Analysis of a territorial approach to the delivery of nursing home care services based on historical data

Abstract

We analyze a territorial approach to deliver nursing homecare services to a territory public health. We present the case of the CSSS assigned to Côte-des-Neiges, Métro center and Parc Extension, specifically the case of the Côte-des-Neiges site (CLSC CDN), where a territorial approach is used since 1980. We first give an historical comparison of patient visits delivered in 1998-1999 and in 2002-2003. We follow with an in-depth analysis of the home services delivered in 2002-2003 to determine whether or not the territorial approach can well support the changing needs of the population. We conclude that the territorial approach to deliver homecare nursing services does not sufficiently support fluctuations in population needs for services. Not only is it difficult to predict these fluctuations, but it is difficult to accurately quantify the true needs for services since the availability of nursing services tends to determine the services actually delivered. In sectors of the territory where resources are more scarce (based on previous population needs analyses) or demand for services is greater, the result is work overload for the nursing staff. In addition, this results in service delivery inequities across the entire territory. Therefore, a more dynamic assignment of clients to the nurses based on each nurse's work load and case load rather than based on the geographic location of clients is worth the extra administrative time in case assignment to ensure a more equitable case load attribution between nurses as well as less inequities between clients in terms of service delivery considering their needs.