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Aging in Place – Home care must be expanded

The Advocate, March 2013 - There are very few people who want to move out of their homes and live the rest of their lives in an institution. Yet government policies in B.C. and Canada seem to have been designed to force them to do exactly that.

It doesn’t make sense.

From every standpoint – morally, socially and economically – it would be far better to support the frail elderly and people with disabilities in their desire to remain in their own homes, and in their own familiar communities.

We all remember the tragic stories of elderly married couples who have been separated from each other and forced into residential care in faraway communities.

 

A different approach

Public health care expenditures in Canada are overwhelmingly directed towards institutional care. Tine Rostgaard, of Aalborg University, an internationally recognized expert on policies that allow people to age in place, says care for the aged in Denmark is universal with the goal of allowing people to age in place, near friends and family in their own communities. About 75 percent of public expenditures on elder care are targeted to home care, and 25 percent to institutional care.

In Canada, she says, the balance is reversed with only 20 percent going to home care, and 80 percent allocated to institutional care.

The key to the Danish system is prevention. Preventive home visits with the elderly, most often by a nurse, must by law take place once a year. After a structured discussion of general well-being, social networks, housing, finances, health and functional ability, the municipality must follow up and offer needed services.

“There is strong evidence for the preventive effect,” says Rostgaard.

“The visits result in an increase in the use of home care services (including personal care and practical assistance such as cleaning).

“The visits also result in a fall in mortality, an increase in functional ability, and a lower rate of admission to hospitals and nursing homes.”

 

A huge unmet need

Statistics Canada reported Dec. 19, 2012, that just over a million people – 25 percent of those aged 65 and older – are receiving formal or informal home care.

More than half of them depend on family, friends and neighbours for help.

Close to 180,000 seniors report that they had unmet needs for professional home care services.

About two-thirds of them (63%) said personal circumstances such as inability to pay prevented them from getting the services they need.

About one-quarter of seniors (24%) cited shortcomings of the health care system, with the service simply not available.

The remaining 13 percent blame a combination of personal circumstances and unavailability of services.

“Research shows that unmet needs for assistance are associated with negative consequences including inability to prepare food for oneself, injuries, depression and reduced morale, higher hospitalization rates, and increased risks of falls, institutionalization and premature death,” says Statistics Canada.

Women, and those who live alone, are almost twice as likely to have unmet needs. Housework and personal care are the two most common tasks with which seniors need, but do not receive, professional assistance.

“Home care can alleviate demands for hospitalization. It can reduce readmissions to hospital, and as well, it can decrease the likelihood of institutionalization,” says Melanie Hoover, one of the authors of the Statistics Canada study.

 

Saving money by doing the right thing

Wendy Young, Canada Research Chair in Healthy Aging at Memorial University in Newfoundland, says expanding home-care services could save the health care system a lot of money.

“How many people understand that granny getting her housework done actually saves the health care system an incredible amount of money?” says Young.

“If she can’t get her housework done, then she ends up being admitted to a nursing home.”

The Canadian Institute for Health Information reports that five percent of acute hospital beds are occupied by people waiting for an alternative level of care.

About 85 percent of these patients are seniors who wait more than a month for long-term care. Waits for those who have access to home care are closer to a week.

The Conference Board of Canada estimates spending on home and community care to be just 4.6 to 5 percent of total health spending.

With such limited public support, people must rely on informal, uncertain unpaid care, amounting to 242 million hours a year in B.C.

Compared to home and community care services:

• Assisted living is 1.2 to 1.8 times more expensive.

• Long term care is 2.2 to 3.4 times more expensive.

• Acute care is up to 8 times more expensive.

About one half of the people who are on waiting lists for long-term care could remain at home if they received appropriate care.

 

Continuing cuts in home support services

Since the late 1990s, home support services in B.C. have been continuously eroded. Needed services have been eliminated.

“Time spent with clients is rationed to the minute,” says Darryl Walker, president of the BCGEU, the union which represents the largest number of home support workers in B.C.

“Duties which used to be a part of making sure the client was supported at home have been eliminated.”

The assistance that has disappeared includes housekeeping, cooking, cleaning, taking clients for walks, shopping, and taking clients to medical appointments.

“These critical non-medical supports – which research shows contribute to a person’s recovery and health – have been removed from the public support system,” says Walker.

Instead of providing a needed service to help people live at home, the provincial government is shifting even more of the burden to untrained volunteers. The United Way’s “Better at Home” program is hit-and-miss, varies greatly from community to community, and depends on unreliable short-term funding.

An initial three year pilot program in five communities, undertaken at significant cost, shows this approach clearly does not meet the need for service.

The pilot program managed to register just 798 clients – and over 40 percent of those registrants gave up on or never used the service during the three years it was in operation.

 

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