and (b) Filling in the gaps: home-care workers often worked beyond the scope of vague, incomplete or out-of-date care plans. We found considerable inconsistencies between care plans and the care that was delivered. Care plans that were comprehensive about care needs, and rich in person-specific information aided the delivery of person-centred care. Lack of documentation was sometimes associated with observed failures in person-centred care, as helpful information and strategies were not shared. Including information in care plans about how, as well as what care tasks, should be completed, and frequently discussing and updating care plans can create more person-centred plans that reflect changing needs. Electronic care planning systems may support this.

Care Planning for Community-Dwelling People with Dementia: A Systematic Scoping Review

“…Tere were six descriptive studies which predominantly used qualitative methods: a mixed methods study on the involvement of people with dementia in care planning that used surveys and interviews with social workers [18], a qualitative study on the experiences and views of staf on care planning for people with dementia [43], a qualitative study that reviewed care plans of people with dementia and observed home care worker delivery of the actual care [44], a qualitative study that interviewed home care workers about what they need in care plans [45], a qualitative study of the perceptions of nurse practitioners on their role in dementia care and care planning in general practice [46], and a paper describing a care pathway program that included care planning [47]. Tere were seven expert opinion pieces [48][49][50][51][52][53][54].…”

“…When care plans were developed after a multidisciplinary assessment, it was suggested that a multidisciplinary team should be involved in that care planning [31,47]. When care planning is for home care, it was suggested that home care workers have input [44,45]. Comprehensive assessment as part of care planning was suggested in multiple papers [2, 26, 27, 29-31, 33, 35-39, 42, 47, 48, 52].…”

“…When reviewing progress, this should be evaluated and recorded against the objectives in the original care plan [2]. Two papers described that suboptimal home care occurs when care plans are not up-to-date [44,45].…”

Views of homecare staff and carers on oral needs and dental care for people living with dementia: A qualitative study

“…However, care plans may be incomplete or out-of-date and there may be considerable inconsistencies between care plans and the care delivered. 9 Various practices were reported in the systems of noting potential risks or problems. While most homecare managers saw it as their staff's responsibility to spot problems and report their concerns to the seniors and/or families, they acknowledged that some lacked the skills to notice such problems or the confidence to do so.…”

“…Such assessments and care plans are often general descriptions of the activities to be undertaken (e.g. 'undertake personal care'), or lack detail 9 .…”