	Home Care and Support Services: Home Health Aide Services, Personal Care Aide Services, and Homemaker Services

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

HCS 3: Client-Centered Service Philosophy

The organization that provides in home care and support services is guided by a client centered service philosophy that promotes:

client and caregiver participation in their home care service design and implementation;
autonomy, risk of harm reduction, and optimal functioning and health, in the most suitable, safe, supportive, and least intrusive environment available; and
key program quality indicators.

Research Note: A review of studies on quality of life for family caregivers, noting various intervention definitions, measures of the same constructs, and changes over time in client, caregiver and family life conditions, reinforces the importance of using a theory for program development and evaluation that includes the individual, family, and environment to guide home care interventions and outcomes.

Research Note: A large state-wide study of factors associated with home care elder abuse and neglect found family ties and informal support, worker-client relationship and language compatibility, and provider turnover to be more important program quality factors than service delivery model. Client sense of security was greater with consumer directed versus agency model care, and greatest with family versus non-family consumer directed care with some ethnic differences noted, where the agency model studied is lean, low cost and with little or no social work involvement.

Research Note: A small-scale, brief quality improvement demonstration project that examined how service delivery in a large agency can be more effective, efficient, and attuned to promoting functional outcomes of older individuals, identified twenty largely preventable barriers in traditional, everyday homecare routines. Examples of obstacles noted are: lack of agreed upon goals; length of visits that don’t match client needs; and “doing for” clients resulting in loss of confidence, physical de-conditioning or increasing dependence.

Research Note: Reviews of research on a preventive “home visit” intervention, available in Europe, question the efficacy of an intervention that depends completely on elder individuals to follow recommendations and locate resources. Home visits consist of an in-home check up and assessment. Unlike home visiting interventions in the United States that provide on-going in- home support, which with sufficient staffing and hours have proven highly effective, the home visit assessment is difficult to evaluate due to both methodological issues, such as grouping common interventions to conduct meta-analyses, and data collection, including knowledge of degree of client compliance with recommendations.

Research Note: A Home Care Satisfaction Measure (HCSM), developed under the auspices of cooperating interdisciplinary university departments and a research institute, is reported to be the first such measure based on views of older consumers that also meets standard psychometric criteria. The HCSM offers a consumer-based indicator of quality with potential for use as an outcome or performance measure. Research and the development of benchmarks against which agencies can compare their performance to national home care satisfaction results is on-going.

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	PURPOSE: Individuals who receive Home Care and Support Services obtain a maximum level of independence, functioning, and health, and extend the time it is possible to live safely at home and in the community.

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	SERVICE PHILOSOPHY The theoretical framework that describes and explains an organization's approach to service.


	CAREGIVER The provider of physical, emotional, and social needs to another person, often dependent and unable to provide for his or her own needs. Caregiver is the generic term used for the direct service providers in Community Care and Support Services (CCS).


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	INDICATOR A described activity, event, outcome, or benchmark used for measurement in monitoring the quality and outcome(s) of service.


	FAMILY Two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. Child care and child socialization, income support, long-term care, and other caregiving are among the functions of family life. The definition of "family" will rest with an individual's indication of who plays a family member role, including current or former foster family, adoptive family, extended family members, fictive kin, or significant others. Organizations that believe family is the central constellation in a child's life, and that family attachments are of primary importance for human development, will strive to work with professional staff to develop a common understanding of "family."


	EVALUATION The review and assessment of organizational operations, programs and services.


	CONSUMER The individual, family, group, or community that seeks or receives services.


	CLIENT See service recipient.


	SOCIAL WORK Professionally responsible interventions carried out by persons with formal, professional education at the BSW or MSW level from an accredited school of social work and appropriate licensing, certification, and registration credentials. Interventions are directed toward improving the transactions between people and environments to enhance the adaptive capacities of the participants and improve environments for all that function within them. Social work is a professional practice with a consumer group consisting of individuals, families, small groups, organizations, neighborhoods, and communities and involving the disciplined application of knowledge and skill.


	RESEARCH For purposes of COA accreditation, all forms of internal or external research involving persons served except internal program evaluation and outcomes research, or educational projects performed by students and interns that are part of their professional training.


	CRITERIA Systematically developed, objective, and quantifiable statements used to assess the appropriateness of specific decisions, services, and outcomes.


	ASSESSMENT An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.


	PERFORMANCE A measure of how well an organizational system provides services to consumers. Performance is often based on key indicators, such as rates of service, cost per consumer, degree of satisfaction with services, and extent of consumer access to services.


	BENCHMARK The quantifiable measurement of best practices in the industry. Organizations can compare their results with the industry benchmark. For example, a benchmark for a community service organization might be to respond to all non-emergency telephone inquiries within 24 hours.