Positive first steps towards independence at home
TheStar.com – Opinion/Commentary – Ontario’s announcement of plans to move to more self-directed care in one’s home should be applauded.
May 15 2015. By: Åke Blomqvist, Colin Busby
Ontario’s minister of health, Eric Hoskins, announced plans this week for change in the province’s home and community care programs, and should be applauded. One central aspect of the minister’s plan, to give homecare patients greater control over the decisions regarding the services they receive, is promising.
Self-directed care, in which patients and their caregivers get a greater say in provider choice as well as in what services they receive, can transform the way home and community care is delivered. It would put public dollars behind the idea of a “patient-centered” system and could galvanize public support behind what will surely be a rocky road to a better community care system.
The current state of services for those seeking help with independent or assisted daily living is poor. As noted in the Ministry of Health’s home and community care report earlier this year, many Ontarians do not know what services are available to them given their needs, do not have coordinated services across providers, and are frustrated by waits for care and family stress.
While the province’s plans aim to improve the services to all patients in need, such as individuals with disabilities and dependent children and youth, a big driver for future homecare needs will come from an aging population and rising needs among dependent elderly.
The move toward a self-directed subsidy follows in the footsteps of what European countries have been doing for years. France, Germany, the Nordic countries and others have moved to systems in which all elderly have access to standardized needs assessments and greater say over their care paths – arguably even more so than in Ontario’s plan.
The main government contribution for maintaining autonomy among the elderly in France, for example, is a cash voucher. The size of the voucher depends on both the patient’s care needs and his or her income. Recipients can use the cash subsidy to pay for care from any approved provider at a patient’s location of choice. And recipients are responsible for paying the difference between what the provider charges and the size of the subsidy.
The French approach has gone a step further than what Ontario is proposing, by offering public support for all forms of assisted living – from basic home-care needs thru to facility-based care – in the form of a self-directed subsidy. This gives people more say about what services they choose to have in their homes, and who should provide them, and greater choice over the location and type of facilities that match their needs.
Depending on how it’s administered, a self-directed care subsidy could even become a form of income support for family members who take time off work to provide care. Family caregivers, around 3.3 million of them in Ontario, already supply the bulk of homecare – so this would be a welcome change, and a less cumbersome form of support than a non-refundable tax credit.
For now, the planned experiments with self-directed long-term care will take place only in Ontario, but the idea of supporting care for the elderly in this way could be applied more broadly. For example, the federal government could consider revising old-age security payments to include an adjustment based on the recipient’s level of disability, thereby adding a disability-test to the means-test component to Canada’s universal government transfer to seniors.
For Ontario, the planned increase in funding for home and community care – of around $250 million per year – will not be sufficient to cover all patient needs, so individuals should expect to cover a share of their needs out of private savings. To the confusion of many, Canadian medicare does not include home or nursing home care as part of its service bundle. And barring a large increase in taxes, public home and community care services likely will not become fully publicly funded programs anytime soon.
A well-designed public subsidy that aims to improve independence for the elderly would need to be set clearly, so that individuals know what they would qualify for, for a certain level of need, and what they could reasonably expect to have to top up themselves. In France, the clarity of their funding model has contributed to creating the world’s largest (per capita) supplementary long-term care insurance market where private benefits are set according to the public needs assessment.
Ontario’s announcement of plans to move to more self-directed care in one’s home should be applauded. And while it is only fair that patients currently waiting for care would express some discontent with the slow roll-out of the plan – where pilot projects that might seem like delayed immediate help – we should take this announcement as a positive step forward. And the experience of European countries is proof than Ontario’s reforms could be bolder still.
There will be no quick and easy fix to home and community care. But Ontario’s announced plan should move us towards a better path.
Åke Blomqvist is an Adjunct Research Professor at Carleton University and Health Policy Scholar at the C.D. Howe Institute, where Colin Busby is a Senior Policy Analyst.
< http://www.thestar.com/opinion/commentary/2015/05/15/positive-first-steps-towards-independence-at-home.html >
Tags: budget, Health, ideology, participation, standard of living
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