Report: Home care quality will slip

As governments continue to rely heavily on home care as an alternative to conventional healthcare, it’s likely either you or someone in your family will eventually require this service.

In fact, a recent Health Canada report predicts that if current trends continue, every Canadian family will at some point need home care.

So, if the current system is barely coping now, how will it fare down the road with the expected increase in the number and complexity of caseloads? Add to this unhealthy mix an aging population and the danger signs are everywhere.

Growing need
Demographers suggest that over the next 10 years most of the baby boom generation will be over the age of 65. In other words, they’ll be in the age category that most heavily relies on home care services.

CARP’s Report Card on Home Care in Canada concludes that policy makers should now be in a position “to establish a clear direction for home care’s development.” CARP President Lillian Morgenthau concurs.

“With the system’s current shortcomings and increasing burden, the need for home care reform is clear,” she says. “It’s imperative that policy makers begin ining out the flaws, or the quality of care will begin slipping.”

Home care by default
While there’s no clear-cut solution to the current home care crisis-simply identifying the problems and digesting their scope is an overwhelming task-there’s a growing sense of frustration that not enough is being done.

Any momentum gained from past political promises or national initiatives has been lost, says CARP’s report, “and we continue on a course of home care by default, and not design.”

The obvious danger is that the flawed system will begin resulting in sub-standard care for patients. There currently isn’t enough information available to suggest that home care patients are experiencing a decline in health care, but the red flags should be raised.

Stressed system
Karen Parent, co-author of Home Care in Canada, gives an example of a situation that could develop in an over-stressed system:

“A person who has a stroke is typically discharged from hospital to recuperate at home. What happens if this person can’t get the services of a therapist or a nurse in a timely manner? It’s obviously going to affect the outcome of his or her recovery,” she says.

This scenario is likely happening right now, but when it’s placed up against long waiting lines for surgery, it fails to register as an issue of national importance. Parent says it should be on the agenda and blames its absence on political inertia. She says if all the political rhetoric uttered on this issue could be translated into direct action, there’d be no concern in the home care community.

All talk, no action
But the big step from talk to action hasn’t happened and many experts are beginning to if it ever will. “Home care reform is off the radar,” says a doubtful Parent. “Politicians continue speaking of its importance but it remains the poor cousin to other sectors of health care in Canada.”
Professor Neena Chappell agrees. As director of the University of Victoria Centre on Aging, she’s had vast experience with the home care system, mainly from the informal caregiver perspective, which she’s been studying since the 1970s.

“We all should be worried about the future of home care,” Chappell says, also pointing to the political inertia that’s paralyzing reform.

“Federal health minister Alan Rock has shown a lot of awareness on the issue but you’ll notice that in the health care agreement he made with the provinces before the last election, home care was dropped from the table.”

Part of Health Act
Chappell says that ideally, the system could be made part of the Canada Health Act, with its services guaranteed and paid for by federal/provincial transfer payments.

Currently, home care is funded from a mix of provincial and local sources, as well as from the wallet of the home care providers. But she doesn’t see much cause for optimism here.

“At this point, people are hesitant to open up the Canada Health Act,” says Chappell. “But, whether it’s through opening up the CHA or through other means, it’s absolutely essential that we develop an adequate home care system.”

As long as debate and rhetoric forestall positive action, there’s good reason for Canada’s 50-plus population to be concerned about their futures, when they need home care.

“We’re losing confidence in the system, we’re losing the workforce who support it and we’re potentially heading toward a serious problem with being able to meet the needs of a growing elderly population,” says Parent.

No champion
Who or what will motivate change is the “million dollar question,” says Parent. Right now, it’s an issue without a champion-there’s no political incentive to spur movement.

“Canadians need to become involved in the debate, to bring this issue into the political forum.” she says. “That’s part of what CARP is doing with this report.”

Outside those who use it, very few Canadians are even aware of what home care is and what services it offers. With a little education, says Parent, we can become aware of the key issues and demand improvements from our elected officials.

“We have to break the home care gridlock, and start mobilizing politically and economically,” says Parent. “If we’re serious about healthcare in this country, we must make home care a viable option.”