Home care needs to be a priority

By Réjean Hébert, Postmedia News
Canada falls short on services to help our aging population stay out of institutions

The 2014 federal-provincial Health Accord negotiations last week in Victoria should have been an opportunity to transform our health care system to respond to the aging of our population and the associated pandemic of chronic diseases coming our way. There is little doubt that home care should be a priority in any future discussions – along with health prevention, primary care and integrated care.
As things stand now, Canada is far from meeting our home care needs. Many Canadians might be surprised to learn that less than 15 per cent of public funds spent on long-term care are dedicated to home care services. How does this compare to similar economies? It’s clear, Canada falls short.
Other Organization for Economic Cooperation and Development countries invest significantly more resources: the Netherlands, France and Denmark, for example, invest, respectively, 32 per cent, 43 per cent and 73 per cent of their public long-term care funding on home care. By contrast, and despite all the political rhetoric, in Canada most of our funds go toward nursing homes.
The result of inadequate funding for home care means that the responsibility for caring is transferred to informal caregivers — mainly women — who get burned out and often have to leave the workforce to care for aging parents, with negative effects on their career paths and pension contributions.
According to OECD data, Canada dedicates 1.2 per cent of its gross domestic product (GDP) to long-term care. If nothing is done to transform the health care system, with the aging of the population this proportion will rise to 3.2 per cent by 2050.
This growth could be significantly reduced to 2.3 per cent if a sizable investment (e.g., 0.4 per cent of GDP or $5 billion) is made in home care now.
In the short term, a substantial return on investment would be generated by keeping women in the workforce and creating home care jobs in the public, private and social economy sectors. In the medium term, a further return on investment would likely result from decreasing the use of hospital beds by patients waiting for nursing home beds and reducing the need for nursing homes.
Investing in home care immediately will allow Canada to make the necessary shift that will help control the costs in this sector and reduce the financial burden on future generations. But there is not only an urgent need to invest more resources in home care; the approach and financing structure should also be changed. Any health accord negotiations should open up an opportunity for real transformation.
We need to change the philosophy of home care: It should become a right and not a privilege as it is now. It means that when you suffer from disabilities, you have the right to benefit from the appropriate services with public funding. Services should also be provided wherever people live instead of moving them to facilities where services are available. This has been done successfully in countries like Denmark, where publicly funded services are delivered regardless of where the older person lives.
To achieve this, a public long-term care insurance plan should be created, like many European and Asian countries have done in recent decades. With this type of plan, the needs of frail older people are assessed, a service plan is proposed and specific benefit is calculated. This benefit is used to cover the necessary services from public (“in kind”), private, social economy or voluntary organizations, according to personal choice and the availability of such services in the local community.
We should not opt for “cash-for-care” allowances as in some European countries since this type of benefit has undesirable effects: the creation of a “grey market” with untrained and underpaid workers, risk of financial abuse, poor quality services, and keeping women in traditional roles.
To finance this universal publicly funded insurance plan, a specific fund should be created to which the current budget for long-term care would be transferred to ensure a clear separation of this money from the rest of the health care funding. By prioritizing home care, this fund would drive the necessary shift from institutional to home care. This in turn would allow older people to stay in their own homes with their loved ones and limit the predicted growth in costs associated with aging.
It is time for a Continuing Care Act in Canada that would prioritize integrated care and home care, and include the creation of a public long-term care insurance plan to adapt our health care system to the aging of the population and prepare for the future in a responsible and equitable way.
Réjean Hébert is a geriatrician and professor at the Research Centre on Aging of the Université de Sherbrooke. He is also an adviser with EvidenceNetwork.ca, a non-partisan online resource designed to help journalists covering health policy issues in Canada.