The global pandemic of COVID-19 has brought long-standing gaps in the Canadian care system sharply into focus, particularly for older adults who cannot live independently. As we collectively grasp the enormity of the troubling living conditions for Canada’s residents of long-term care, and the resultant deaths due to to the pandemic, we must also consider how such tragedy could have been prevented — or at least minimized — in the first place.
It has been almost 20 years since Roy Romanow led the Royal Commission on the Future of Health Care in Canada, highlighting an urgent need to build Canada’s home-care programs. In 2009, the Canadian Healthcare Association published a road map for how to get there. And Canadians have repeatedly affirmed their wish to receive care “closer to home” and forego the ever-expanding costs of institutional care.
Too bad these calls for robust home-care services across the country have been largely ignored in favour of an inadequate piecemeal and patchwork system where few Canadians get the care they want or need.
Of the almost $264 billion that we spend each year in Canada on health care, estimates suggest anywhere from $3 billion to $9 billion of this is directed toward home and community care.
Home care has never been encompassed under the Canada Health Act, and decades of cutbacks to federal health transfer payments under previous federal governments have shifted greater proportions of the costs of home care to the provinces. This has resulted in wide variation in what home-care services look like across regions.
We also routinely devalue the importance of home care in this country.
Home support workers are often considered the lowest priority in contrast to other health-care workers. During COVID-19, clients who receive home care, as well workers who provide the bulk of these services, are in many areas experiencing the effects of rationed access to personalized protective equipment (PPE). In some provinces, many clients have also experienced reduced access to some basic services — like bathing — that have (incredibly) been deemed “non-essential.”
Now, imagine what life might have been like for today’s older Canadians had earlier recommendations for home care been implemented.
We would have had, among other things, national home-care standards, funding mechanisms and services to support older adults and persons with disabilities living at home or in alternate settings. We would have had decent support for Canada’s family caregivers, who provide the vast majority of support for those at home.
Or imagine if Canada had adopted innovative home-care programs used in other countries.
We could have had self-managed nursing teams in each neighbourhood in the country, providing care to everyone who needs it. The Buurtzorg model in Netherlands has demonstrated lower costs, higher patient satisfaction, higher professional satisfaction and improved outcomes for those in need of care.
We could have also had highly integrated housing and heath-care policies that would ensure the right level of support is put in place for each older adult over time so that those who want to stay home can do so safely. That is what Denmark managed to implement as a part of its public universal health-care system.
Instead, Canada has opted for a remarkably uninspiring “status-quo” over the past several decades.
Well before the COVID-19 crisis, the home-care sector has been showing very clear signs of strain and dysfunction. Home care nurses in our research told us that home care is in a state of disarray. They face mounting pressures to get people with increasingly complex medical and social care needs out of hospitals without any substantial investment in publicly funded home care.
Nurses also told us they are under constant pressure to speed up and limit their services and even ration the care they provide.
Could all of the deaths from COVID-19 in Canada’s long-term-care system have been prevented? Probably not. But if Canada had something more in place, perhaps most older Canadians would not require help within institutional settings in the first place.
Our seniors and persons with disabilities deserve something more than what is essentially a patchwork system of subsidized and user-pay home-care services and something more than pushing family caregivers to breaking points.
In these unprecedented times, we have the opportunity to fundamentally rethink how we care for some of our most vulnerable Canadians. To ignore this opportunity only serves to perpetuate the ongoing inequities that exist in our care system.
By Kelli Stajduhar
Thu., July 16, 2020