Cracks in home care need filling

The Atlantic provinces are aging quickly, and the cracks in home care need filling.

The Atlantic provinces are reporting the highest proportions of the population aged 65 and older in Canada, from 21.2 per cent in PEI to 23.6 per cent in Newfoundland and Labrador, according to a 2021 Statistics Canada report. Yet, our current health care systems are ill-prepared to meet the rising demand for senior care. Home care, a vital health care service in elder care, must be urgently reformed to address gaps and inefficiencies.

Home care is designed to help seniors age in place and maintain independence by providing tailored support in the home. Studies show Canadian seniors prefer to stay in their own homes for as long as possible. However, the fragmented and overburdened system of home support makes it difficult for seniors to achieve this goal.

Cracks in the current system

There have been numerous news reports published in recent years documenting the prominent issues with home care in the Maritimes. From a lack of available support workers in Newfoundland and Labrador, to a ‘disconnected system’ in New Brunswick, to long wait lists in Nova Scotia, it is clear that home care needs fixing.

Although the implementation of home care is slightly different in each province, they all suffer from a significant shortage of home care workers and fragmentation resulting from a mix of public and private service provision.

The dangers of privatization

The landscape of health care in Canada is becoming increasingly privatized, particularly for services deemed ‘non-essential.’ However, this trend undermines the capacity of the public health care system to provide comprehensive care for Canadians.

The model of service provision usually involves allocating provincial funding to contract private companies that then provide direct home care to clients. However, the inconsistent coordination between public and private entities can lead to a lack of unified standards, both for care provision and home care staff, and results in an added burden on clients who must navigate between multiple providers.

Privatization can also bring significant risks. During the COVID-19 pandemic, a study showed that for-profit long-term care homes had a higher rate of death, thought to result from the prioritization of profit margins over essential investments in staff and infrastructure. Although these findings cannot be directly applied to the unique context of home care, both home care and long-term care are similarly threatened by the lack of regulation, oversight, and transparency required of private companies, which increases the risk of harm.

Funding for personal care is needed

Home care is generally offered in two streams: nursing services, which includes medically necessary services such as wound care or medication management, and personal care support, such as help with dressing, bathing, cleaning, cooking, or respite care. Essential medical services are fully funded by provincial bodies, whereas personal care services are often only partially subsidized. This leaves these ‘non-essential’ but still incredibly valuable services out of financial reach for many.

The Nursing Home Without Walls program in New Brunswick offers a promising pathway for providing personal home support, free of charge. The program employs existing community resources to provide in-home support, such as health care navigation assistance, social visits, transportation, and meal delivery. It has already demonstrated positive outcomes such as a reduction in unnecessary emergency visits, decreased loneliness, and enhanced knowledge and sense of security. This initiative highlights the potential benefits of fully funding non-medical but essential home support services for improvements in the care of seniors.

Home care workers are struggling too

Home care workers are also suffering from the overburdened nature of the health care system. They are overworked, underpaid, and do not have enough paid sick days, contributing to high rates of burnout. Therefore, increasing the capacity of home care necessarily involves improving the working conditions for home care workers.

The reliance on private home care companies exacerbates the problem by introducing a lack of coordination and standardization, particularly in wages and benefits for home care workers. The fragmentation of the system between various independent companies also makes it hard for home care workers to unionize and advocate for better working conditions at a provincial or national level.

Nova Scotia recently introduced a new pilot program aimed at training and hiring more continuing care assistants. This program offers free tuition, books, a wage supplement and guaranteed work after graduation to incentivize the training of more home care workers. Removing the financial barrier of home care support education is a promising initiative supporting home care workers that other Atlantic provinces could consider implementing as well.

Hypothesizing change: An interprovincial comparison

A 2023 study comparing home care in Nova Scotia and Manitoba presents interesting possibilities for how home care can be reimagined in the Maritimes. Although imperfect, Manitoba’s system resulted in better outcomes comparatively, such as a longer period spent in the home prior to entry into long-term care.

One key difference between the provinces’ systems is that in Winnipeg, home care services are exclusively provided by public employees. This allows for more consistent coordination of services across the province that systems in the Maritimes are lacking. For example, among the 11 privately-run home care sites across Nova Scotia, visiting nursing is offered at all 11, whereas personal care support is only offered at 6, reflecting a gap in ‘non-essential’ services that nonetheless relieve caregiver burden greatly.

Planning the way forward

Studies show that an improved model of home care is certainly possible in the Canadian context. Furthermore, there have been positive developments in the Atlantic provinces in recent years.

In November, Newfoundland and Labrador became the first province to announce a planned increase in wages for home and personal support workers as part of the Aging with Dignity Action Plan. PEI has a similar federal funding agreement, which aims to increase access to in-home acute and palliative care through the Mobile Integrated Health initiative.

Also this month, the newly elected Liberal government in New Brunswick announced their priority areas, which includes expanding the Nursing Home Without Walls model and investing in wage increases for personal support workers. Nova Scotia has re-elected Tim Houston and it remains to be seen whether home care will be a priority in this province in the coming years.

Despite this valuable incremental progress, the Atlantic provinces must also explore bold reforms to home care by creating and funding a robust, publicly run home care system, which ensures better standardization, accountability, and all-around support for home care workers. Without these changes, the system will continue to leave seniors and their families without the support they urgently need.

Erin McKenzie is a Master of Social Work (MSW) student at Dalhousie University.