Health system missing key preventive means to postpone and avoid more costly care
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Vancouver–Reduced access to publicly-funded home support means frail seniors and people with disabilities are being left without the basic supports needed to monitor their health and postpone, or even avoid, the need for residential or hospital care.
This is the central finding of From Support to Isolation: The High Cost of BC’s Declining Home Support Services, a new Economic Security Project study, published today by the Canadian Centre for Policy Alternatives. The BC Ministry of health claims that home support has been enhanced since 2001, yet the study finds that:
- The number of people receiving home support dropped by 24% between 2000/01 and 2004/05, and the number of hours dropped by 12%.
- This decline continues a trend that began in the mid-1990s. However, since 2001, reductions in access occurred at the same time as both residential care and hospital beds were cut.
- BC has gone from 17% above the national average in access to home health services (home support and home care combined), to third lowest in Canada in 2002/03.
- Home support services have shifted dramatically to clients with higher needs, and have become more narrowly focused on medical tasks. The public system provides less and less of the daily living services that focus on prevention and maintenance, such as meal preparation, shopping, housekeeping and social contact.
“Home support can and should be about prevention,” says Marcy Cohen, co-author of the study. “A good home support system acts as the eyes and ears of health care. It helps to identify more serious problems as they emerge and ensures that people can live independently in decent and healthy conditions. This can reduce overall health expenditures and should be part of the solution to BC’s shortage of long-term care facilities and overcrowded hospital wards.”
But as Arlene McLaren, co-author of the study and a Professor of Sociology at Simon Fraser University, notes, “Services have not been expanded to meet growing demand. Instead, Community Health Workers are increasingly forced to rush from one client to another, without being able to take time to monitor their wellbeing, or even talk to them about how they are doing. Clients report that they aren’t getting the level of support they need to live with dignity. They are isolated, and afraid of what will happen to them if services are cut further.”
The study points out that the decline in home support affects the economic security of workers, clients, and the friends and family who care for those who can’t afford to pay for needed services. “Both the people who rely on home support and the workers who provide it are mostly low-income, economically vulnerable individuals, mainly women,” says Cohen. “Lack of adequate home support also puts pressure on family and friends, some of whom are forced to forgo employment income to provide care themselves,” says McLaren.
Among the study’s recommendations to the provincial government:
- Study the Danish home support system, which provides a range of free, universally-available, 24-hour services for seniors. Yet overall eldercare costs are lower in Denmark than in neighbouring Sweden, which charges user fees for home support and provides fewer services concentrated at higher care levels.
- Increase funding for home support to ensure that individuals who require only prevention and maintenance supports (ie, meal preparation, cleaning, etc) receive the services they need, and that these services are part of the care provided to all home support clients.
- Increase integration of home support with other health services.
- Improve working conditions for Community Health Workers; provide more opportunities for them to have input into care planning; and develop a mechanism to support continuing education.
From Support to Isolation builds on research published in the 2005 CCPA study Continuing Care Renewal or Retreat, which documented cuts in residential, acute and home-based health care. Both studies were produced through the Economic Security Project, a joint research initiative of the CCPA and Simon Fraser University, funded primarily by the Social Sciences and Humanities Research Council of Canada (SSHRC).
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