Abuse in home care: an analysis of research, practice, and policies in Manitoba

Problem: Home care services enable people to receive care while maintaining independence, is associated with positive health outcomes, and can serve even those with complex care needs. Yet, there is a risk of abuse towards home care clients, and on the other side, a potential for harassment of workers. This study aims to: consider how policies and documents on abuse in Manitoba home care settings reflect trends in recent research and identify how they align with the healthy public policy approach. Theoretical framework: This study draws on the concept of healthy public policy (HPP). HPP originated from the field of health promotion and aims to incorporate a public health approach to policy making. Methods: Manuscript one consisted of a scoping review following the PRISMA-ScR guidelines, resulting in a review of 52 studies to map the current state of research on abuse in home care. Manuscript two piloted a set of HPP criteria to analyze 24 home care policy documents in Manitoba gathered through an environmental scan. Findings: Manuscript one documented two types of abuse: abuse towards clients and abuse towards home care workers. There was a high prevalence of verbal abuse towards care workers. Care workers who experience abuse from clients living with dementia can benefit from tailored interventions. Migrant care workers are particularly vulnerable to exploitation in home care jobs. Clients most often experience financial abuse and neglect. No interventions to protect clients were identified. Manuscript two demonstrates the usefulness of the HPP criteria by finding that policy documents reflect at least one criterion from the HPP framework, with only one document meeting all criteria. Discussion: Applying the knowledge from manuscript one to the documents gathered in manuscript two indicates that while some trends are present in policy documents, others are notably absent. In particular, proactively protecting clients from abuse, and the need for training to protect care workers who support clients living with dementia. Conclusion: Policies and practices should be frequently reviewed against evidence-based knowledge and health promotion techniques to promote up-to-date policy making with the potential to improve the health and well-being of care workers and clients.

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