BRIEF FROM THE CANADIAN HOME CARE ASSOCIATION

EXECUTIVE SUMMARY

Home care is a priority for Canadians - from policymakers to health providers, to the individual providing care for a family member. The shifting population demographics, changes within the hospital system and medical advances are transforming health care in Canada - the delivery and setting of care. The approach to health care delivery is no longer reactive and episodic, but instead has evolved to one that is proactive, focusing on health promotion, chronic disease management and independence at home. The location of health care is no longer perceived as the exclusive purview of hospitals and/or physicians’ offices, but has expanded to include home and community care. Increasingly complex care can be, and is, provided at home, which is where Canadians want to manage their health care needs or live out their days. Home care is cost effective and care effective, however an unintended consequence of moving health care to the home has been a shifting of the responsibility for costs from the public purse to the individual, disadvantaging a large number of Canadians. At a minimum, families assume the accommodation costs while a person is ill and, in some cases must finance equipment, supplies and medications.

The federal government has a vital role in health care to “facilitate reasonable access to health services without financial or other barriers"ⁱ. With the transformation of the health care system, the government must undertake strategies to strengthen and target policy and funding for home care as an integral component of the health care system in Canada.

Canada has a strong economy, prudent federal fiscal management and comprehensive social programs. The need for the federal government to balance these priorities in the face of global and domestic economic pressures and uncertainties, while ensuring access to health services, has been taken into account by the Canadian Home Care Association (CHCA) in forming its recommendations.

The CHCA represents policymakers, administrators, providers and researchers in home care from across the country and therefore has a unique and comprehensive perspective of the sector. In offering recommendations, the CHCA has considered the investments and initiatives adopted by provinces, territories and federal programs. The recommendations provided will enhance current programming in place across the country and support the goal of optimizing the role and value of home care. Accordingly, the CHCA offers three recommendations that address: 1) caregiving responsibilities undertaken by families that risk precluding their active participation in the workforce, 2) the imperative for innovation in technology, and 3) the policy work that will clarify and frame home care and thus health service in the 21^st century in Canada.

The CHCA believes that by adopting the following recommendations, the federal government will demonstrate sound fiscal policy by alleviating undue financial burden placed on individual Canadians through a strengthened home care sector; and effective social policy by reinforcing their commitment to our public health care system.

RECOMMENDATIONS

1.   Announce a Caregiver Strategy for Canada as a framework for directing and coordinating measures to support family caregivers who assume extraordinary financial burden in order to support the delivery of health care at home.

2.   Target funding to the development and implementation of innovation and innovative technologies to optimize the delivery of home care and empower Canadians to become involved in their own health and wellness.

3.   Task an expert panel to articulate a set of harmonized principles for a national home care program so that Canadians clearly understand their rights, options and resources for home care.

Background

Home Care is “an array of services for people of all ages, provided in the home and community setting, that encompasses health promotion and teaching, curative intervention, end-of-life care, rehabilitation, support and maintenance, social adaptation and integration and support for the family caregiver.” ⁱⁱ

Home care allows Canadians of all ages to recover or manage their health care issues in their home setting and age in place surrounded by family, friends and their community to which they can continue to make a meaningful contribution. Home care is a critical component of health care restructuring, primary health care renewal, chronic disease management and ‘aging at home’ strategies across the country.

The Aging Population and the Changing Health Care Setting

Projections by Statistics Canada indicate that the number of senior citizens will increase rapidly over the next few decades, reaching 23% to 25% of the population in 2031 and 25% to 30% in 2056.ⁱⁱⁱ (In 2005, the figure was 13 %.) The age transformation in Canada will have profound consequences on individuals, communities and the nation as a whole.^iv

While seniors today are typically healthier and more independent longer in life, the demographic shift is driving a need to broaden our approach to health care and leverage resources to support seniors to remain independent at home for as long as possible. Chronic conditions are more prevalent among the elderly and the proportion of seniors with a disability or handicap also rises with age. Currently, four in five seniors living at home have at least one diagnosed chronic condition compared to one in ten of those between the ages of 25 and 54.^v The number of chronic conditions has been found to be the strongest determinant of the frequency with which seniors consult physicians and use medications. Having chronic conditions also increases the likelihood of being hospitalized and receiving home care.^vi According to Statistics Canada, “the need for home care services in Canada can be expected to increase in the coming years. As the number of elderly people in the population grows, so will the prevalence of age-related chronic conditions that may jeopardize an individual’s ability to live independently in the community.”^vii

Recent Canadian and international research suggests that community-based services that are integrated and co-ordinated across the health care system can be a cost-effective way to maintain seniors’ independence and that it can prevent premature admissions to hospitals and long-term care facilities.^viii The availability of home care services can facilitate early discharge from an institution effectively addressing the number of patients waiting in hospitals that do not require intensive / acute care - a challenge in Canada’s health system.

Canadians want to receive care in their homes, and if given a choice would prefer early discharge from hospital followed by provision of home care.

Advancements in Home Care - First Steps

As early as 1990, governments have recognized the role and value of home care. In September 2004, home care was identified as an “essential part of modern, integrated and patient-centered health care”, and it was declared that the quality of life for those in need would be enhanced by improving access to home and community care services. The subsequent 10-year plan to strengthen health care committed governments to provide first dollar coverage by 2006 for specific home care services based on assessed need and identified a core set of services for acute, palliative and acute mental health home care.^ix While this commitment was an important first step in the process to strengthen home care across Canada, the limited scope of services articulated in the plan did not address the future challenges or realize the full potential of the home care sector. Our 21^st century health care system requires a broad view of home based health care and must include new and innovative approaches to care that support family caregivers and leverage the efficiencies of technology.

The Vital Role of Family Caregivers

“Family caregivers” provide care and assistance for spouses, children, parents and other extended family members and friends who are in need of support because of age, disabling medical conditions, chronic injury, long term illness or disability. A family caregiver’s effort, understanding and compassion enable care recipients to live with dignity and to participate more fully in society. Caregiver tasks can include clinical activities (wound dressings and injections), personal care (bathing, dressing, eating or toileting); support activities (preparing meals, managing medication), and activities such as coordinating the myriad of services that care receivers may require.

Family caregiving is a crucial part of home care. The contribution of families relieves governments of substantial public costs^x, often at the expense of the individual’s personal health and financial wellbeing. A 2009 survey reported that “boomers” provide 42 hours of care and travel 225 KM each month to help their aging parents. 39% provide financial assistance to their parents - an average of $498/month.^xi The imputed economic cost to replace family caregivers with the paid workforce at current market rates and usual employee benefits and support would be $25 billion.^xii

Canadians recognize that they will be called upon to play a caregiving role for a loved one who is ill; and that, for many, that role will be of lengthy duration. 60% of caregivers provide care for more than three years.^xiii While caregiving is a positive experience for many, people often have to miss work or reduce work hours and forgo job opportunities to provide care which has economic ramifications for caregivers, their families and employers.

Innovation and Technology

Evidence from across Canada shows that technology solutions increase efficiency and effectiveness thereby enhancing health care and home care capacity. Innovative technology is an enabler to improving the linkages between health system partners. Active and passive remote monitoring has been shown to effectively complement the home care practitioner, enabling access to health care when the provider cannot be present in person.^xiv Electronic documentation systems enhance the ability for providers to connect and share information in a timely way thereby improving service to the patient and decreasing time spent on communication and redundant clerical activities.^xv This electronic connectivity will be most effective when broadband coverage is available across the country.

Technology initiatives have focused on acute care and on developing electronic health records for patient care relating to an admission to hospital. While the acute care experience is an important episodic event, Canadians have the greatest longitudinal interaction with the health system in their communities - through visits to their family doctors and management of their health conditions in their homes and communities. It would therefore follow that future investment in technology needs to reflect the essential role of community based services within our health care system.

The Request for the 2012 Budget

The CHCA believes that by adopting the following recommendations, the federal government will be creating the right balance of investment to address the risk of undue financial hardship on families, contain its costs and associated taxation, and keep Canadians employed and contributing to a prosperous economy.

Recommendation - Announce a Caregiver Strategy for Canada as a framework for directing and coordinating measures to support family caregivers who assume extraordinary financial burden in order to support the delivery of health care at home.

Family caregivers are vital to enabling the delivery of home care services and as such make a significant contribution to the health care system. The current federal measures for caregivers are good; however there is an opportunity for improvement in the form of policy, regulation and/or financial support. A Canadian Caregiver Strategy creates a framework that can be adopted by all jurisdictions and sectors in order to align efforts to support family caregivers who face extraordinary challenges, including being forced to leave the workforce. It will enable coordination for multijurisdictional approaches, demonstration initiatives, support for research, education and the dissemination of knowledge and best practices. The elements of the Strategy include:

·         Safeguarding the health and wellbeing of family caregivers

·         Minimizing excessive financial burden placed on family caregivers

·         Enabling access to user friendly information and education

·         Creating flexible workplace environments that respect caregiving obligations

·         Investing in research on family caregiving as a foundation for evidence-informed decision making

Recommendation - Target funding to the development and implementation of innovation and innovative technologies to optimize the delivery of home care beyond incremental staff increases and empower Canadians to become involved in their own health and wellness.

Effective application of technology can help to ensure that the health system is appropriately and efficiently used. It improves the ability to measure, evaluate and manage health care. Technology helps to improve care the at the point of delivery and the quality of life for those wanting to remain independent at home. For the home care provider, technology improves the ability to see more clients, decrease paperwork and access the right information at the right time enabling collaboration with other providers. For the individual, technology facilitates independence. Innovative robotics, remote monitoring and cueing systems have the potential to exponentially leverage the human capital.

There is an urgent need for innovation in care at home and in the development of innovative technologies to assist clients, family caregivers and practitioners better manage the health care, access the health system and support communications of health status across the health team including those, such as specialists, that previously might only have been available through travel and related challenges.

Recommendation - Task an expert panel to articulate a set of harmonized principles for a national home care program so that Canadians clearly understand their rights, options and resources for home care.

Canada’s national health care program is a source of pride for Canadians; however, shifting care out of the defined health system (hospitals and doctors) to the home and community, places individual Canadians at risk of undue financial hardship as they assume costs of care that were previously managed in the hospital setting; and take time away from work to provide supportive care for loved ones.

The federal government has committed to “investing in our system of universal health care”^xvi providing support to communities and families. Accordingly, the federal government needs to invest in Canadians who often directly assume the cost and provision of care at home. A low cost, high yield step is to task an expert panel to articulate national home care principles that would harmonize provincial / territorial home care programs. The approach would be to begin by working with provinces and territories to gain agreement on the principles and develop policy that supports adoption. This work would set a pan-Canadian framework for home care services and clarify expectations across the country of the rights, options, and resources that an individual can be expect when receiving home care in their community.

Conclusion

Securing Canada’s system of universal health care involves embracing the new paradigm. The Canadian Home Care Association believes that the recommendations provided align with the government’s goal of “prosperity and a high standard of living for all” and are fiscally responsible. The return on investment for every dollar to support the provision of home care is exponentially enhanced by the in-kind contribution of families. There are innovative practices and technologies that will also provide a significant return in staff efficiency and improved client access to care. Finally, the policy work to harmonize principles for home care will establish home care as an integral component of the health care system for the 21^st century.

The CHCA believes that by adopting its three recommendations, the federal government will address the risk of undue financial hardship, contain its costs, and keep Canadians employed and contributing to a prosperous economy.

1.    Announce a Caregiver Strategy for Canada as a framework for directing and coordinating measures to support family caregivers who assume extraordinary financial burden in order to support the delivery of health care at home.

2.    Target resources to the development and implementation of innovation and innovative technologies to optimize the delivery of home care beyond that which staff can provide and empower Canadians to become involved in their own health and wellness.

3.    Articulate a set of harmonized principles for a national home care program so that Canadians clearly understand their rights, options and resources for home care.

About the CHCA

The Canadian Home Care Association (CHCA) is a not-for-profit membership association dedicated to ensuring the availability of accessible, responsive home care and community supports to enable people to stay in their homes with safety, dignity and quality of life. The Association is governed by an elected Board that has representation from every province, territory and the federally funded programs. Members of the Association include organizations and individuals from publicly funded home care programs, not-for-profit and proprietary service agencies, consumers, researchers, educators and others with an interest in home care. Through the support of the Association members who share a commitment to excellence, knowledge transfer and continuous improvement, CHCA serves as the national voice of home care and the access point for information and knowledge for home care across Canada.

EndNotes

i       Canada Health Act, retrieved from http://www.hc-sc.gc.ca

ii      Canadian Home Care Association, www.cdnhomecare.ca

iii     Statistics Canada Population Projections for Canada, Provinces and Territories 2005-203, Catalogue no. 91-520-XIE http://www.statcan.gc.ca/pub/91-520-x/91-520-x2005001-eng.pdf  

iv     Canadian Institute of Health Research, www.cihr/institute/aging

v      Statistics Canada, 2003

vi     Rotermann M. (2006) Seniors’ health care use. Statistics Canada. 16(Suppl.): 33-45

vii    Statistics Canada. 2006. Seniors and Home Care. Stats Can Catalogue no. 82-003-XIE. Ottawa. www.statscan.ca

viii   Béland F. etal (2006) A system of integrated care for older persons with disabilities in Canada: Results from a randomized controlled trial J Gerontol A Biol Sci Med Sci. 2006 Apr; 61(4):367-73.

Ix     First Ministers agreed to provide first dollar coverage for short-term acute home care for two-week provision of case management, intravenous medications related to the discharge diagnosis, nursing and personal care; short-term acute community mental health home care for two-week provision of case management and crisis response services; and end-of-life care for case management, nursing, palliative-specific pharmaceuticals and personal care at the end of life.

x      Torjman, S. etal (2004) Disability Tax Fairness Report, p88

xi     Investors Group. (2009) Days, dollars, and distance: The Story of Boomers on Call. Retrieved from http://www.investorsgroup.com/english/aboutUs/news/2009/091019_boomers.shtml

xii    Hollander, M., Lui, G., Chappelle, N. (2009) Who Cares and How Much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly. Healthcare Quarterly, 12(2) 2009: 42-49

xiii   Health Canada. (2002). National Profile of Family Caregivers in Canada - Final Report. www.hc-sc.gc.ca

xiv   Canadian Home Care Association (2008) Integration through Information Communication Technology for Home Care in Canada Final Report

xv    Ibid

xvi   Budget Speech, June 2011