Home-care crunch coming

TheStar.com – opinion/editorialopinion
October 05, 2012.   Sherri Torjman

Doris Landry is an elderly woman receiving care at home. She had been discharged from hospital with a life expectancy prognosis of one to two months.

But then the unthinkable happened. That feisty lady had the audacity, from the confines of her bed, to buck the system. She outlived the two-month limit.

This unexpected development, reported Sept. 30 in the Star, normally would be considered good news. Unfortunately, her “untimely” longevity means that she no longer will have access to the same level of community care. Her home-care services and equipment supports will be reduced because she exceeded the designated limits.

Limited funding for home care understandably means tough rationing decisions. But the result can be perverse policy and practice.

We need to figure out how to build a robust system of community-based care. The home-care sector is drastically underfunded relative to its many challenges.

Most important is the need to increase the supply of services in order to meet heavy demand both now and in future. Improved wages and working conditions are also essential so that the home-care sector can attract and retain good people.

Some would argue that we already spend too much on health care. They claim that we simply need to shift funds from expensive hospitals to less costly community care. These savings can be achieved partly through innovations that enhance effectiveness and efficiency.

Innovations, while crucial, will take time to effect the required shift in funds. Additional dollars are needed right now. Lack of home care means that many patients cannot be discharged from hospital. About 7,500 Canadians currently live in hospital because they have nowhere to go and few supports.

The need for home care is expected to increase. By 2036, close to one in four Canadians will be age 65 or older. Population aging itself does not equate with increased demand. We are a healthier population, overall, than in the past.

But an aging population does mean that more people are living longer with chronic conditions and many will require some form of care at home. Statistics Canada reports that Canadians have a 50 per cent chance of needing long-term care by age 75.

The Canadian Life and Health Insurance Association estimates the cost over the next 35 years of providing care to baby boomers at $1.2 trillion (in current dollars). Government programs will likely cover about half this cost. As a result, Canadians will face a long-term care funding shortfall of close to $590 billion — or about $54,000 for each baby boomer.

It is time to explore new forms of financing for community care. Canada needs to have this conversation — the sooner the better.

Some form of public or social insurance, for example, might be considered. Social insurances generally are employed in the event of a shared risk that affects a substantial proportion of the population — in this case, the provision of long-term care for the elderly.

Canada’s social insurance experience is confined to income security programs. But several developed nations, including Germany, Japan, Korea, the Netherlands and Luxembourg, employ a social insurance model to help pay for long-term care.

Other financing proposals include some form of individual savings accounts for the purchase of home care and other community-based supports. These instruments could be designed like a Registered Education Savings Plan or Tax-Free Savings Account.

There may also be new fiscal measures that attract funds to the home-care sector. Tax incentives have been employed in the past to incentivize investment in identified activities, such as film production and research. Alternatively, Australia employs a form of bond — effectively an interest-free loan — to assist with the costs of long-term care.

All these financing options require study to determine their cost implications and administrative viability. We need answers about potential costs and unintended consequences of any new funding arrangement. But right now, we are not even asking the right questions about what is possible.

The excuse that we lack funds to provide good-quality, sufficient care is both tired and unacceptable. The only resources that are truly lacking are the ingenuity and creativity to bring more resources to the home-care table. Doris Landry — and all other Canadians — deserve nothing less.

Sherri Torjman is vice-president of the Caledon Institute of Social Policy.

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