In Conversation with Allen Power on Why Continuity of Care Goes Beyond Showing Up

A caregiver showing up for a scheduled shift is only the most visible part of providing care at home. What happens between those visits and what a caregiver learns by being there consistently can be just as important.

Allen Power believes continuity is fundamental to creating that kind of care. For people living with dementia especially, familiarity can shape whether a person feels safe, understood, and comfortable during some of the most personal moments of daily life.

But continuity also creates something less visible, i.e., knowledge.

A caregiver who regularly works with the same person begins to understand their preferences, capabilities, communication patterns, and small changes in behavior. That accumulated knowledge cannot always be transferred through a handover or written care plan.

As home care agencies navigate staffing shortages, turnover, scheduling constraints, and geographic challenges, maintaining that continuity is not always simple. The question is: how can agencies balance operational realities with the human value of keeping trusted care relationships intact?

To shed light on this, we interviewed a home care industry expert to share their perspective on why care continuity matters and the deeper role of familiarity in care.

Let’s dive deeper and understand what Allen has to say on the relevance of continuity in care and why knowing a person is as important as knowing a care plan well.

Question 1: Why does continuity between a client and their caregivers matter so much, beyond simply having someone show up for a scheduled visit?

Having consistently assigned care partners is not only critically important but is, in fact, the only humane way to support people living with dementia.

Personal care requires a great deal of familiarity and trust in order for a person to feel safe during an interaction. When it becomes difficult to remember the caregivers' names, faces, or other personal details, that sense of security is eroded and can lead to misunderstandings or crisis reactions.

Consistency is also important for those providing support, as they can better know the person's preferences, their capabilities, and the unique ways in which they communicate. Even you and I—without a dementia-related diagnosis—should stop and ask ourselves how many different people we would want to help us get dressed, bathe, or use the toilet, and how we would feel if a stranger wanted to do these things.

Question 2: As home care agencies grow, what can get in the way of building consistent, trusted relationships between clients and caregivers?

Consistency can easily be affected by the forces that currently challenge home care services. These include a lack of adequate staff, high levels of burnout and turnover, clients' wide geographic locations, and difficulty matching one's schedule with that of the client.

All of these challenges tend to make organizations default to systems that work more to their convenience (e.g., rotating or reassigning staff) than the needs of the clients. Unfortunately, what looks like a more efficient operational approach becomes less so when those we serve are less well known to us (and vice versa), and both staff and client dissatisfaction tend to increase in such systems.

Question 3: What can happen when clients are repeatedly assigned different caregivers, and how can that affect the experience of receiving care at home?

Lack of continuity not only distresses clients in the ways mentioned above, but the handover of knowledge between rotating staff will never be adequate when compared to the deep knowing that comes from being with the same people regularly. Consistently assigned staff can pick up little nuances that may be an early signal of a medical illness or drug side effect, thus preventing unnecessary hospitalizations and complications.

Multiple studies conducted in long-term care settings have shown that consistent assignments lead to a multitude of improved clinical outcomes and improved satisfaction on both ends.

Question 4: When agencies have to balance client preferences, caregiver availability, and staffing realities, what principles should guide decisions about continuity?

Both caregivers and clients should be asked for their preferences for care partnerships, and assignments should be made to match both groups as far as possible. Even people with significant dementia can often respond to staff photos to indicate preferences.

Nevertheless, as mentioned, geography and availability can make ideal pairings challenging. When it is not possible to match everyone exactly, preference should be given to those for whom familiarity is most important, and intimate care should be reserved for the days when the best-known staff are available to visit.

Question 5: What should technology be doing to strengthen the relationship between a caregiver and client, rather than getting in the way of it?

AI and other technology should be both supportive and enabling of both parties. It should meet their expressed needs as a caring dyad, rather than being imposed from outside as a tech "solution" created by those who don't understand the work. Technology should help foster better communication and make tasks easier and more effective to complete but should never replace the hands-on, relational aspects of caring.

Question 6: Looking ahead, what do you think home care needs to get right to grow with technology while keeping the relationship between the client and caregiver at the center?

I have recently spoken with a few different people who are developing A.I. platforms that can organize personal information about a client (particularly those with dementia) that help care partners better know the person.

These platforms also use that information to create algorithms to help those care partners to work through a challenge by reminding them of the person's history and preferences, suggesting possible triggers of distress, and offering potential approaches for care and support. I think this shows great promise, but only if those platforms are designed by people who have a progressive, holistic, and strengths-based view of dementia.

In a similar vein, home monitoring technology should be used for enabling people, not restraining them.

Lastly, AI may improve the process of matching up clients and caregivers according to their preferences and may help suggest better staff transportation patterns where geography is a barrier.

In conclusion

Continuity is easy to reduce to a scheduling problem: A few examples are who will be available, who can actually cover the shift, and how the schedule will get filled.

Every consistent caregiver relationship builds familiarity that cannot be fully captured in a handoff. Over time, caregivers learn how a person communicates, what makes them comfortable, what is unusual for them, and what matters to them.

Technology can help agencies make those relationships easier to build and hence sustain—from matching caregivers more thoughtfully to making relevant information easier to access. But the technology should support the relationship, not become a substitute for it. Because in home care, knowing what to do is only part of knowing how to care for the person in front of you.