Original Air Date: March 8, 1998

What is home care?

Home care is an array of services to prevent, delay or substitute for long-term care or acute care to keep people in their own homes for as long as possible. Services can include:

• medical
• nursing
• homemaking
• meal preparation
• nutritional counselling
• physiotherapy
• occupational therapy
• transportation
• social services/adult daycare
• "friendly" visits

  What role should home care play in our health care system?
  

  • Home care is an array of services to prevent, delay or substitute for long-term care or acute care to keep people in their own homes for as long as possible. Services can include:
  • Home is the place where health should begin. Everything else (hospitals, etc.) should be the alternative. We've built our system the other way around. Hospitals and doctors' offices are the norm-we turn to them first-and home care is seen as alternative therapy.
  • It's going to require a cultural shift to properly utilize home care to allow us to capitalize on treating people in the comfort of their own homes.
  • The prospect of changing how we get health care is very challenging for the elderly population because many just don't understand.
  • It's easier for younger people because they've been inundated with change all their lives.
  • Two things are required for home care to work: (1) caregiver support and (2) a safe home environment.

    What is the purpose of the National Conference on Home Care?
    

    • Home care is the third of three issues recommended for review by the National Health Forum. (The other two were pharmacare and information technology.)
    • Topics will include the current situation, the future, and how home care can help advance our whole health system and make it more sustainable.
    • As well, participants will look at where home care fits within the Canada Health Act (it has been funded by the provinces to date). If it was to fall under the Canada Health Act, there would be more consistency and standardized treatment.

      What's wrong with our current system?
      

      • We aren't capitalizing on the strengths that are already in the system-funding and marketing things appropriately. People don't know what's available, so they can't take advantage of things.
      • We aren't using technology to the extent we could: telemonitoring patients in their homes and "alert" systems worn around the neck are very effective, but not used extensively.
      • We don't recognize/support caregivers. There are really no incentives for people to become caregivers. On the contrary, many caregivers give up careers and suffer dire financial consequences when they take on the task.

        How can we improve our current system?
        

        • We need to "incentivize" home care-make it more attractive and accessible, and less complicated. People need to know who the providers are, how scheduling works, and who they can call.
        • Introduce innovative funding incentives for age-proofing (grab bars, etc.), to help keep people in their own homes. It's cheaper to pay for someone's grab bar than it is to hospitalize them.

          What are hospital closures and restructuring doing to our health care system?
          

          • Patients are having shorter stays, and more day surgeries.
          • As a result of medical advances (i.e. arthroscopic surgeries instead of invasive surgeries), home care providers are getting increasing numbers of more complex cases. Those cases require more intense and frequent home care intervention.

            Is the home care system overloaded??
            

            • It's different in each province, but with the aging of our population, there's an overall need for more chronic intervention.
            • For the individual workers, it's a stressful occupation, and a lonely job. They are pressured to do more with less.
              

              How does someone qualify for home care?
              

              • You must be covered by your home province's health insurance (OHIP, MSI, etc.).
              • Your health or medical condition must meet criteria set by the relevant body in each province (i.e. in Ontario, it's the Community Care Access Centres). For example, for palliative care in Ontario, you must have a terminal diagnosis and the expectation that you will not live beyond three months.
              • Your needs will be constantly reviewed and evaluated to ascertain how much care you'll need, and for how long. (Home care workers are given target dates for things to be achieved, like a "healing time frame" for wounds.)
              • If you need more care, your home care worker (i.e. a nurse) can become an advocate, pushing the government agency in charge to increase support.

                What about people who don't qualify (they don't meet medical criteria, or they don't qualify for provincial medical coverage)?
                

                • Home care services are available on a fee basis for those who don't otherwise qualify.
                • They do have "charitable funds" that are available for people in dire consequences (dependent on an assessment).

                  What have hospital restructuring and cutbacks across the country done to the provision of home care?
                  

                  • People are leaving hospital "quicker and sicker," and home care workers (particularly nurses) are doing things now they didn't have to do before. More acute care is needed by those being released. Things like chemotherapy, IV and dialysis are all being done in the home now, which didn't happen years ago. Even organ transplant recipients are being discharged to home within two weeks of surgery.
                  • As a result, not only are there greater demands on home care workers, but they are constantly having to upgrade their training to keep up with the advanced technology they are using.
                  • Anything you can get in a hospital you can now get at home through home care.

                    What's the effect on families when people are sent home so soon?
                    

                    • It's stressful. In families where, for example, both husband and wife work and they must arrange for care for an elderly parent, it can be extremely difficult to juggle the competing priorities. It can be very expensive if you don't meet the "need" test or don't qualify for provincial medical coverage.

                      What's the effect on home care staff?
                      

                      • They must juggle their own time demands to try to find the time for upgrading and education to keep up with technological advances.
                      • Sicker patients means home care workers are constantly making stressful ethical decisions re palliative care, medicating for pain, etc.
                      • In the case of the VON, they've had to lengthen their visiting hours. They used to operate from 8:00-4:30. Their new hours are 7 a.m. to 11 p.m., seven days a week.
                      • A patient's condition can change drastically from one visit to the next. When a home care worker arrives at a home for a scheduled visit, he/she can walk into a situation that is much more drastic and/or time-consuming than anticipated. When this happens, the health care worker must stay until the person is stabilized or handed over to hospital, and the schedule can be thrown entirely out of whack, leaving subsequent appointments waiting...and waiting....