Home care is in desperate need of a fix. Services are rationed, rigid, and difficult to access. Policies contribute to high staff turnover and to the widespread shortage of community nurses and personal support workers. A bolder new approach to home care delivery is needed now. Ontarians feel the dysfunction – and so do we and we provide these services.
We are Home Care 2020, three CEOs using our experience to champion change. Our organizations deliver more than 45,000 Ontario home care visits a day and have been caring for Canadians for nearly three centuries. One of us is a nurse. All of us have been family caregivers. Each of us has experienced the same roadblocks that deeply concern our patients and their families.
Patients and families consistently tell us that they want faster and better access to home care services that include more flexible options – whether it’s managing a chronic illness, returning home after a hospital stay, or delaying a move to a long-term care home.
Consider that each day there are more than 4,000 (mostly seniors) occupying hospital beds they shouldn’t be. If even half could be cared for at home, there would be enough space to accommodate the 1,100 waiting for and needing those same beds.
Yet… hospitals, the most expensive care setting, have become the default for care when it’s not available in the community or at home.
Consider that wait lists for long-term care homes are staggering and will get worse. And, most seniors want to remain in their homes.
Yet… confronted with the stark options available – institutionalization or grossly insufficient home support – they have no choice.
Consider the threat of coronavirus. Now more than ever we need to keep high-risk people at home where possible. Yet… home care services are rationed and bottlenecked.
As government turns to improving Ontario’s home care, here are four simple yet transformative ways to make it work better for patients, families, and those providing care:
- Return nurses to home care: Today, a separate tier of thousands of nurses inside government called care coordinators, determine who is eligible to receive publicly funded care and which supports they will be allowed to receive. This has become a function unto itself. With the nursing shortage in Ontario, we need these nurses back in the community, serving patients and working closely with other providers in the person’s care circle. Determining needed services, can, and should be a role that is integrated into the team that delivers in-home care thereby freeing up precious nursing time for care.
- Allow direct referrals: When it comes to eligibility, allow doctors and nurses to determine who needs home care. Let them refer patients directly without a separate eligibility process that often takes days, in some cases weeks, before any care is provided. Patients would get care at home more quickly and more efficiently.
- Focus on patient needs, not patient time: As in every other part of the system, home care funding should be about meeting the needs of patients – not allocating limited hours of care. Some patients don’t want all the visits assigned while others could use much more help. Home care is inexpensive compared to other care settings. Let’s take advantage of that by delivering the care needed, rather than on the time assigned to that care.
- Create a “long-term care at home” option: Let’s help people stay in their homes, where they want to be. Based on research, we know that some seniors waiting for a long-term care home placement could remain in their own homes for longer with more supports and a wider range of services.
Let’s create a program that would allow this to happen. Admittedly it would cost government more than what is currently spent on home care services for these seniors, but the savings would more than offset institutionalized care. It would also enable employment stability resulting in a steadier, more consistent team of caregivers instead of a parade of new faces coming through the home.
Fixing home care requires a major shift in the rules that govern how it is delivered and funded. It means changing the way our organizations are paid, possibly eliminating guaranteed market share arrangements many have come to enjoy and holding providers accountable for costs as well as results for those receiving care.
It’s time to end the status quo. Ontarians need and deserve better home care. Let’s all step up and make it happen.
Recent Comments
In response for the need of Home care for seniors …their needs to be drastic changes ..
First to help the PSWs …they get min wages ..work long hours ..l have seen on many occasionss
this people are exhausted …they travel from one town to another ..why not give them a round near their own homes …to give them car allowances ..they don’t get any money for using their own car
Give them more training ..too go in the home they never know what to expect at times …they love the job but they need more help and incentives ..they burn out much more then a trained nurse .
And for the seniors ..some need more care then others …to be allotted less then 15mins a day is unreal ..and for the caregivers their needs are not met ..to look after a love one 24/7 ..is not right they need help also help in the home ..to do a bit of housework ..shopping and having respite when needed …and not all caregivers are well and they are seniors as well ….yes l am a cargiver to my husband ..who has mild dementia and other health problems ..my husband is also aWW2 veteran ..
no help is available ..from Veterans affairs either …yes l would like time off but this poorly managed