Summer in Canada has brought fewer new COVID-19 infections and an economy that is slowly reopening. But even as many Canadians are breathing a collective sigh of relief, health-care leaders are preparing for a winter unlike any that has come before.
Every winter is difficult for hospitals in Canada, which are often over-full and under-resourced. But this year, a potential surge of COVID-19 cases could put further stress on an already stretched system.
Better publicly funded homecare needs to be part of our strategy to prepare for what may be our worst winter yet.
We’ve known for a long time that homecare needs to be improved. In Ontario alone, there have been several expert reports in the last few years calling for homecare reforms and two successive governments have made changes to homecare governance. Yet, problems remain.
In 2018, I led a study asking patients and caregivers from across Ontario about the challenges they faced when transitioning from hospital to home. Again and again, the same answer came up: patients just simply don’t get enough homecare to meet their needs.
Improving homecare was the top priority for people with different backgrounds and from different regions of Ontario – men and women, patients and caregivers, kids and adults, those living in rural and urban areas, those living alone and those not, those with disabilities and those without, and those with many admissions to hospital and those with just a few.
People shared their stories with us. A frail 90-year old woman being offered limited hours to help her stay in her own apartment. A middle-aged woman having to “fight” to get the services she needed. A loved one not having enough care to support both the morning and bedtime routines. A wife reporting frequent no-shows without any warning. A son reporting his father received homecare a week after being discharged instead of 24 hours as promised.
Many comments related to not having enough hours of support from personal support workers, but patients and caregivers also spoke about gaps in nursing, palliative care, physiotherapy, occupational therapy and speech therapy. Some mentioned they were lucky to be able to pay privately for some of these services but wondered about those who couldn’t afford to do so.
These challenges with homecare predate COVID-19. But things have only gotten worse. Anecdotally, wait times are longer, service is less consistent, and hours are still inadequate. At the same time, helping people stay safely at home has never been more important.
Canada will need strong public health measures to avoid an increase in deaths from a second wave of COVID-19. That means smart testing, rapid contact tracing, instructions to isolate, and effective support to do so.
Hopefully these measures will keep the COVID-19 numbers down. But if there is a surge, we need to ensure our hospitals have the capacity to support sick patients. That means keeping people out of hospitals whenever possible.
High-quality homecare can help people transition more quickly and smoothly from hospital to home. It can help avoid potential readmissions but also reduce the number of admissions in the first place, keeping our hospital capacity open for potential COVID-19 cases.
Better publicly funded homecare can also delay or avoid a transition to long-term care. Long-term care homes had high mortality rates from COVID-19 in the first wave and there are worries about what a second wave would bring. Even if someone wanted to enter a long-term care home, new rules meant to minimize spread of infection will also mean longer waits. Notably, our engagement with patients and caregivers found that improving publicly funded homecare was a top priority also for people living in long-term care.
It’s time to put into place recommendations from past reports calling for better homecare — we need better funding for homecare, standards outlining the amount of care that is consistent across jurisdictions, and better integration with other sectors including hospitals and primary care.
Improving publicly funded homecare will help us keep many of the Canadians most at-risk of COVID-19 complications safely at home —out of hospital and high-risk congregate settings — protecting them and opening hospital capacity for others. They’ll be better off but so will all of us.
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