The devastating toll of COVID-19 on long-term care residents in Canada has underscored the need for increased public funding for home care, advocates say.
Most seniors want to stay at home for as long as possible, and their families want to support them to do so, but the cost and limited availability of home care forces many to “give up” and place their loved ones in long-term care, said Sue VanderBent, CEO of Home Care Ontario.
The Canadian Institute of Health Information estimates one in nine newly admitted long-term care residents could have remained at home with proper supports – a figure that is especially alarming in light of how the novel coronavirus has ravaged these facilities.
“This pandemic has scarred all of us. This is burned into our memories now, so planning for the future becomes even more important,” said VanderBent.
“People will demand that they have the supports to stay at home and receive care at home and end their life at home, because it’s just too scary now.”
The tragedy unfolding in long-term care homes across the country has shed new light on persistent problems in the elder-care system. Residents of these facilities account for 10 per cent of COVID-19 cases and 72 per cent of deaths in Canada.
But a major piece of the system is home care and it is often ignored, said VanderBent, whose organization represents home care providers in Ontario.
“We’re probably the same as any other province in that the home care system itself is generally an afterthought. It is not generally funded in a way that contributes to a robust system.”
Ontario has a roughly $63-billion health-care budget, of which about $3 billion is spent on home care, she said.
The lack of funding means that home care workers make about $4 less an hour than those who work in long-term care, making it hard to retain staff, VanderBent said.
It also means providers can’t offer enough hours of care to support an elderly person who, for example, might wander or turn the stove on while their family member is at work, she added.
“We’re not thinking about, ‘How do we help families look after their loved ones?’ That’s the way we should look at it,” she said.
“Families just give up because they really feel they have no choice, and they should have more choice.”
The Ontario Health Ministry said in a statement it recognizes the critical role home care plays in ending so-called hallway health care and supporting the province’s COVID-19 response.
It said the provincial government passed legislation last year that changed the way home care is delivered and broke down barriers that have separated it from other parts of the system.
The government invested an additional $155 million last year to expand home and community care, and last October announced a temporary wage increase for personal support workers, including those who work in homes, it said.
A study by VanderBent’s group found very low levels of COVID-19 transmission in the home care sector during the first wave of the pandemic, representing 3.5 per cent of overall cases in the long-term care, retirement home, hospital and home care industries.
British Columbia has also seen very few infections in home care settings, said the province’s seniors advocate, Isobel Mackenzie.
Mackenzie found in a 2019 report that approximately 4,200 long-term care beds in the province are occupied by seniors who could live in the community with home support or assisted living.
Home support is unaffordable to most seniors, she concluded, writing that a senior with an income of $28,000 is required to pay $8,800 a year for daily home support.
She also wrote that 51 per cent of home support clients are at high or very high risk of placement in a long-term care facility, but despite this, 86 per cent receive less than two hours of home support per day.
Mackenzie made multiple recommendations, including the removal of the co-payment, and the province committed to working on them before the pandemic hit, she said.
Alberta and Ontario do not charge a co-payment for publicly funded home care and B.C. is the most expensive of the provinces that charge, she added.
Before COVID-19, many families put their loved ones into long-term care because they assumed it would be safer than being at home, Mackenzie said.
“People have been, I think, more sensitized to what care homes can do and not do,” she said. “That may influence some decisions for some people about whether to put their loved one in care or not.”
Of course, there are always going to be people who can only be properly cared for in a long-term care home, she added.
B.C. Premier John Horgan promised in the provincial election campaign last fall to expand publicly funded home care. The commitment also appears in the mandate letter for Health Minister Adrian Dix, but no details have been revealed yet.
Shirley Bond, the Opposition Liberal interim leader and critic for seniors services and long-term care, said seniors want a variety of options, including staying at home for as long as possible.
Horgan has accused the B.C. Liberals of under-funding home care while they were in power from 2001 to 2017, saying that access to home support fell by 30 per cent for those over 75.
Bond countered that clients receiving home health services increased by 36 per cent while her government was in office.
Horgan is the premier now and he has a responsibility, she added.
The Opposition will also continue to press for an in-depth analysis of what went wrong inside long-term care homes, which account for more than 600 of B.C.’s over 1,100 deaths, Bond said.
The B.C. Health Ministry did not immediately respond to a request for comment.
Across the country, only 3.4 per cent of public health funding is spent on home-based care, according to the Canadian Home Care Association and Carers Canada.
The association wants the federal government to direct funds to the provinces for home care and create national legislation that defines and strengthens caregivers’ rights.
COVID-19 has increased the burden on family caregivers, said Catherine Suridjan, the association’s director of policy and knowledge translation.
More than eight million people in Canada provide unpaid care for their loved ones and are at risk of suffering from burnout, she said.
“If you’re thinking about the long term, are you going to end up having two patients instead of one?” she asked.
Home care is the least expensive option for the government and the most preferred option for seniors, said Laura Tamblyn Watts, CEO of national seniors advocacy group CanAge.
Keeping someone in their home costs far less for government than funding a brick-and-mortar facility with full-time staff, Tamblyn Watts said.
“This is the answer that we must move toward, while at the same time shoring up our neglected systems in long-term care for the few people who will need that high-level nursing care.”