It’s been over a dozen years since my Dad passed away. He died in his home. He wanted no part of any type of care facility. During the last years of his life, he required a variety of home care services. Towards the end, those services were around-the-clock.
My Dad lived in Ontario. I lived in British Columbia. As my Dad’s health deteriorated, I made it a point to regularly visit and stay with him. I would help him with his daily living needs. I considered myself a member of his caregiver team; a remote member.
While in that caregiver mode, I sadly observed many, many home care service situations and events that reflected silos in action. Since then, I’ve heard the stories of many other family caregivers, through family and friends, and as a volunteer facilitator of a family caregivers support group. Silos are everywhere.
Silos in home care service delivery
As a mediator, my goal is to build bridges between people. I tell myself I’m in the silos-busting business. Busting silos starts with actually identifying situations, as silos.
With regards to my Dad’s home care service delivery, here are five, all-to-still-common, silos that I observed:
- silos between care agencies; lack of overall service coordination; while an individual care agency coordinates their home care workers, nobody is coordinating the services across care agencies and professionals
- silos between individual care providers; miscommunication during service hand-offs; e.g., care-related information about my Dad is not communicated between shift workers
- silos between care providers and family; poor communication: of my Dad’s care status with family members, and of my family’s care interests;
- silos between care providers and care recipient; rotating wheel of caregivers minimized the extent to which meaningful relationships were formed, between caregiver and recipient, Dad
- silos between family members; mea culpa 🙁
The above silos stew, in whole or part, from poor communications and relationships. The result is that quality of care suffers, conflicts abound, and satisfaction is in high demand.
3 Strategies for breaking down silos in home care service delivery
I/We use the silos metaphor as a pathway to bridge differences. Our goal is to have everyone singing from the same song sheet.
To deal with silos, we need to build on the things all silos have in common; the sky above (our vision) and the ground below (our values).
Psychologically, I believe this build-on approach works because its often easier, and more constructive, to increase our positive behaviours; e.g., our capacity to reach out and recognize shared interests, vs. obsessing over negative behaviours; e.g., being judgmental, abrasive, etc.
To break down those home care silos, here are three strategies, that demonstrate leadership:
Get to know the care recipient’s story. My Dad’s story was his, alone. A person’s story is a wonderful vehicle to journey with. If every caregiver knew the story of the person they were caring for, what an opportunity for shared connection and relationship! Learning the care recipient’s story is the heartbeat of patients as partners. Making the time and having an efficient template for capturing, and sharing, their story is key. The therapeutic-restorative biography (TR-Bios) approaches, advocated by pioneer geriatric psychiatrist, Gene D. Cohen, in The Creative Age, provide such a model. Bonus: Creating those TR-Bios makes for a terrific inter-generational activity.
Improve your team’s communication and conflict management skills. The word ‘communication’ has its’ roots in Latin, and means to make “common”; i.e., get on the same page. Effective communication is when our message’s intent, action, and effect are all in-sync. Conflict in the workplace, home, is inevitable. Communications and conflict management go hand-in-hand. The biggest barrier on both fronts is typically ourselves, and our emotions. Improving self-awareness and becoming conflict competent fosters emotional intelligence, and gives you a leg up on making common, and breaking down silos.
Connect with people who share similar outlook and are motivated to action. “Home is the new health care institution.” Complex? Yes. Home care is its’ own system. It takes a system to change a system. Collaborative action is required. Collaborative action requires motivated individuals (positive energy, all around), connected, and drawn to a shared strong magnetic attractor (need or problem, “pain point”), working together, for mutual benefit; e.g., relationship-based care service delivery.
Castles in the air
When I reflect back on my Dad’s home care situation, I could write a book about all the communication adventures that went down. That situation has changed little, for the millions of people aging-in-place, and their caregivers.
Looking ahead, I envision a ‘Care Grid‘; a new type of grid; supporting our aging society. Its features will include tools for breaking down silos in home care service delivery.
“If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.” ~ Henry David Thoreau.
Let’s do it.
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