By Greg Basky for SHRF
A couple of years ago, leaders from Eden Care Communities came to Tim Maciag with a challenge: Could his software engineering students at the University of Regina come up with technology that would make it easier for their clients to request home care services? As part of their capstone class, Maciag’s students successfully developed a basic smartphone app that served as proof of concept that, yes, a tech solution could in fact make what was a cumbersome process more efficient.
Now, with the support of a SHRF Innovation Grant, Maciag -- a lecturer in software systems engineering in the faculty of engineering -- along with experts in health policy and information management are working to advance that CareOnDemand app into something that can not only help home care clients get the services they need to stay healthy and at home -- but also generate the kinds of information that will give policy makers a clearer picture of the need that exists for what Roy Romanow recommended become the “next essential service” in his 2002 Royal Commission report on the future of health care in Canada.
Informed observers have suggested the COVID-19 pandemic -- which has drawn attention to problems in long-term care homes -- is providing a window of opportunity to rethink our over-reliance on institutional care of the elderly in North America. Studies show home care costs less than institutional long term care, is preferred by seniors, and is better for clients’ quality of life and wellbeing. In Saskatchewan, the proportion of our population who could potentially benefit from home care is growing: by 2036, the number of people over age 80 is expected to double.
Ramona Kyabaggu is lead researcher on the project. She believes the app can help address the current dearth of good data. “In home care there's a disparity in not only the quality of information, but the quantity of information, when we compare it to other settings like acute care or even long-term institutional care,” says Kyabaggu, who coordinates the masters of health informatics and information management major at the Johnson Shoyama Graduate School of Public Policy (JSGS). “We're creating a potential mechanism to collect and share information with key stakeholders and decision-makers -- whether that's the administrator in a health facility or the Ministry of Health.”
Right now, clients and their families don’t have the kind of access to home care services that they’d like, according to Cheryl Camillo, an expert on health system reform and health policy at JSGS who is a co-principal investigator of the project. “We hear that over and over again from individuals,” says Camillo. “People want to age at home, and their family members would like them to remain in their homes too, but that's difficult because they can’t get the care and supports they need to do so. This research is an opportunity to facilitate aging in place by making home care more patient-centered by allowing patients to more easily request and receive the services that they want.” The current process for accessing services can be convoluted, says Camillo, complicated by issues such as limited eligibility for publicly-financed services, or a patient being stuck in an acute care hospital bed, waiting for home care to be arranged so they can be discharged.
The Eden Care Community is the team’s “laboratory” for this work. Borrowing a page from the software developer’s playbook, Maciag and his tech colleagues will be running rapid, iterative rounds of testing and tweaking of the existing app, working with Eden Care clients and their families -- and home care workers. The goal is to refine the app so users have a better idea of what supports are available to them and find it easy to access them. Both sides of the care equation say it’s important to them to develop a longitudinal relationship. “We want to help build this community of people that they (clients and workers) know and that they're familiar with and that they're comfortable with over time,” says Maciag, who is also a co-principal investigator with the study. Among the options they’ll be exploring is whether voice-activated, smart home devices -- think Alexa or Google -- can be used to make the tech “invisible” to clients and at the same time, be a user-friendly way to ask for services.
In parallel to the software engineering, Kyabaggu will be using machine learning to analyze CIHI data on home care use across the country, to determine whether the people who can most benefit are getting support, or whether clients who have easy access and coverage that pays for service are the biggest users. Ideally, she says, the app would help prioritize delivery of service to those most in need. The team is also analyzing how policies in different provinces influence both over- and under- utilization of home care services. They hope the data they collect with Eden Care can provide a more detailed picture of some of the problems clients and their families face in accessing support.
By spring 2022, Kyabaggu, Camillo, and Maciag should have a more robust app and a set of recommendations for health care policy makers and administrators, based on what they learn. They want to leverage what they achieve with this project to apply for additional funding from provincial and national granting agencies, which would allow them to create a tech tool that can be used beyond Eden Care Communities and beyond Saskatchewan.
Ultimately, the project is about improving the interplay between the people providing care and the people who need care, so the latter can remain healthy and in their home. Camillo says she’s excited by the project’s potential. “Frankly, as a health policy scholar, a former health policy maker, and a patient and a family member, I'd like to see us improve long-term care by allowing people to age in their homes with the proper supports. This is way, way overdue.”
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