A Review of Challenges to the Provision of Home Care and Home Support Services Across Canada
AUTHOR(S) & CREDENTIALS: Jenna Roddick, Coordinator: Research and Knowledge Translation
AFFILIATED INSTITUTION(S): AGE-WELL National Innovation Hub: APPTA
ACKNOWLEDGEMENTS: Samuel Hunter, Research Assistant
What inspired you to begin working on this project? Describe the main issue or challenge the project aims to solve.
It is commonly known that the population of older Canadians is increasing. In just five years (2024), the population of adults over the age of 65 will reach approximately 20% in Canada and 11 years later (2036) projected to increase to 25%. While often spoken of as a burden, this demographic shift offers Canada an opportunity to make sustainable changes in the health care system and build inclusive communities and services for all. Interestingly, higher rates of health care usage were not necessarily associated with increasing age as much as the presence of chronic conditions. Focusing on addressing health limitations may be more important than focusing on age alone. However, programs often have an age cut of for eligibility, which creates a service gap for those who have specific needs due to a particular condition. A recurring consensus in the literature exploring older adults’ perceptions and hopes of how they will live their later years, is that they want to be able to age in their homes or communities. Home care and support offers a cost-effective way for the system to ensure the health of its aging population.
Briefly summarize your project.
The evidence synthesis was conducted to better understand the difficulties experienced by older Canadians in navigating and accessing the health care system and social support system.
Discuss some of the past, present, and/or intended future real-world applications of this work.
Lack of availability, issues with eligibility criteria, personal characteristics (follow through, language barrier, etc.) cost, and deciding to not seek services have been described in the literature as barriers to home care. The most frequently reported barrier was lack of availability of services. All of these barriers contribute to unmet needs and the importance of highlighting these issues is paramount for identifying where improvements and changes need to be made. The 2016 Canadian Community Health Survey (CCHS) reported that of those receiving home care services, over one-third of people had unmet home care needs, most of which being unmet support needs rather than health care needs. This shows the importance and need to better fund home support workers in entering and remaining in the field. Unmet needs are linked to negative health consequences for the client and lead to increased costs to the healthcare system that otherwise may have been avoided by proper home care provision . For home support services, 46.1% indicated in the 2015/2016 CCHS that their needs were either partially met or unmet. Variations in access to home care services and financial coverage (provincial/territorial/federal) for home care services might be a contributing factor for unmet needs, since one-fifth of respondents cited cost as a barrier. Similarly, analysis from the General Social Survey reveals 24% of those who reported having unmet needs were 65 and older.
If applicable, identify any important policy implications this work may have.
There have been a number of recommendations and acknowledgements around the challenges seniors face related to receiving services in-home. A report prepared by the Federal government identifies the importance of addressing the gaps in the provision of financial support, calls for innovative approaches to providing care, identifies the importance of non-medical services such as home support, and expresses the need to make services more available and accessible, especially in rural areas. Similarly, the CMA has recommended that a targeted home care innovation fund be established in order to address some of the major challenges the system faces.
The recently published National Dementia Strategy highlights important issues and perspectives regarding access to care related to the diagnosis and treatment of people living with dementia. This document, Together We Aspire, highlights many calls for action including increasing awareness and reducing stigma, development of guidelines for early diagnosis, understanding the effects of dementia on our communities, and support for community-based projects . Movement in this direction will help many seniors at risk for dementia receive appropriate care, specifically those who are more likely to experience inequities in care such as Indigenous peoples, ethnic minorities, low-income, and rural community dwellers.