Advancing Home and Community Care in Ontario

Posted by Steve Jones

Tue, Dec 2, 2014

The Home and Community Care Expert Group is an advisory group whose job is to provide the Minister of Health and Long-Term Care with specific, practical recommendations to improve home and community care. In October 2014 they published a whitepaper titled Advancing Home and Community Care in Ontario,. which addressed where home care has been successful and where it has failed. (Quotations in the following paragraphs are from this document.)

According to the paper, the mandate of Ontarios publicly funded home care system is to support families to provide care at home. In order to provide proper and sufficient care to allow their loved ones to remain at home, families frequently supplement CCAC services with privately-paid care services from a provider such as Qualicare.

Successes

• Since home care was established 45 years ago in 1970, service has increased so that 700,000 Ontarians now receive almost 38 million home visits per year.
• The current process for service providers to contract with CCACs is based on quality, whereas the old system was a request-for-proposal process based on price. CCACs use measurements of client satisfaction, missed care, referral acceptance rates and discharge report rates to determine whether service providers are performing up to standard.
• Home First is a program to allow those being discharged from the hospital to receive intensive support at home so that they can go home earlier, reduce the risk of ending up back in the hospital, and avoid having to go into long-term care immediately. The program has proven effective for less complex cases where the senior can return close to the functioning they had before hospitalization within a reasonable time frame. (See our article on maximizing your CCAC benefits from last week.)

Frustrations and Failures

• A recent scientific trial by Maureen Markle-Reid of McMaster University determined that providing seniors with regular, proactive nursing support rather than professional services after the fact can enhance quality of life and reduce the risk of falls, medication interactions, depression and caregiver stress. In fact, studies show that significant savings occur when seniors are treated at home rather than hospitalized or institutionalized. Yet the amount of nursing services provided has not changed in recent years while the number of clients served has increased 14%. (See our article on the decline of community-based healthcare in Ontario.)
• In 2010/2011, 58.1% of clients served by CCAC have high care needs, and increase of 21% over 2009/2010. These clients take more of the resources CCAC has available and leave less for frail elders with longer term, lower care needs, including those who are at risk for losing their independence because their family and community can no longer care for them adequately at home.
• Current funding limits and inflexible eligibility criteria do not align or respond to real world challenges, such as seniors who need only a small increase in services beyond established limits in order to stay in their home, but not enough to need the full range of services from a long-term care (LTC) facility. As Ontarios population is proportionally getting older, more seniors will need some services to remain independent at home, which is almost always less expensive and more to the seniors good than entering institutional long-term care.
• Under current procedure, applicants must wait for services until the CCAC completes a lengthy and sometimes redundant assessment. Paperwork before care is [contrary] to the belief in Canada that the frail and vulnerable should have unfettered access to care.
• Families form the backbone of the home care system in Ontario. The demands of caring for elderly relatives can surpass the physical and emotional abilities of untrained family members. Yet every day, family caregivers are asked to do more because the CCAC does less.

Recommendations

• Change financial resources and focus from placing elders in hospitals and LTC facilities to home-based care at every opportunity. The home care system must shift from predefined service limits, visit times and defined tasks to one that is responsive to the persons rights and wishes in their own home.
• Trust the members of the healthcare team, including doctors, therapists, nurses, and private providers, to be able to determine what the patient needs. Streamline CCAC case management to support those with the most complex needs, who consume most of our healthcare resources and are the most vulnerable.
• Allow service provider organizations to do what they do best, using their own efficient delivery procedures, training, education, and clinical practices. They are experts and do not need micro-management to achieve the best outcomes for those they serve.
• Coordinate and integrate services between CCAC and their health system partners ” doctors, hospitals, LTC facilities and private service providers. Foster, rather than discourage, these partners to function as a team for the good of the patient.
• Communicate fully with partners and most importantly the clients and their families. Right now, families often say they were never told they could purchase services that CCAC would not provide, or could pursue other home-based options to prevent institutionalizing their loved one.
• Support family caregivers with training, respite, and equipment and supplies, as well as with activities such as bathing, dressing, cooking, and managing medication. Family caregiving, as a social norm, will be enhanced if families are provided greater support to maintain their natural and desired caregiving role including access to quality privately purchased care.
• Update the current outmoded funding standard to a model of payment for successful outcomes. Focus on home as the preferred place of care, and allocate resources to support it.