Executive Summary

This report addresses the considerations of safely providing equipment, supplies, and medications to individuals receiving health care at home and in community care settings. The report outlines best practices, identifies gaps, and provides recommendations and a standards roadmap to address those gaps.

The development of national standards and guidelines that address the many existing gaps and shortcomings in home and community health care will positively affect Canadians. The demand for care in the home is increasing steadily, and health technologies are making many additional types of care possible. These, in turn, bring challenges in terms of safe and effective implementation. The overarching theme of this report is to identify these challenges and propose effective approaches for addressing them.

The following list recounts some of the opportunities for developing standardization and guidance needed to help improve the safety and effectiveness of home and community care:

• A set of national standardized requirements on the eligibility, coverage, co-payment, and funding policies for provincial and territorial home and community care programs to facilitate efficient and equitable access to home health technologies.
• A standard to help ensure that the environment for the delivery of home care is safe and appropriate, that provides details on duties of owners and occupants; structures, facilities, plumbing, and space requirements; safety and personal security; lighting and electrical systems; thermal comfort, ventilation, and energy efficiency; moisture control, solid waste, and pest management; and chemical and radiological agents.
• A unified national guideline for the safe disposal, from the home setting, of medications, chemical hazards, and biomedical waste.
• Standards that address the criteria used in selecting home health technologies, intended for prescribing health care professionals and individuals who are making their own purchases.
• Standards, equivalent to those that address the management of hospital equipment in Canada, but for home health technologies, to include preparing equipment for reuse.
• Standardized guidelines for infection, prevention and control (IPAC) in home and community care settings, to counteract incomplete knowledge and training on cleaning, decontamination, disinfection and sterilization. Best practices should address risk-prioritized methods for screening and remediating risks and surveillance techniques in the home.
• A best practices guideline or standard that focuses explicitly on mitigating medication errors in home and community care would likely significantly prevent injuries and deaths and serve all Canadians. Risk factors that should be taken into account in the context of widely divergent home and community care clients include polypharmacy; medication scheduling; management of missed doses; interactions with other prescribed medications as well as with over-the-counter medications or supplements; and safe storage.

The report is divided into seven major sections, with each section addressing unique problems encountered in the home care environment that the recommended standards and guidelines aim to address.