Home care needs to be made a national priority in Canada

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For 18 years, Cathy Harman has been a home care worker based in Durham Region, Ontario. She performs bowel treatments for people with disabilities, including seniors, who aren’t able to use the washroom independently.

It’s challenging, but Harman wouldn’t trade it for anything.

"I love the fact that what I do enables them to stay in their own home and live some kind of life," she said. "Without that help they would have to be institutionalized, and let me tell you, when they are institutionalized they just whither away."

Canada's aging population: High needs individuals require higher level care

Canada’s population is not only aging, but is grappling with significant health problems as they age. For many, nursing homes are not option, either because of personal preference or wait times.

It’s why home care -- and workers like Harman -- has become an important option, and one that unions, governments and private citizens are trying to ensure can meet the demands of the ever-growing seniors population and relieve stress on caregivers -- relatives and spouses who take on the responsibility of caring for the aging members of their families -- who depend on people like Harman to help them.

Provinces and the federal government are attuned, in some respects, to the growing need for home care services. All provinces and territories can provide a personal support worker or nurse depending on the needs of the senior or disabled person. Other resources vary province to province.

Funding for support services like respite workers -- who can help caregivers with simple household chores -- or equipment depends simply on where you live. In Ontario, only ten per cent of people receiving homecare get access to rehabilitative services, which can be key for someone recovering from a fall or other injury.

But the funding isn’t consistent across Canada, and some people only see marginal increases in care despite their worsening condition.

What many would like to see is an increase in homecare services as people develop illnesses or disabilities that require a higher level of care.

"As the needs increase, the caregivers hours increase," explained Shilpi Majumder, a policy lead at the Health Council of Canada. "But the homecare hours don’t increase proportionally." The Health Council of Canada’s 2012 report on the state of home care in Canada found that home care for people with high-needs illnesses -- like dementia -- only increased by a few hours despite their higher needs.

"Those that are less mobile, more likely to have dementia -- these are the high need seniors," said Majumder. "And those family caregivers who are taking care of them are getting more and more distressed."

Majumder noted that in Ontario, the number of seniors with dementia in home care situations is between 12 and 32 per cent -- a significant number with an illness that requires intensive care that may be beyond the abilities of relative or spouse to deal with.

Family caregivers require more support

What is covered by the provinces still doesn’t reflect the full cost of caring for a loved one at home. Over 50 per cent of family caregivers are employed, and depend on home care so they can provide adequate care.

Carolyn Markotich cares for her mother, Blanche, at home. Blanche has limited mobility -- she currently has to use a wheelchair -- and dementia. Carolyn works for the parks and recreation department in Sydney, Nova Scotia, a job that requires her to work full days and occasional evenings.

"Blanche can’t be left alone, of course, because she really can’t look after herself." It costs Carolyn approximately $2,000 a month to have people in to look after Blanche while she works.

Carolyn was also recently informed she would have to buy a lift to facilitate getting Blanche out of bed, as home care workers won’t lift her out of the bed to protect themselves from the risk of injury. The lift will be over $2,000 in cost. She’s also had to purchase a commode, as well as other equipment and supplies to make life easier for her mother.

Carolyn does get $400 a month to offset costs, as well as a few hours a week of respite care in addition to medical home care provided by the province of Nova Scotia. "[But the money] is just a drop in the bucket," she explained. She’s the sole income provider for her and her mother.

The stress of home care disproportionately affects woman. A 2007 study cited by the Health Council of Canada found that women make up 60 per cent of all caregivers, and in many cases they were caring for a spouse.

Many people who are caring for their parents are aging themselves, and could soon face the same illnesses and challenges as the person they’re responsible for caring. While few would describe caring for their loved ones as a burden, the costs and responsibilities of doing so can weigh heavily on family caregivers.

Making home care support a national priority

The National Pensioners and Senior Citizens Federation (NPSCF) is trying to make sure that home care is on the national agenda.

"Seniors are the fastest growing population in this country and everyone knows this and no one has planned properly for it," said Herb John, the president of NPSCF. "I think a lot could be resolved with some federal leadership on these problems."

Both the Canadian Home Care Association and the Health Council of Canada have suggested that home care principles be harmonized across the country. "For example, Australia has a national home care system," said Majumder. "We think Canada can draw from these other practices in other countries."

For the time being, however, family caregivers and people who rely on home care are happy there is some sort of system in place. Carolyn treasures the time when her respite worker comes, giving her a few precious hours to do the groceries or other errands.

"I’m glad there is something I can count on," she said. 

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