7 system-wide benefits of expanding home care and home support
Home support is more than a nice-to-have service that helps people age at home. It’s a proven, cost effective, public solution that will improve services for everyone across the health system.
The BC government increased investments for home support by 42% in five years, says a 2023 report by the Office of the Seniors Advocate. That’s a noteworthy investment, but it hasn’t been enough to keep pace with the growing need for home support services in an aging population with increasingly complex care needs.
It’s hard to estimate the real need for home and community care in the province because demand is artificially kept low by prohibitive co-pays. And in many areas where home support might play a beneficial role in a patient’s care journey, we simply don’t have the workforce needed to integrate it in the system.
But fear of the potential real demand in the face of a too-small workforce shouldn’t stop us from continuing to invest aggressively in home support.
The majority of our peer OECD countries include home support in their health care system. It’s a cost-effective part of a high-functioning public health care system, with proven benefits that reach far beyond helping seniors age at home.
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Reduce emergency room overcrowding
People who do not have access to care in community are often forced to turn to their local emergency room for non-urgent care needs. Regular at home care, home support, and monitoring can prevent minor issues from escalating into emergencies that require more intense interventions. -
Free up hospital beds by speeding up patient discharge
Up to 18% of inpatient hospital beds in BC are occupied by patients that could be discharged if they had access to community-based alternatives with the appropriate intensity of clinical care and non-clinical support. Because these services are not available, patients stay longer in hospitals and are often readmitted shortly after being discharged. -
Help reduce surgical wait times
Fully-funded home support would mean that patients who are waiting for or recovering from surgery can receive appropriate care at home, rather than in hospitals. This approach can lead to fewer cancellations of scheduled surgeries, faster recovery, reduced hospital stays, and more efficient patient flow. Investing in home support, especially for seniors, helps reduce overall wait times for everyone.
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Relieve caregiver burnout
Overall, 34% of family caregivers in B.C. are in distress and this rises to 57% when looking at clients who are receiving less than an hour per day of home support. Increasing access to home support and respite supports caregivers in their desire to keep their loved ones at home and out of long-term residential care as long as possible.
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Free up long-term care beds for residents with higher care needs
In BC, 61% of seniors moving into a long-term care facility had no home support 90 days prior to admission. B.C.’s rate of newly admitted long-term care residents with low care needs is 34% higher than the national average. These statistics tell us that providing basic home support could easily allow more people to live at home, helping reduce wait lists for residential care.
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Improve primary health care access
When community health workers and allied health professionals are included in primary care teams, other team members like family doctors and nurse practitioners can focus on preventative and planned care. Patients can be referred to other team members like physiotherapists and dietitians who can also help address issues before they escalate to emergencies. Team-based care also leads to better workload distribution, helping address recruitment and retention issues in primary care. -
Invest in climate resilience
Expanding home support at the scale we need could create tens of thousands of new care economy jobs in Canada. These jobs are good for local economies and are less carbon intensive than alternatives that require large-scale infrastructure development. Community health workers could also be well positioned to take part in emergency responses by ensuring vulnerable residents have life-saving touch points during extreme climate events.
Valuing the home support workforce
In order to reap the potential benefits of a well-resourced home support system, we’ll need to first acknowledge a long-standing cultural tendency to under-value domestic care work, which is disproportionately performed by women and immigrants. While Community Health Workers (CHWs) have made significant gains in establishing education, training, and care standards, there is still a long way to go for the profession to get the recognition it deserves in our health care system.
To ensure the true need for home care is met, we must also invest in recruitment and retention of the CHWs who provide that care. While CHWs have the same training and qualifications as care aides in facilities, their wages and work conditions do not reflect the real value and challenges of their work. Indeed, CHWs often have a greater scope of practice than workers in facilities as they often perform tasks, such as lifts, by themselves at the risk of personal injuries. In recent years, CHWs have also dealt with increasing complexity of care, with more patients having multiple conditions, including mental health or substance use complications.
BC has recently taken significant steps to increase the home support workforce. The Health Career Access Program has trained thousands of new CHWs and gotten them started in the field. The most recent round of sectoral bargaining saw improvements in terms of bringing wages of CHWs much closer to those of care aides in facilities. Financial top-ups now exist for CHW wages in rural areas. These improvements must continue in order to retain the existing and newly trained workers to this workforce.
Removing financial barriers for patients
While the majority of provinces do not charge for home support services, BC charges the highest co-pays. A senior with an annual income of $29,000 must pay $9,000 a year for one-hour daily visit of home support. This means it is often more financially feasible for a senior to move into publicly-funded long-term care, even though residential care costs the public up to four times the cost of at-home care.
These co-pays are not only inequitable. They also keep the demand for home support services artificially low. Removing the financial barrier to home care will significantly increase demand, which only emphasizes the urgency with which we should invest in this important workforce.
While it may seem like an ambitious and costly direction, it’s worth remembering the overall cost-effectiveness of home support. Investing in this type of care would result in exponential savings by reducing pressures on more costly parts of our system, including emergency rooms, inpatient hospital care, surgical care, and long-term care.
Resources
We Must Do Better: Home Support Services for B.C. Seniors | Office of the Seniors Advocate