HESA Committee Report

ANALYSIS OF IMPLEMENTATION

HOME CARE

Based on the available information, there has been varying degrees of progress on meeting the commitments, with some jurisdictions clearly providing all elements of the agreed-upon home care commitment at first-dollar coverage, while others have partially met the commitments.   Some jurisdictions provide some home care services, but may not be able to provide all elements of each basket item (e.g., intravenous medications related to the discharge diagnosis, case management, crisis response and personal care).

Short-term acute (i.e. following hospital discharge) home care and end-of-life services have progressed the furthest, although not all services specified are currently available in all jurisdictions at first-dollar coverage.  In particular, the availability of personal care services on a first-dollar basis varies among jurisdictions. 

In terms of palliative care, first-dollar coverage for case management and nursing at the end-of-life is generally provided where jurisdictions have well-integrated home care programs.  Access to pharmaceuticals for palliative care clients is variable.  Where it exists, it may be delivered through a palliative-specific pharmaceutical plan; in other jurisdictions, necessary drugs may be covered under existing plans for target populations (e.g., those for seniors, persons with cancer or AIDS, or with special financial needs or disabilities).  Many jurisdictions provide personal care for palliative care patients, but not necessarily with first-dollar coverage.

Short-term acute community mental health home care is the least advanced service in many jurisdictions and remains the most difficult commitment to meet.

The health care service delivery structure of many P/T systems means that most home care services are delivered at a local level through regional health authorities (such as Local Integrated Health Networks (LHINs) in Ontario, and Centres locaux de services communautaires (CLSCs) in Quebec).  Therefore, there may also be variations within provinces and territories with regard to service provision.

Federal Accomplishments

Veterans Affairs Canada (VAC) has one of the most comprehensive national home care programs and exceeds the 2004 Health Accord home care commitments.  VAC continues to evaluate and augment the Veterans Independence Program (VIP) in response to changing needs of eligible clients.  Many of the services offered are based upon eligibility and need and include screening and assessment tools, ground maintenance, and housekeeping and personal care services.  All benefits and services must be pre-authorized by VAC.  The VIP offers nursing care to clients but not continuous nursing (i.e., on-going care of more than two hours per day by a registered nurse).  Budget 2008 provided $282 million over three years to ensure that surviving primary caregivers in need receive the help they require to remain independent in their own homes.

Health Canada’s First Nations and Inuit Home and Community Care program is funded to provide basic home and community care services (nursing, case management, respite and personal care) to people with chronic or acute illness, disabilities and the elderly in their home communities.

Health Council comments

As the deadline for reporting on progress on home care was December 31, 2006, until recently the Health Council had little opportunity to assess progress (its third annual report, issued in February 2007, did not have the benefit of the December 2006 reporting).  Generally speaking, the Health Council has expressed concern regarding the lack of reporting and data collection challenges.

In a January 2008 report, the Health Council noted that in 2005, 2-5% of Canadians used home care services while 3-4% of seniors 65 years of age and older said they needed home care services they did not receive.  The Health Council noted that while governments have expanded home care services since the 2004 Accord, more needs to be done.  It notes that in 2006, one in four Canadians said they cared for a family member or close friend with a serious health problem in the last 12 months, with 22% of those caregivers missing one or more months of work and 41% using personal savings.  The report recommends that all jurisdictions expand their coverage of home care services and make this expansion a priority in health care renewal.

Report:

Fixing the Foundation: An Update on Primary Health Care and Home Care Renewal in Canada, January 2008.