Health care in the home is ethically as well as structurally different. 

  • First, the care provider is in the patient’s home, in the context of their family, living arrangements, cultural community and so on. Conversely, the care provider is not in an institution and does not have that context of other staff and colleagues, familiar surroundings, authority structures, and support. 
  • Second, many people do not have good models for understanding their roles when health care is provided in the home. From the patient’s perspective they may be used to friends or family members “visiting” their homes – and so the inclination may be to treat the care provider as a guest or friend. And that poses a challenge for the care provider who must act in a professional fashion but who must also maintain a good working relationship with the patient. 
  • Third, health care is often intimate and in the home that level of intimacy is increased. The patient is not only physically exposed to the care provider, but their home life is also open to an outsider. 

Since May of 2022 we have been working with Home and Community Care Support Services to develop a Framework for Supporting Ethical Practice for home care services throughout the province of Ontario. That framework makes explicit connections to the HCCSS Quality Framework, the Patient Engagement Framework and the Provincial Equity, Inclusion Diversity and Anti-Racism Framework. In addition, we have developed a new ethical decision-making tool SCORE, (Situation, Context, Options, Recommendations, Evaluation) which is available as an interactive fillable form, with “mouse-over” explanations and links to relevant supporting materials. 

Please contact us for further information and support.