What happened to the national home care program?

November 1, 2000

In 1997, after wide consultation across the country, the federal government's National Forum on Health concluded that home care should be considered an integral part of publicly funded health services. A year later, the National Conference on Home Care identified home care as a vitally important component of a responsive and sustainable health care system. Numerous studies have come to the same conclusion: home care is key to the modernization of Medicare.

Nevertheless, national standards are still nowhere to be seen in home care. The federal government abandoned the dream of national home care in this summer's negotiations with the provinces. The result? Funding, eligibility criteria, services covered and delivery structures vary widely depending on where you live. Home support programs can be eliminated by a policy shift at any level. And the growing gap between the care people need and what they can access in the public system is creating new opportunities for large for-profit corporations to gain more ground in our health care system.

Our research on home care in BC reveals some very troubling developments. Hospitals have been downsized without a parallel investment in home and other community-based care. Hospital stays declined by 46 percent in BC during the 1990s. But the number of patients receiving home support dropped by 19 percent, and people assessed at the lowest level of need lost 78 percent of their home support hours. This at a time when the number of elderly people in BC who were 70 years or older--the primary users of home care--increased by 25 percent.

Cuts to home care mean less access and higher user fees for some of the most vulnerable members of our society----low income women, people with chronic ailments and disabilities, and seniors living in poverty. In 1998/99, four out of five single seniors applying for home care subsidies had annual incomes below $20,000. Fully 94 percent of home support applicants with disabilities had incomes under $10,000 a year.

Lack of home care creates serious problems for patients, family members, care providers and the health system. These include: declining patient health due to poor nutrition, stress and isolation, and higher out-of-pocket costs; hospitalization; higher injury rates among workers; lost work time for relatives; the potential for falling standards of care; loss of continuity of care; and the denial of people's basic human right to live at home and participate in their community.

Cuts to home care also hurt our entire public health care system. This year, Canada ranked a distressing 30th in the World Health Organization's survey of 191 national health systems. The reason for our poor showing? According to WHO director Dr. Julio Frenk, our poor showing reflects the erosion of our universal health care system by more out-of-pocket costs. With only 70 percent of total health expenditures being public, Canada ranks the lowest of the G-7 industrial nations after the United States.

Private spending on health care grew by 50 percent in the 1990s. A recent study by the Dialogue on Health Reform found that about half the increase came from the shifting of services covered under the Canada Health Act to sites of care that are not subject to the funding conditions of the Act----in other words, homes. International research clearly shows that private, for-profit health care leads to inefficiencies, higher costs, increased regulation and barriers to coordination of all sectors of the health care system. More privatization will increase the cost of health care over the long term.

It's high time we brought our politicians up to speed with what Canadians need, want and deserve.

Home care must be publicly funded, publicly delivered and administered, and not-for-profit. We need a strong legislative framework that guarantees the right to quality care no matter where health services are delivered. That means extending the conditions for federal funding to cover all sites of care, beginning with home care. Dedicated federal funding--like the money recently targeted to primary care--and national standards for home care are essential. Now is the time to invest in ourselves and, with a ballooning federal budget surplus, we need to hold our politicians to account on why they continue to drag their heals on a national, public and non-profit home care plan.