Understanding the perspectives and experience of community-based providers is an important input to understanding and improving the experience of individuals and their caregivers. What does integrated care mean to the range of providers who deliver home care and support services in the community? What do they think are the most important elements of integrated care, and how do their experiences stack up against them?

In 2009-2010, The Change Foundation worked with the Community Provider Associations Committee (CPAC), an umbrella group of associations that includes most organizations providing home and community care in Ontario, to survey more than 2000 community care providers about those, and other, issues.

We captured frontline views from care coordinators, regulated health professionals (registered nurses, nurse practitioners, advanced practice nurses, registered practical nurses, physio and occupational therapists, speech language pathologists, dietitians, social workers, respiratory therapists, and pharmacists) and personal support workers. The work, encapsulated in a new report released today, Integration of Care: The Perspectives of Home and Community Providers, complements the Foundation's earlier work (June 2008) probing patient/caregiver perspectives on navigating the system.

The survey data were generally positive. Survey respondents clearly articulated that client-focused care, working well with other providers, prompt and complete information, effective communication with the client and with other providers, and timely assessment and care are highly valued. They view client involvement and client-focused care as integral to a well-coordinated system of care. Prompt information about care plans and changes to plans, having complete information from other providers, and good communication among providers were viewed as key to integration. However, analysis of the quantitative data indicates that there is a gap between community providers' ideals and their reality.

The majority of respondents would like to provide client-focused care. However, providers in the home care and community support sector are working within a broader healthcare delivery system that has evolved over time and undergone significant change. Based on what The Change Foundation has heard from individuals and their caregivers, it is a delivery system still not known for its client-focused orientation.

For example, more than a quarter of respondents (28%) were not informed in a timely manner when a client to whom they were providing care was moved from home to hospital or to another care facility. Almost half of care coordinators and regulated health professionals (48%) did not know if there was a single person in charge of communicating all necessary information to the facility. When the client returned home from the facility, almost one-third of respondents (31%) did not receive information about the discharge care plan promptly-36% of care coordinators, 27% of regulated health professionals, and 18% of PSWs.

Four predominant themes emerged from our analysis of the survey responses: human resources strategy development; operational design improvements; information exchange and communication improvements; and improved linkages with primary care. The Foundation offers targeted recommendations for each area. For those interested in detailed data and/or data specific to the various provider groups, four technical reports are available. There are three provider technical reports, and a fourth comparative summary report analyzing the responses of all provider groups.