Social Policy in Ontario

Canada’s haphazard support for home care is leaving seniors in the cold

Posted on July 12, 2016 in Child & Family Policy Context

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NationalPost.com – Full Comment
July 11, 2016.   MICHELLE HAUSER, National Post

My mother-in-law is a veteran of the province of Ontario’s home-care system.

After her husband passed away, Harriet took on the textbook profile of a senior in Canada: an 80-plus woman with multiple chronic care needs, able to stay in her home, thanks to a supportive medley of friends, family, private hires and home care.

For nearly 10 years we nagged her to downsize and move someplace, “Where everything will be done for you.” All the while she countered us, saying, “My workers” — her personal support workers (PSWs) — “say I should stay in my house as long as possible.”

I labelled the PSWs “busy-bodies” but it turns out they knew better: aging in place is the gold standard because it offers freedom of choice, familiarity of surroundings and flexibility of care.

Yes, there are excellent assisted-living and long-term care facilities but nothing can be as “person-centred” as staying in your own home: having breakfast in your pyjamas, getting dressed whenever you damn well feel like it and being, as Harriet is fond of saying, “useful.”

Watering your own plants: useful. Opening and closing the drapes in the dining room so the upholstery doesn’t fade: useful. Maintaining an optimal supply of apples in the cold room: useful. Knowing when the water filters need to be changed: useful.

Home care, as our politicians and policymakers know, is what makes all this possible.

Why then, are hundreds of thousands of Canadians living with unmet home care needs? Why is our nation lagging behind other Organization of Economic Co-operation & Development (OECD) countries in home-care spending? And why are we so all over the legislative map, from province to province, in terms of services and support?

Last August, the Canadian Medical Association (CMA) published a Policy Framework to Guide a National Seniors Strategy for Canada, which included recommendations about home care.

The CMA has identified lack of funding as a major problem. In 2008-11, the demand for home care rose by 55 per cent, with no comparable increasing in spending. In fact, the CMA says, “In some provinces the proportion of funding for home care has actually gone down.” Our bottom-of-the-pack status among OECD countries only confirms this.

What it means, in practical terms, is that too many people who need help are falling through the cracks.

In 2012 — when nearly 2.2 million Canadians with a chronic condition received some type of home support — a Statistics Canada study found that nearly 461,000 more didn’t get the help they needed and another 331,000 only received some help.

Some of those left out in the cold were caregivers. According to a 2007 Conference Board of Canada estimate, informal caregivers provide 10 times more hours of home care than paid professionals. They don’t just prop up the system, they are one of its pillars so preventing burnout isn’t just compassionate, it makes good fiscal sense.

The CMA also advocates for national legislation that will set standards to address “access, volume, frequency and types of services” in home care.

Unfortunately, only lip-service has been paid to the need for a national seniors strategy. In the meantime, provincial governments are left to build the plane while flying it: reworking out-of-date legislation, wrestling with questions about user fees, all of which might be simplified by having national standards.

Global forecasts for the home-care services market predict rapid growth over the next two decades as more and more baby boomers opt for aging in place and eventually become clients themselves.

Many OECD nations have significantly increased their funding for home care versus institutional care in anticipation of this demographic shift. It’s time for Canada to do the same. If we continue to treat home care like the neglected child of our health-care system even more people are going to fall through the cracks.

And I say this from first-hand experience, having become a home-care veteran this past year — in the respite category.

After a failed experiment with institutional living — where everything was done for her, and she hated it — my husband’s mother moved in with us.

At first it felt more like a home invasion: the loss of privacy, all the different people coming and going, the second-guessing from PSWS — why haven’t you done this? and why don’t you try that? — and the “I can file a jagged fingernail but I can’t clip it,” and other idiosyncrasies one might expect from the Ministry of Health in Ontario.

At some point, though, the roster stabilized, we got to know each other — what the PSWs could do, what they couldn’t — and I soon began to look forward to that time, around mid-morning, when one of our home helpers arrives.

Harriet might be in the throes of coaching me on the finer points of boiling an egg — she’s just trying to be useful, I remind myself — and is happy to see her PSW so the day’s washing and dressing can begin.

And the family chef (who honestly thought she knew how to boil an egg) can return to writing and making lists of the small stuff she will not sweat if she lives to be 90.

Tags: disabilities, Health, housing, ideology, standard of living

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