Image Image Image Image Image Image Image Image Image

The Impact of Home Care Nurse Staffing, Work Environments and Collaboration on Patient Outcomes


Study Overview

In Canada, it is estimated that up to 80% of direct home care is provided by personal support workers (PSWs), also known as unregulated care providers (Berta et al., 2013). Within Ontario, PSWs work in home care under the direction of Registered Nurses (RN) and Registered Practical Nurses (RPN). Increasingly, nursing care is delegated and provided by unregulated care providers such as PSWs. Little is known about the provision of nursing care activities by PSWs and the role of the nurse in assigning, delegating, teaching and supervising these activities in home care. As the health care needs of Ontario’s home care clients increase in acuity and complexity, it is important that Ontario’s home care workforce is capable of meeting the demand.

The home care work environment is unique among health care settings. Compared to institutional-based nursing, home care nursing occurs in unpredictable complex environments (i.e. patients’ homes). Nurses often lack control over their work environments as nursing care is often supplemented by family members or informal care providers. The home environment is often ill-suited to the provision of safe nursing care. The challenges of the work environment paired with organizational processes often characterized by inconsistency and poor coordination impact patient outcomes.

Research on the relationship between the structures and process of nursing care and patient outcomes in home health care is limited. Further, contextual differences make it challenging to apply similar knowledge, generated through institutional-based research to home-based nursing care. This study will examine current structures of home care provision, the roles of RNs, RPNs and PSWs and the relationship between structures of nursing care and home care client outcomes.


Study Purpose

The focus of this study is the delivery of nursing care to long-term / maintenance (LTM) home care clients in Ontario. This study employs a mixed methods non-experimental design to examine the structures of home care provision within the context of Ontario’s home care sector. Understanding how nursing care is structured in the community will inform the optimization of nursing care providers roles, resulting in best possible outcomes for Ontario LTM home care clients.


Study Phases

This study is now complete. View the final report: Final Report Home Care Outcomes

Phase I: Synthesis-Complete

The goal of Phase I is to gain an understanding of current structures of home-based nursing care delivery for LTM home care clients. This will be done by conducting a jurisdictional scan to identify current legislation and policies influencing structures of home-based care across Canada. This phase also includes a literature review of existing research related to the structures and outcomes of home care and the delegation, teaching and supervision of nursing care activities performed by unregulated care providers.
Read More

Phase II: Analysis – Complete 

In this phase, findings from the jurisdictional scan and literature review will be analyzed and applied to the context of home-based nursing care delivery in Ontario. Results of this analysis will be used to understand possible consequences of policy alternatives.
Read More

Phase III: Primary Research – Complete 

In the final phase, chart reviews and focus groups were conducted concurrently to describe and examine current structures of home-based nursing care delivery in Ontario for Long Term / Maintenance (LTM) clients.
Read More

Applied Health Research Questions (AHRQs)

A portion of the Ministry of Health and Long-Term Care funding for this project has been allocated to address Applied Health Research Questions (AHRQs) identified by health system providers and policy makers. The aim of the AHRQ process is to build research evidence to inform policy and practice benefiting the broader Ontario health care system. See below for completed AHRQs.
Read More

Structures and Outcomes of Home-Based Care in Ontario: From Knowledge to Action

This forum brought together individuals and stakeholders from home care service provider organizations, home and community care associations and government to validate study results and to discuss the impact of study findings on the future direction of community-based care.
Read More

Research Team

This study was conducted by a team of researchers from the University of Toronto led by Dr. Ann Tourangeau. The study was funded by the Government of Ontario. The views expressed are the views of the research team and do not necessarily reflect those of the Government of Ontario.


Study Partners and Collaborators
Hamilton Niagara Haldimand Brant CCAC
Mississauga Halton CCAC





More Research