The human resources shortage continues to impact organizations across the healthcare sector. There are many factors contributing to this crisis, many of which were apparent long before the pandemic. But COVID-19 certainly exacerbated the issues and organizations across the health system are eager to find solutions to ensure clients continue receiving the care they need while working within their human resource constraints.

VHA Home HealthCare’s Essential Care on Weekends (ECoWs) initiative is an example of a healthcare organization turning inwards to optimize its existing staffing resources to find a sustainable solution to their unique experience of the health human resource crisis.

In 2021, at the height of the pandemic, many Personal Support Workers (PSWs) at VHA Home HealthCare (VHA) had to reduce their availability to work to care for children at home while schools were closed and to care for sick family members. VHA was struggling to recruit Personal Support Workers (PSWs), especially on weekends when PSW availability was most limited. This affected VHA’s ability to take on new clients, particularly those discharged from hospital who often had complex needs requiring more intensive care.

This situation was critical. Though meeting client needs had always involved providing some weekend care, the dramatic rise in clients requiring complex care had increased the demand for weekend personal support. VHA had an ethical and contractual responsibility to ensure all high-intensity clients received care on the weekend as well as weekdays. In moving forward with a solution, VHA would have to balance the preservation of the client-provider relationships with the safety risks of missed care.

Ready. Set. Launch. 

“We knew we needed to try something different to address the significant health human resource concerns,” said Sandra McKay, VP, Research & Innovation at VHA and a member of the ECoWs steering committee and project team. “The idea for this pilot was generated through a ‘design sprint’ solution-finding session between team members and client partners. Together they came up with bold, creative ideas that we then distilled into a program we could implement.”

Collaborating with Home & Community Care Support Services (HCCSS), VHA developed the pilot program, Essential Care on Weekends for Personal Support, aimed at increasing the number of complex clients who could receive care on the weekend while working within the constraints of PSW availability and location.

A scheduling optimization strategy, the ECoWs initiative focused weekend care on providing essential care to clients with complex care needs. PSW travel considerations were core to the success of the operation. Previously, scheduling coordinators would allow up to 30 minutes or more travel time between clients. Under ECoWs, schedules were adjusted so that care and travel could be completed within one hour, and PSWs were reassigned to clients within a smaller geographic area enabling them to travel between clients within 15 minutes.

Clients who received weekend support but did not require daily care were moved during the week often with the PSW who provided care on the weekend. Thanks to an effective communication strategy, clients willingly accepted this change if their PSW remained the same. This permitted more capacity for complex clients who required daily care and resulted in a permanent shift for clients eligible for weekend care.

Though scheduling PSWs in small work groups on the weekend meant more care and less travel, this also meant some relationships on the weekend were impacted. Recognizing the special bonds between client and PSW, and the impact of change on frail seniors and those struggling with dementia, a framework was put in place to mitigate the impact of this new scheduling practice. A toolkit of strategies was developed to guide staff through the decision-making process and help clients transition whenever changing provider was necessary. The approach included home visits, transition planning, and new PSW shadowing of current staff if needed.

The roll out of a comprehensive communication and engagement strategy was also key to ensuring a smooth process for VHA’s clients and families as well as the care providers involved. Engagement with Managers and Care Coordinators was critical so that shared messages supported this change.

“Clients, families, and staff needed to be informed in advance about the program’s goals and processes,” shared Sandra Tedesco, Regional Director where ECoWs was implemented. “We sent personalized information letters to clients and families and also held one-on-one conversations and home visits. And we held team meetings so our personal support workers, coordinators and supervisors would all understand the reasons for implementing this program and its goals as well as how it would work. This helped to empower them to deliver the essential care their clients needed and to answer any questions from clients and families.”

Implementing the ECoWs program into a workable schedule required finding a balance between the needs of clients and the availability of providers. A strong emphasis was put on ensuring client safety and positive experience. Coordinators and Personal Support Supervisors worked together to review client care plans and consulted with clients and families ensuring their health needs were met by the scheduling of PSWs.

“We’ve learned a lot about supporting organizational change and effectively sustaining it over time,” said Margery Konan, Senior Project Manager with VHA who co-chaired the ECoWs steering committee and project team. “A strong commitment was needed from everyone – PSWs, coordinators, supervisors, our data & analytics team and senior leadership as well as the ECoWs steering committee and project team.”

Impact and Findings

“This is a great example of the benefit of applying an innovative approach to address a long-standing homecare sector challenge,” said Sandra McKay.

“At the outset, we created a comprehensive communication and operational processes to support smooth implementation and a robust evaluation plan to understand the impact and facilitate ongoing improvements to the model. We were very encouraged by the results of the pilot. Our review of the service delivery data, along with the feedback we received from clients and staff, demonstrate it made a very positive impact.”

“The transition was very smooth for my clients,” shared one PSW involved in the program. “Thanks to all the communication efforts, my clients knew what to expect during their weekend visits.”

A coordinator added, “Our PSWs appreciate being able to work within the same area and not have to travel so much between clients. The reduction in travel time made it easier for PSWs to see more clients during their weekend shifts.”

Formal valuation of this model is outlined in Optimizing Weekend Schedules in Home Health Care: The Essential Care on Weekends for Personal Support Quality Improvement Project, published in Home Health Care Management & Practice, and demonstrates that ECoWs was successful in increasing access to and consistency of care for clients with the highest care needs: missed care rates decreased by 38% on weekends and 40% on weekdays, weekend visits delivered per week and referral acceptance rates for clients requiring higher intensity care increased, and the number of unassigned weekend visits at the beginning of each week was halved signaling increased schedule stability for clients and providers.

Implications for Homecare Sector

The ECoWs scheduling optimization strategy demonstrates how a homecare organization can increase capacity without acquiring new technology or additional staff. Investing in a comprehensive communications and engagement strategy and employing a transparent and ethical decision-making framework for staff proved effective at facilitating operational changes to improve the capacity to provide timely quality care.

Homecare plays an important role in our healthcare system by providing quality person-centred care to vulnerable community members in their home where most people want to be. A growing aging population is making the role of homecare ever more important, and strategies such as Essential Care on Weekends can help address the sector’s challenges to meet the increasing demand for its services.