Report: The Importance of Home Support
for an Aging Population
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What kind of services and supports are needed for seniors to maintain their independence, remain socially engaged and still be supported as their health declines?
Given growing concerns about the rising health costs of an aging population, finding solutions – that maximize both cost effectiveness and health outcomes – is one of the biggest challenges facing BC’s health care system today.
The Ministry of Health’s stated goal is clear enough: support seniors to remain independent in their own homes for as long as possible. The reality on the ground is, however, something different.
Instead of making it easier for seniors and family caregivers to access the basic home support services seniors need to remain in their own home – such as assistance with meal preparation, bathing, and medication management – it is now more difficult than ever for older adults, particularly those with more moderate needs, to access these services.
From 2001/02 to 2009/10 access to home support services for people 75 and over declined by 30 percent. In 2013-14 the number of clients receiving home support was virtually identical to the number receiving services in 2001-02. Yet, over those 12 intervening years in BC, there was a 49 percent increase in those clients 80 years or older, and an increased demand for home support services due to shorter hospital stays and more restricted access to residential care.
BC was a leader in the provision of prevention-oriented home support services from the 1960s to the mid-1990s.6 This is no longer the case. Today, BC’s Ministry of Health has the most restricted criteria for accessing basic homemaking services, like meal preparation and laundry, of any Canadian province. If you look more broadly at the full range of publicly funded home health services (i.e. inclusive of home making, personal care and professional nursing and rehabilitation services), less than two percent of BC’s population has access to these services – also lower than any other province in the country.
In this research project, focus groups were organized with the people most directly connected to the home support system – clients, family caregivers, family physicians, home care nurses and community health workers (i.e. home support workers) – in order to learn about their experiences with the shortfalls in the home support system, and to reflect on how these experiences compare with what the research tells us is needed to provide high quality, cost effective care and support for seniors as they age. There were 44 focus group participants, primarily from two health authorities – Vancouver Coastal Health and Fraser Health.
This research project builds on a number of earlier studies on the BC home support system and on reports from both BC’s Auditor General and Ombudsperson. These reports were critical of the lack of leadership provided by BC’s Ministry of Health to ensure that home support services are adequate to meet population needs. The overall goal of this report is to develop recommendations for the Ministry of Health on the key changes needed to improve the home support system in ways that will optimize the quality of care and the overall cost effectiveness of health services.
The full report includes the findings from the focus group research and a review of the research literature on the way home-based services can be organized to: support healthy aging, address the burden of care on families, and ensure high quality, cost effective service delivery. The summary report summarizes the key findings from the focus groups and insights from the research literature.