In
2000, over 1 million Canadians were enrolled in home care
programs across Canada. Total home care expenditures (public
and private) have increased from 1991 – 2001 by 204%, from
$1 billion to $3.1 billion. Although this increase is substantial,
it still only represents 3.3% of the total health care expenditures
in Canada.
What is causing this increase in demand and why is home care
still underfunded in relation to the total health care system?
A
rapidly growing elderly population: As the number of Canadians
over age 75 increases, the need for services to support them
increases proportionally. In the 1998 / 99 National Population
Health Survey, 12% of Canadian Seniors reported receiving
publicly funded home care services. The dilemma we face is
finding the right balance of residential services and home
care services and meeting the demands of aging Canadians to
stay in their own environments as long as possible.
Hospital bed reductions: The trend is now toward shorter
hospital stays, earlier discharge, and the use of outpatient
procedures, resulting in more reliance upon home care. More
than 275 hospitals across the country have been closed, merged,
or converted to another type of care facility, the number
of approved beds is down substantially and the number of people
being cared for in hospital day-surgery programs has increased.
Home care is critical to sustaining a hospital system with
fewer beds.
Advances
in technology: Medical advances have not only made shorter
hospital stays possible but have resulted in more outpatient
alternatives. Ensuring good quality care often means that
clients will require follow-up attention at home. Conditions
that previously required hospitalization, such as pain control
and infusion therapy, can now be managed at home. Advancements
in treatment protocols and accessibility to high tech equipment
make palliative care, chemotherapy treatment and other specialized
medical services, in the home a very real option for Canadians.
Higher acuity of clients in the community: In a 2001
CARP survey, 89.7% of the home care service provider respondents
felt that the complexity of care has increased over the past
three years. Home care programs across Canada provide complex
services to a broad base of clients including clients with
mental health issues, complex geriatric problems, oncology
and palliative clients, clients with acquired brain injury,
paediatric clients, clients experiencing problems with complex
wound/ostomy management and continence management.
