What is happening within the Home Care Industry?
An Update from the Principal Owners of Mosaic Home Care Services & Community Resource Centre, Jane and Nathalie
Many home care providers are being taken over by companies focused on aggressive acquisition based growth. These include an increasing number of private equity vehicles that look to acquire and sell within short time frames. In order to finance acquisition, pay off debt and reward equity investors, and ultimately exit the home care market, the predominant focus is often on raising cashflow withdrawn from the business as opposed to longer term investment in care and care standards.
What does all this mean for the delivery of person-centered care within our communities?
We are definitely seeing more and more providers using the term person-centered when describing their services. But are we really seeing meaningful developments in person-centered care and community engagement or are we just witnessing a rewording of existing service representation?
Are service providers addressing the wider needs of the person as a whole, as a human being first and foremost, as opposed to primarily assessing clinical incapacities and delivering services to address these care needs? Both processes can produce a personalized care plan but only one of them is going to be person-centered.
Are care providers aware of what makes up person-centered service frameworks, of those areas of the wider person that come within the scope of their service and those areas that do not? How do they connect, or connect the person, with the wider universe of care and community to ensure the intrinsic
capacities and needs of the person are addressed? We know that we cannot meet all needs, which is why we look to a person and a family’s social networks and the wider community’s assets to help facilitate person centeredness and care objectives. This is part of our formal model of person-centered care.
Does care assessment, care planning, care oversight and delivery employ a non-clinical lens of engagement and is it co-produced with the person and their family? A person centered care assessment will often take longer than straight forward “what supports do you need?”. It should address “the physical, social, emotional, cerebral, spiritual, creative and cultural assets and capacities of a person” and care planning and care oversight ways of enabling these capacities while supporting the person with their care needs. This also means that a home care organisation needs to possess much more than just care coordination skill sets.
More profoundly, it takes time, culture, long term service development, training and constant re-evaluation of the fundamentals of person-centered care to be able to deliver it, meaningfully and effectively. It needs to be managed; it is a fundamental living framework a deeply embedded organism and skillset within the organization.
Person centeredness is something that runs right through the organization, from senior management and operations, to care oversight, navigation and coordination, to the front-line caregiver. A recent 2024 report “The implementation of person-centered plans in the community-care sector: a qualitative study of organizations in Ontario, Canada” emphasized the importance of culture and commitment to person centeredness across the organization:
“in order to be successful, commitment to this process should extend across all levels of the organization, be fully integrated into organizational service delivery, and be reflected in organizational philosophy, values and views of persons-supported”
So the question is clear. Can the home care model be one focused primarily on cashflow and acquisition while at the same time claiming to be empathic and person centered? Are private equity and growth focussed acquirors of home care fundamentally empathic and person-centered?
We cannot be both. Why? Person-centered care requires organizational support and commitment from the top and empathic structural discipline focused on the person and their intrinsic capacities with services and service delivery merely a means to an end as opposed to an end in itself. And, person-centered organizations are not merely focused on clients and families, but staff, front-line caregivers and communities.
Person-centered care organizations are building, with others, the social capital and supportive communities of today and tomorrow. They are organic complex and ultimately community connected entities that need close attention and support.
Home care is a very competitive industry, easy to enter but extremely hard to gain a meaningful foothold. The ability to differentiate yourself from the competition is therefore important. This makes it all the more attractive to use terms such as person-centered care in order to do so.
Finally, we would like to draw your attention, if you have time, to our podcasts featuring Professor Andrew Miles & Professor Sir Jonathan Elliott Asbridge from The European Society for Person Centered Healthcare who will discuss the slow adoption of person-centered care in the health care system and the difficulties in implementing it within health care organizations, concerns which are echoed in the academic literature addressing person-centered care.