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Year 3 Highlights 2018/19

Meeting patients’ needs for personal support services in a system without enough personal support workers

A young woman helps an elderly man with his walker


A mother contacted Patient Ombudsman to complain about inconsistency in the personal support services available to her daughter through the LHIN.

The mother relies on these services for respite and to help her to continue to meet her daughter’s significant care needs. The complaint outlined a range of issues, including missed services, last minute or no notice that services would not be provided, frequent changes in workers who lacked knowledge of her daughter’s care plan, and difficulty contacting the LHIN’s contracted service provider.

What we did

Patient Ombudsman contacted the LHIN, shared the mother’s concerns and asked for a response outlining how the LHIN was responding to the issues raised. The LHIN confirmed that it was aware of the mother’s concerns and acknowledged that a system-wide shortage of personal support workers had contributed to inconsistent care to the patient. The LHIN had been working with the contracted service provider to improve communication, ensure workers have appropriate skills and training, make every effort to ensure shifts were filled and that appropriate notification would take place if there was a scheduling problem. The service provider confirmed that it was working to ensure a consistent team are scheduled and that supervisors will monitor the schedule closely.

Patient Ombudsman received a total of 226 complaints about LHIN-coordinated home and community care. Almost half (43%) of these complaints involved personal support services. The majority of these complaints related to the level and consistency of service available, including complaints about missed services, frequent changes in personal support workers, changing or unresponsive service schedules and workers lacking the skills or preparation to provide the needed care. For the most vulnerable patients with significant care needs and fragile informal supports, inadequate levels of care or inconsistent service can have serious consequences. The challenge arising from a system-level shortage of personal support workers was a consistent theme.

There is little LHINs can do to solve the shortage of personal support workers on their own. The solutions are primarily provincial health workforce planning and funding issues. However, there are opportunities for LHINs to work with their contracted service providers to improve care and care experiences for home care patients. Patients and caregivers often reported that they had no notice that services would not be available on a given day and they were left on their own to put contingency plans in place. For patients without informal supports, sometimes there was no contingency plan and patients were left in situations that put them at significant risk.

Tips for patients and caregivers

  • Make sure you know who to contact if you experience a missed service visit. If you don’t get a timely response, don’t be afraid to escalate you concern to your LHIN care coordinator or the LHIN patient relations representative.
  • Ask your LHIN care coordinator to help you plan for contingencies to ensure that you or your loved one are safe at home.
  • If you are experiencing persistent problems with missed or inconsistent care, make sure your LHIN care coordinator knows, and ask for a meeting to discuss your options.
  • Keep records with the dates and times of your communications with the LHIN and your contracted service provider.

Suggestions for LHIN Home and Community Care

  • Ensure that contracted service providers are communicating with patients and/or caregivers when there are service changes or when planned visits cannot be provided.
  • Proactively work with patients, caregivers and service providers to develop contingency plans for vulnerable patients, including appropriate escalation protocols to ensure that patients are not left at risk.
  • Make sure that contracted service providers are appropriately prioritizing services for vulnerable patients, especially patients with fragile informal supports.
  • Ensure patients and caregivers know who to contact if they have questions or concerns. Make sure they know how to escalate their concerns if they’re not satisfied with the response they are receiving.