The intent of the home and community care program is for clients and family and friend caregivers, to work in partnership with home and community care, which supplements care and services. Clients’ comments revealed a need for greater clarity to understand their roles and expectations relative to the home and community care program.

Clients are not always aware of the home and community care program, the spectrum of services available, and their expected role. They questioned, for example, whether a particular service they received was provided by home and community care. Overemphasis was placed on the word ‘home,’ and clients expressed confusion or lack of awareness that services can also be provided in community locations. This suggests an opportunity to inform clients about the program, the array of care and services available, and the diverse settings in which care and services are delivered.

"It is not clear as to what actual home services are available. The title ‘Home [Care] Services’ is misleading. You need to change your name to describe what it is you really do."

"Only that "home" care should change the name - the doctor said I could go home as "home" care was arranged. They only came to my home twice in the 6 weeks I was a patient, otherwise I had to go to [community]. I really don't know who home care is. I do not know what they do."

"I really don't know who home care is. I do not know what they do."

In addition to informing clients about the home and community care program, clients wanted specific information about:

"A written list of needs provided would be valuable. Often, I do not know what I could have to cover my needs or what to ask for."

"I think it would be nice for home care to provide a list of trusted people to call - that home care has an alliance with and knows and trusts - to provide people with someone to call for other services. I have never needed to seek outside help for house cleaning, yard work and those kinds of things and it is hard to do that on your own if you are very [unwell]."

"Professional care people usually say that the request is not their expertise, describe a professional that might be able to help but not refer or offer a number."

"The government closed the home care in [place], and we have not received any information where we are to go if we need this service again."

Clients also described their role, or family and friend caregiver’s role in their care, such as coordinating appointments, services, equipment, supplies, and preparing for staff visits. Sometimes they are involved in care delivery, such as changing their own wound care bandages, or providing staff with education or course correction when care is delivered incorrectly. Some conveyed they did not feel adequately prepared for the extent they are expected to be involved. This reflects a disconnect between clients’ expectations regarding home and community care’s level of involvement, and what occurs in practice.

"Proper bandages were not always available. I had to buy some."

"Some staff are not properly trained in eyedrops and rush. I have to train them on the spot."

"[Home and community care staff] would just drop off supplies on the doorstep outside. I felt they should have changed my dressing, not me for the first while. It was tiring for me."

"They are supposed to come once a week but often don’t come for [a few] weeks. My [family member] is a [nurse] and they expect [them] to change my dressings."

Clients may also be responsible for some costs associated with home and community care, such as long-term use of personal medical supplies and equipment. However, this expectation is not always clearly understood by clients. To offset costs, some clients apply for assistance through provincial programs such as Aids to Daily Living. Other clients are left with the decision to pay out-of-pocket when they are unaware of financial support programs, or support through these programs are denied or delayed.

"Home care was previously supplying wound dressing supplies but lately they seem to be forcing me to find supplies by myself or keep harping about how they are difficult to obtain, or they are being directed to have clients provide their own supplies lately."

"Lacking information about where to get supplies and what is covered through [program]."

Lastly, clients want staff to value their role in their care and services and actively seek their input by engaging them in dialogue during care and services and at care planning meetings. Clients want to be able to articulate their needs, requests, concerns, questions, and preferences, and for their feedback to inform positive improvements in their care and services. Thus, the ability to understand and be understood is important to clients to ensure they can participate in their care. This requires home and community care staff, case managers, and providers to listen with empathy and compassion, and modify their communication approach as needed to attend to differences in language (e.g., native language, the complexity and comprehension of words used), speech pattern (e.g., speed, volume), and modality (e.g., verbal, written, American Sign Language).

"I would like to be more involved in the planning of my care."

"I sometimes would like to see a registered nurse visit patients to see if they have any questions/concerns."

"I am hard of hearing and my processing speed is slow. Language difficulties prevent me in part from understanding the vocabulary used to describe my care."

"Language is ableist often."

"Barely any support for clients who use ASL or non-verbal communication (including writing)."

Clarifying the roles and expectations of clients, family or friend caregivers, and the home and community care program early on may help to ensure common understanding and set clear and reasonable expectations. This could involve exploring clients’ and caregivers’ comfort and preference with these roles and engaging in conversation about the supports or resources available. In addition, adapting approaches to communication so clients can understand and be understood and meaningfully participate in their care.

Accessible and timely is a theme conveyed in clients’ experiences with accessing home and community care services. Access to needed services and in a timely manner was often discussed in relation to staffing levels and staff availability in clients’ comments, as well as funding and scope of the home and community care program.

Timely access to services and its interconnection to staff availability

Many clients experience difficulties accessing home and community care services in a timely manner at various stages of their journey. Most of these clients discussed their experiences accessing professional care services, though some noted delays with personal care services. Delays were experienced when initially starting services, a concern raised most often by acute care clients. Also, delays occur when new services are added, or services are restarted such as after hospital discharge. While some clients reported delays that lasted days, others said delays lasted weeks or months, negatively impacting their ability to get their care needs met. Clients often attributed lack of timely access to services to insufficient numbers of home and community care staff, when staff are sick, on vacation, or leave their position.

"It took at least 3 months before getting the service to come in our home."

"I was released from hospital not able to walk. I was told that someone would be here in a week. It was [a few] weeks, not eating not bathing."

"Extremely long delays in accessing physio and occupational health services. Ongoing physio needs limited often due to staffing shortages."

"When you need specialty services there needs to be more availability of services, one [type of] nurse assigned per region is not sufficient."

In addition to their concerns about the timeliness of access to services, clients also described concerns accessing services they feel they need. Specifically, they want more support with needs related to social determinants of health. These clients noted they could not recover if their basic needs are unmet, such as access to nutritious meals, transportation, or a safe and comfortable living environment. Also, clients do not always feel they have enough services and desire greater frequency, duration, and more types of services approved in their care plan. Some of the services clients commented they want more of include wound care, bathing support, home assessment, compression stocking support, and physiotherapy and occupational therapy.

"Home care needs to include having someone make a sandwich or a snack when we are sick and injured and have no one and can't afford a meal service. This is a critical part of getting better. There were days I ate chips and cookies because I could not move to make a sandwich. 15 minutes to make a sandwich is all that we would need."

"They did not help - for example they told me to take a cab to take my [sample] to the lab when they did not know whether I could afford that or if I could manage on my own. I cannot get anywhere without help."

"The help was really good and helped me get my strength in a positive direction, but I felt I needed more help to get me there. So, I am not losing my balance."

"At no time did home care come to my house to see if it was setup properly or safe."

Though some clients formally requested services through their case manager, they are not always approved because it is outside the scope of services provided by the publicly funded home and community care program, or these additional services fall outside the approved/allocated services as assessed by an AHS case manager. When services are recommended by a health care professional who works outside of the home and community care program, home and community care does not always approve it.

"My case worker has constraints placed on [them] by AHS as to what [they] can put on our care plan. Any extra services we have to pay."

"I thought I made a reasonable case for support stockings. Request was denied without a good explanation."

"Post-surgical orders from surgeon were not met, and I had to depend on friends and neighbours for care that should have been offered by professionals."

Ensuring timely access to services, responsive to the breadth of clients’ needs, including social determinant of health needs, may enhance quality of care and health outcomes for clients.

Flexibility and access

Clients’ comments reveal a desire for greater flexibility from the home and community care program and staff. Inflexibility is felt to contribute to delays accessing needed support, unmet needs, or care not meeting their preferences. Policies and procedures are also noted as being inflexible. For example, authorization processes to approve additional care hours, services, or equipment and supplies require following rigid guidelines that can be time consuming, and result in delays.

"My doctor wants me to get compression socks, gave me a prescription for them, sent me [for tests] and sent a report to care worker. [The care worker] said I would have to wait [a few] months before I could get them, said they had their own staff that did the tests.""

"They were limited by policies and procedures that hindered their ability to help. For example, my OT's recommendations for a bathroom adaptation was vetoed by a [program].""

"Care services were very specific with zero deviation to assist with changes that were very short term. There needs to be flexibility to assist in certain circumstances."

Being "flexible" and "adaptive" to clients’ needs and preferences may improve access and positively impact quality of care. Regularly review policies and practices to ensure they are consistently applied and meet clients’ needs as clients’ needs evolve.

Access experience for people living in rural areas

While clients who live in metropolitan or urban locations attribute lack of timely access to services to insufficient numbers of staff, clients who live in rural locations perceive total absence of staff or services within their communities.

"I needed professional care that involved treatment options that weren't offered, provided or available in this small community. Home care does not have trained staff, nor do they have the [type of] supplies to provide [what is needed] on a regular basis. My wound wasn't healing until my family member provided this needed service."

"We have never had professional staff because there is none in our area."

"More need to be hired to come out and deal with my needs, as there are not enough staff that go into the community."

"I would not have received any personal care services had I not spent hours on the telephone sourcing which area I was in with Case Managers."

To access some professional care services like wound care, clients (particularly maintenance clients) commute to towns or cities that are sometimes long distances away at a time when they are recovering and not always feeling well. While some clients have help from family or friends, others do not. Clients’ experience visiting an office for services is not always satisfactory, requiring their active involvement to educate staff on how to provide their care because of poor staff continuity and care continuity.

"I could have used home care a bit longer post surgery rather than attending the clinic sooner than was comfortable for me."

"While having IV antibiotics, I had to go into town as there wasn't enough staff to come to my [home]."

"All of my care takes place in the hospital where the home services is located. [Many nurses are] part-time so I never know who will be looking after me on any given day. Each person has his/her own routine, and I find myself educating the staff attending to my dressings about what the actual routine is that the Case Manger has established."

"More supports have to be provided to clients who live outside of population centres. More funding to cover additional costs for travel, more details on service areas of home care companies, funding for specialized transport to cities."

Clients appreciate when home and community care services can be provided in their home, though this could come with challenges. For example, staff who are unfamiliar with a particular rural location may find it difficult to locate the client, resulting in delays. In addition, some reported their services are cancelled and rescheduled in the event of unsafe weather conditions or staff shortages.

"The people in [city] are unaware of where I live only because ‘help’ is [a number of] kms away!"

"I live outside city limits, so many services are not available, and we're always the first cancelled if resources need to be redirected."

Locating staff and services within communities, including rural and remote locations, is important to clients to ensure timely delivery of care and services. Clients suggested subsidizing travel costs for those who must commute to access services outside of their community.

Bridging gaps

When clients’ needs cannot be met in a timely manner or fully addressed by home and community care, some seek support to bridge the gaps. This may include relying on friends or family caregivers, privately hiring services that are beyond the scope of the publicly funded home and community care program, other health care professionals such as family physicians, or community-based resources like support groups who have specialized knowledge about a health condition. For urgent needs, clients accessed the emergency department, regardless if they live in rural, urban, or metropolitan locations.

"I live in a rural area, so the physical therapy is understaffed and covers a large area. Physical therapy usually ends up being taken care of by relatives instead of an actual physical therapist."

"I need more, the hours I get is not enough, I hire privately to get the amount of care that I need beyond the hours provided by the government."

"I requested having my wounds dressed twice a day instead of once and was ignored until I got my doctor to request it."

"There aren't enough properly trained care workers. And the ones who stick with it are worked to the bone for not enough pay, causing apathy and burnout which then creates churn. The whole system needs reorganization, restructuring, and re-evaluation in funding to be anywhere close to what it should be."

"Incentives for full-time care for family members."

"All these types of services are completed by family members, I think it is ridiculous I can't get money to pay my relatives to do services for me, their time is worth something too."

Clients suggest increasing the funding of the home and community care program to increase the number of staff available. They suggest that increasing staff compensation would improve staff wellbeing and result in increased quality of care. Clients also suggest incentivizing friend and family caregiver support in recognition of their role in caring for clients, as they perceive this work represents a cost savings to the healthcare system.

Clients value transparent two-way communication with their staff, case manager, and home and community care provider because it enables clients to make informed choices and advocate for their needs. Clients appreciate when they are regularly informed, welcomed to provide feedback, and able to contact and receive a timely response by phone or email.

"Extremely easy to communicate with.""

"They were fantastic in treating my wound and keeping me informed of the progress and what to expect."

Dissatisfaction occurs when there are communication barriers or breakdowns. For some, a barrier is access to information about whom to contact within the home and community care program for a particular question or concern, and how. For others, barriers occur while attempting to get into contact with a live person. Often clients’ messages are not returned or not returned in a timely manner and clients reported making multiple attempts to track down people or information.

"I wasn't aware at first my case manager was gone. From that point it was like they all disappeared, and I had to keep phoning and requesting how I could get further help."

"Difficult to contact staff. Communication is terrible - not customer focused. So difficult to navigate the system and figure out what is going on, many, many calls, half information, conflicting information, so frustrating. Feel the system is trying to make it extremely difficult so you don't use it."

"When I phone in to [home and community care provider] they are do not answer all the time and after leaving a message do not call back every time."

Clients perceived an opportunity to improve timely coordination of information sharing between teams and healthcare professionals involved in their care to ensure consistency of care and avoid “falling through the cracks.” This includes updating and notifying the team of changes to a client’s care plan, transferring care plans to new providers as quickly as possible, and ensuring recommendations made by healthcare professionals outside of home and community care are accurately captured in the care plan and implemented.

"Some workers are not aware of my requirements, seems there is a lack communication between [home and community care provider] and my caseworker or [home and community care provider] and their staff."

"In the beginning the personal care plan was not being conveyed to the actual caregivers that came to [my home]. There was a disconnect between the AHS care plan and what the [home and community care team] told their home care staff."

"Wound care was not provided as described by the doctor. [My family member] had to attend to it, despite calling home care twice."

Timely and transparent communication could better support collaboration and partnership between clients, home and community care, and other health care professionals. This would ensure clients’ needs can be met appropriately, consistently, and in a timely manner.

While some clients expressed their appreciation for staff who were communicative, arrived on time, and as scheduled, many others experienced dissatisfaction with the scheduling of their care and services. Comments centred around staff resourcing and scheduling and communication about the schedule.

Staff resourcing and scheduling

Many clients described their home and community care service schedule as inconsistent, unpredictable, and unreliable. Staff often arrive late, too early, or sometimes not at all. Clients observed this was in part due to staff availability, particularly when there are staffing shortages, staff absences due to illness, vacation, or inclement weather, or there is inconsistency in the staff who are scheduled.

"Do not have enough staff to meet required visits - never/rarely on time."

"Rarely had the same [home and community care staff]. Could not count on someone coming at approximately the same time each week. Therefore, I cancelled home care prematurely."

"When one of the regular staff is absent, care workers arrive at very inconvenient times, frequently with no notice."

Clients also attribute scheduling issues to poor and unrealistic scheduling. Staff are described as being overbooked and scheduled to see multiple clients at the same time with insufficient time to provide care and travel to the next client. Some clients expressed their sympathy for staff as they perceived staff are stressed and at risk of burnout. When staff are delayed while trying to visit a large roster of clients, a few clients reported feeling pressured to voluntarily cancel their appointment. During care delivery, clients observed staff hurry through care tasks and stay for a shorter duration than expected or as indicated in their care plan, due to time constraints. This contributes to missed and incomplete care.

"Some personal care staff are booked with two or three clients at the same time slot. So, they are always in hurry and stressed with the time constraints. Client has 2-hour time slot, but the visit may last for 30-40 minutes."

"The admin staff from the agency would call when they could not find staff in hopes I would cancel."

"Some staff are rushed and want to leave as soon as possible, signing book but not performing all tasks."

Some clients reflected that the schedule does not always consider clients’ needs, preferences, and life obligations. Specific times of day more suitable to enable clients’ attendance at work or school, or preferred hours of the day are not always accommodated. Likewise, clients’ care needs are not always met when service is limited during holidays, evenings, or weekends, or when time sensitive care such as medication administration or compression stocking support are not scheduled appropriately. Lastly, unexpected yet urgent care needs within the scope of home and community care, such as a catheter change, are not always possible on short notice and require clients to access urgent or emergency care.

"Home care has the impression that you sit at home and wait in excited anticipation for them to come - it doesn't matter what time they show up because as a client ‘we’ have no other life."

"Inconsistent times of arrival. Especially on weekends. Don't know if I can get to [an activity] on time or to appointments or meetings."

"Scheduling staff to come at your preferred time seems to be a bit of a problem. Staff want to come early sometimes because they are just about to finish their shift. It's not a huge problem as it's only compression stockings, but my legs swell more if I don't wear them long enough."

"When I call about a blocked catheter [in the afternoon], they say they can't come and force me to go to the hospital."

"I would prefer if personal care staff would show up at the same time daily. Also, I would prefer if they would let me know that they are not going to show up or be late."

"It is important that to have consistency in both the person attending and the time they arrive."

Improved scheduling and staff continuity could positively impact clients’ experiences overall. This includes scheduling sufficient time to implement clients’ care plans and travel between clients, as well as considering clients’ preferences and commitments when scheduling staff.

Communication about the schedule

Communication about the schedule does not always flow smoothly between clients, staff, and the scheduler, contributing to miscommunication and frustration. Clients find it difficult to contact someone to discuss their schedule or make changes to their schedule, and messages are not always returned in a timely manner. Clients are not always informed about the schedule in advance, and in some cases, there is an incongruence between the schedule home and community care staff are aware of and the scheduler.

"Having to call the office for personal care to change appointments, cancel appointments or ask questions about providers and times is an absolute exercise in futility…They often do not call back after saying they will. Changes they say they have made often do not occur."

"When calling to cancel an appointment I get a recording to leave a message, resulting in a personal care visit anyway."

"We could never count on a specific time when the home care person would arrive. The dispatcher would give us a time and the workers were given another schedule completely."

On the day of scheduled service, clients expressed frustration when they are not notified or given enough advanced notice about the staff schedule, their arrival time, and whether to expect a delay or cancellation. Alternatively, some clients are given an arrival window that spans hours, requiring them to put their day on hold. Many clients also said they received no further follow-up, even if staff communicate there will be a return visit.

"We wouldn't find out what time each day they were coming until a call each morning and sometimes they would say in a half hour, so planning was difficult."

"I would like to have the person that comes on [days] let me know when they will come. The window of time has been over 3 hours, and I find it frustrating."

"Have not seen my professional care for quite a while, I don’t know why."

Improved information sharing between clients, staff, and the scheduler is desired by clients, as well as receiving advanced notice of changes to the schedule and to staff. Timely communication about scheduling could ensure clients’ schedules and other personal commitments are respected.

Having consistent staff over time facilitates trusting relationships and mutual respect. This consistency is an important component of people-centered care, as staff can get to know clients’ needs, wants and preferences, and address these in a manner that is meaningful and comfortable for the client.

"The home care [workers] were very impressive and very professional and showed much respect for me, not just as a client but as a human being."

"My home care nurse was excellent, professional and like a good friend to me, 100% satisfied."

"Our consistent caregivers during the week have been reliable, trustworthy, and good.""

Some clients expressed disappointment that they do not have the opportunity to develop a relationship with staff. This disappointment occurs when staff change regularly, described as a “revolving door of care providers,” or when staff are in a hurry and visits are chronically short in duration and overfocused on care task completion.

"So many different workers make it difficult to be comfortable and build a relationship with them."

"I would like more consistency in the people that come into my home rather than random people every day. Sometimes the person that shows is nice and other times they are uncaring, unkind, and obviously want to get out faster than they come."

Sometimes staff and clients do not get along because of personality differences, or how staff interact with clients, which does not foster mutual trust or respect. Some clients described staff using words such as “impersonal,” “rude,” “dismissive,” and “apathetic.” Some clients also described feeling devalued when they are not treated as a person, such as when they are not engaged in conversation or are ignored and feel staff, “acted like they didn’t want to be here.”

"[Home care workers] lack of caring and understanding of me being a person."

"I honestly felt uncomfortable when some staff never even talk to me."

"They seemed more concerned with completing the task rather than how the client is actually doing."

When clients have a preferred or non-preferred staff member and voice this to their home and community care provider or case manager, their preferences are sometimes honoured.

"[The] regular nurse was excellent. On [their] days off, the other staff filled in. Some of them did not want to follow the care plan; they could be very difficult to deal with. In some cases, I had to ask the case manager to have a couple of them not come back to my home."

"I reported not being comfortable with a worker, and I was assured that they take that seriously, but that same worker showed up again."

Another aspect clients described is respect for them and their home. Clients want staff to dress professionally, knock and announce themselves before entering their home, remove their shoes and coats, and introduce themselves and their role if they have not yet met. They also expect staff to clean up after themselves when they are finished providing their care.

"All the staff were very unprofessional in what they looked like hair, shoes, clothing, very unprofessional. Occasional review of dress code wouldn't hurt."

"Knock - then get told to come in, not just come in. Introduce yourself when in. Don't go past entryway."

"[The home and community care staff] came into my home with dirty boots."

"Put things in garbage, not [the] floor."

Intentional effort to create mutual trust and respect between clients and home and community care may positively improve awareness and understanding of clients’ needs, wants, and preferences. This involves taking the time to get to know clients and treating clients’ homes as a home.

Clients perceived consistency of staff to be integral to consistency of care. Divergences from the care plan and inconsistent care occur when staff are new, temporary, or not up to date on care plan changes. In these circumstances, clients reported missed, partially complete, or incorrect care, which can result in unmet needs or unintended harm.

"Too many different staff members who did not read my file ahead of time. They did not always follow the prescribed protocol dictated by the plan. They were not always prepared ahead of time and were often tardy."

"There are too many different home care staff who show up for my services, and they all do the wound care differently, and I feel this has prevented the wounds from healing faster."

"Never the same person doing the same thing. Does not create confidence."

To course correct, some clients provide staff with immediate feedback and training or request the intervention of a case manager or other healthcare professional involved in their care.

"It seems like you just get used to a home care provider and then they switch providers, usually with me having to teach them how to provide the treatment needed."

"Hands have been crippled by inexperienced staff taking blood…I had to go to the doctor and [the doctor] stopped them from taking blood."

Clients’ comments suggest it would be beneficial if staff regularly review care plans before visits and approach care in consistent ways. If clients have specialized care needs that require specific training and skills, they request trained and competent staff be sent to avoid errors and/or the need for clients to educate staff on how to meet their needs during an appointment.

"There is no consistency with staffing. Several new staff who are not well trained to do the job. At times they are not aware of what to do. They need practical training."

"Need to maintain excellent standards and provide high-quality training. Need to maintain constant supervision to ensure the fulfillment of the standards."

Clients suggest training opportunities and regular supervision be provided to staff. Some notable opportunities, as described by clients, for enhancing staff knowledge and skill development include:

Ensuring home and community care staff are knowledgeable and competent to meet clients’ needs may contribute positively to care continuity, and thus quality of care.

Some clients reflected on whether they feel safe, and this theme reflects the experiences of these individuals. In their comments, clients raised the importance of feeling safe and comfortable receiving care and services and discussing their questions, concerns, and care needs in a way that is free from physical, emotional, cultural, and psychological harm. Clients praised staff for making them feel safe and comfortable.

"They were all very caring and concerned for my safety and wellbeing."

"They were very kind and careful, they knew what they were doing and I am very content."

"The [gender] professional home care staff are very compassionate and take time to ensure I feel cared for."

Having numerous and unfamiliar staff assigned to clients’ care contributes to feeling less emotionally and physically safe. Some clients aged 65 and older expressed discomfort when multiple “strangers” have unrestricted access to their home such as through a lock box, especially at night. It is also disconcerting to some clients when staff do not lock the door to their home upon leaving.

"Why so many different staff? Too many! Need one caregiver or two. My home is private and it's scary to have so many coming that you don't know."

"I am unable to open the door so there is a key locked in a lock box. It is not reassuring to have so many people accessing this lock box."

Being kept physically safe during the provision of care and services is also of concern to some clients. For example, staff who hurry through care tasks, or do not ensure safe water temperature or falls prevention during bathing, make clients feel unsafe and does not facilitate trust.

"I think getting a brand-new person to help with shower is inappropriate -- It always happens, and it makes me anxious to be so vulnerable -- naked -- with someone I've never met."

"I did not feel secure when getting out [of the bathtub]. I asked the personal care worker to help me, but [they] just ignored my requests."

For some clients, discomfort arose when their identities do not align with staffs’ perceived identities and make them feel less secure or culturally safe receiving care and services. Clients aged 65 and older in particular reported discomfort with non-preferred gender of staff. Other clients expressed their discomfort when staffs’ culture, religion, ethnicity, or sexual and gender identity do not align with their own.

"I feel comfortable with [gender] helping me, but I have had [this gender of home and community care staff] come and I feel uncomfortable with [them] seeing me naked. I have talked to my case manager about this but haven't been able to have only [gender] help me get dressed."

"Should be in scrubs, not come in clothes or cultural dress which can be scary."

Feeling safe and comfortable interacting with staff is also a topic raised by some clients. Clients do not always feel safe asking questions or expressing concerns without repercussions. Ensuring clients feel psychologically safe is important.

"I didn't feel "safe" in asking questions because their reactions were not that friendly and respectful."

"One of my workers pushed a bit too hard with a certain service at time when I was mentally vulnerable."

A small number of clients reported experiencing verbal, emotional, and physical harm or abuse and neglect by staff. For example, some clients reported they have been roughly handled during care resulting in unintentional harm. One client reported feeling “dehumanized” by staff, due to the way they treated them.

"[Home and community care] staff were quick and not doing proper cleaning, etc. of wounds. I have ended up with [a number of] infections in past [number of] weeks."

"Once when I had a [medical event] before the caregiver came, [they] completed [care], [wished me well] and left me to contact my family and call an ambulance. I was not impressed!"

Ensuring clients’ safety and sense of security are crucial to preventing any form of harm. Clients expressed feeling safe when staff were consistent, knowledgeable about their care plan, how to meet their needs, and took the time to establish a trusting and mutually respectful relationship.