Monday, April 16, 2012

Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada?

A new Health Council of Canada report on the state of home-care services for senior citizens describes how many people caring for their loved ones with complex and multiple health needs at home are in distress because they are not receiving enough support from the public system.

Everyone begs for more homecare, but no one wants increased taxes to pay for it! Many are unsuited to stay in their own homes. There are a range of options: from Home care, supportive living, adult living, retirement homes, LTC.

Yes, a 24/7 nurse in our homes would be great.
But, no, it is impossible, as Ontario is short nurses as well as budgets for this. Ontario is short nurses by 20%, some have estimated.
We are similarly short of personal support workers, in both home care and institutions, who do most of the physical caregiving our ailing seniors require. There isn't enough personell to fill this need. The highest paying, hospitals, get the great staff. It varies from that, to for-profit private companies, like Bayshore, or other private service providers.

The report recommends governments take a closer look at the need for home care, which can be more cost-effective than hospitals and long-term care facilities as the Canadian health care system grapples with an aging population.
Nonsense. Paying the salary of a PSW, with travel time of a half hour between clients in rural Ontario, does not make any sense. Many working in LTC claim the need for more staff. Not only can we not afford it, it doesn't make sense to take people with high needs and give them individual care in private homes.

Profile of seniors receiving home care 
Across the five regions in this sample, more than 60% of seniors 
receiving home care are women and more than 70% are over 

75. In most regions, 20% or more have a diagnosis of Alzheimer’s 

or other dementia.

Gabriella Skubincan, a spokeswoman for the Ontario Association of Community Care Access Centres, said that the number of home-care hours people are eligible to receive in this province varies according to individual need, circumstances and choices, but the regulated maximum for personal support services in Ontario is 120 hours in the first month and then 90 hours per month after that.

Average expenditures per week
$344 - palliative clients
$185 - other home care clients

  • 2-3 % do not have a caregiver
  • More than 30% of clients in each of the regions examined have a MAPLe score of high or very high
  • More than half experience pain
  • About 15% have severe pain
  • At least 30% have depression, 17 - 30% take antidepressants
  • Under 20% had one fall in the previous 3 months, 
  • Between 10 -  20% visited ER in the previous 3 months.
  • PSWs provided 50% of home care
  • According to 2008 data from Statistics Canada 67% of deaths in Canada occur in hospitals, even though many people would prefer to die at home.
In Ontario:
  • 69% had a PSW
  • 48% had nursing care or monitoring
  • 13 % wound care
  • Only 1% had a social worker
  • 21% had occupational or physiotherapy
In Canada
Hollander, M.J., Liu, G. & Chappell, N.L. (2009). Who cares and how much? The imputed economic contribution to the Canadian health care system of middle-aged and older unpaid caregivers providing care to the elderly. Healthcare Quarterly, 12(2), 42-49. 
  • Caregivers are most often women.
  • 74% of spouses are the primary caregiver
  • 23% of married home care clients are cared for by an adult child
  • Single, divorced, or widowed are 74% cared for by their adult children
  • Other relatives are the primary caregivers for 13%
  • Between 39% and 50% of clients in our sample live with their primary caregivers.

For-profits send nurses and PSWs to private homes, where those requiring help get the help they need. But there are those in long-term care who belong at home, and those in private homes who can afford to hire more staff to look after their loved ones.

  Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? 
April, 2012
Explores the growing issue of home care in Canada. The report takes a deeper look at the seniors who are receiving home care, the family caregivers that are lending support, as well as the challenges of home care in Canada.  This PDF report

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