Report says home care needs attention

Major cracks are forming in home care, a key sector of this country’s health care delivery system. Millions of older Canadians who depend on it risk seeing a decline in their health and quality of life. And, if government and policy-makers want to avoid a crisis, they must begin the process of change before the system is beyond repair.

These grim findings are in a recently released document called ‘Home Care in Canada: CARP Report Card 2000.’ The report is the first of its kind in Canada and attempts to measure the effectiveness of home care delivery in provinces and territories across the country.

The report was funded by CARP, Canada’s Association for the Fifty Plus and conducted by two health care researchers from Queen’s University in Kingston, Ontario.

Under funded system
What it uncovered was an under-funded, fragmented and ungainly system. The report doesn’t point out who’s to blame but does highlight problems that exist.

For example, in the areas of strategic direction, service delivery and support for informal caregivers, the report card gives a grade of D.

In human resources, the grade is even lower-an E. Fuing is graded at C.

Only the areas of knowledge development and collected home care data received a more acceptable B grade. 

More attention needed
“We hope this report not only sparks debate but encourages policy makers to take positive action,” says Lillian Morgenthau, the president of CARP.

“The system can work, but it needs far more focus and attention than it has been receiving to date.”

Promise not kept
The Canadian home care (or community care) system began in the 1990s as an alternative to hospital or long-term facility care. It was originally developed to provide health and social services at home for those who are ill, disabled or dying.

In theory, by moving more cases from hospitals or long-term institutions into the home, cash-strapped governments could save money. The promise, however, was that patients would continue receiving a strong level of support and care at home.

No cohesive policies
But all involved-patients, informal caregivers and health care providers-say this just isn’t happening, and their frustrations with the system are beginning to be heard.

According to the Report, home care operates without cohesive structure, in an atmosphere of chaos and confusion.

“The system is a crazy quilt of policies that differ between provinces and territories,” says Morgenthau. “Home care is failing to deliver on its original promises and older Canadians are paying the price.”

Report authors
‘Home Care in Canada: Report Card 2000’ was written and researched by Karen Parent and Malcolm Anderson, noted health care researchers from Queen’s University in Kingston, Ontario.

It follows up on CARP’s ‘Putting a Face on Home Care’ in 1999, which came out of a national forum on the topic. In that study, CARP identified the major home care issues needing immediate attention.

‘Home Care in Canada’ follows these issues in an attempt to determine if any positive change has occurred. The ratings for each area are based on whether any improvements have been made.

Major shortcomings
With few exceptions, the report reveals that home care achieved unacceptably low scores in most categories. It draws attention to the systems major shortcomings, which it lists as:

• a lack of strategic direction;
• a continuing inadequacy of funding;
• little support for the informal caregiver;
• shortage of qualified health care and homecare support staff.

Some good news
The report gave better rankings for knowledge development and data. The authors noted that government and agencies are now capturing home care data and information. They said the next step is to use this data to begin formulating better homecare policy.

“Quality data and information are absolutely essential,” says Malcolm Anderson, the report’s co-author.

“The backbone of effective decision-making is having high quality information available in the first place. If you don’t have that information, then you’re operating in a void. So it’s a starting point for change,” he said.

“Now it’s up to governments and decision makers to capitalize on these positives and begin the process of incremental change.”