Health Begins at Home: Strengthening BC’s Home Health Care Sector

By Michael Kary and Ravin Johl

What does the word ‘home’ mean to you? To some, home might merely be a place, for others it is a feeling, or something else entirely. Although one’s definition may differ, to most people home is important. As quoted by Maya Angelou, an American poet and civil rights activist, “the ache for home lives in all of us … the safe place where we can go as we are and not be questioned.”

Home is also where seniors generally like to receive their care, including, if required, at end of life. While this is not always feasible, there has been a general societal shift toward supporting seniors to remain in their own homes if possible.

As the Canadian population rapidly ages, home health care has become a critical part of the health system. It enables seniors to live in their homes while supporting them to manage their health and maintain their independence and well-being. Home health care (including home support and home care) is also necessitated by rising health care costs and the need to deliver high quality care. For these reasons, it is more important than ever that we invest our resources into strengthening home health care with the aim of developing a system of care than best supports the needs of B.C. seniors. As such, the BC Care Providers Association (BCCPA) has released its latest paper entitled Health Begins at Home: Strengthening BC’s Home Health Care Sector. This paper builds off an earlier BCCPA paper released in 2017 with the goal to potentially influence the provincial budget expected later this month.

While this paper provides some background on the home health care sector in both B.C. and Canada, it also addresses some fundamental challenges to the delivery of these services. As documented in various reports these challenges include impediments to access, shortages of workers, insufficient home visit times, and ensuring appropriate resources are in place to meet the growing levels of complexity and acuity experienced by clients receiving care. To address these challenges, the latest BCCPA paper outlines eight recommendations, within four key themes, to improve BC’s home health care sector including investments in funding, seniors and quality; as well as fostering innovation (see table 1 below).

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With regards to investments in funding, BCCPA has recommended establishing a permanent Joint Committee on Home Health Care to address some of the unique and considerable challenges facing the sector. This paper also recommends that the BC government undertake an independent and immediate review of home health care funding to ensure fairness and sustainability. Along with providing greater transparency on funding, the goal of such a review should be to help address recruitment and retention issues as well as providing support for crucial training and continuing education. For example, it outlines the need for additional funding of at least $2 million per year to provide training and clinical education to home health care workers in critical areas such as dementia, as well as occupational health and safety.

With regards to investing in seniors, the BCCPA believes more must also be done to increase access to home health care and ensure the needs of seniors are being met. In this regard, it outlines that Health Authorities should increase minimum home care and home support visit times to at least an average of 30 minutes or higher in some instances (i.e. community care settings) including at least $50 million in annual funding to support this goal.  As outlined in the paper, the BCCPA believes 15 minute or shorter visit times is insufficient to ensure the dignity of seniors as well as provide quality care.

As part of the theme of investing in seniors, the BCCPA also believes that the province should look at what other jurisdictions are doing in providing preventative home care visits. As outlined in the paper, the greater focus on preventative care in Denmark has significantly decreased system costs while avoiding expensive hospitalizations. As such, the BCCPA recommends additional funding to support more preventative home health care visits to people 75 and older on a proactive basis to prevent pre-mature frailty and ensure that seniors are provided with the necessary care as soon as possible.

While new home health care investments are critical, it is also important to innovate where possible. This includes, for example, the development of new home health care models and funding approaches that can better deliver the care seniors need. While publicly funded home care was first introduced as a pilot nearly 50 years ago, its design has largely not evolved to reflect the increasingly complex and chronic patients who require care in the home.

The latest BCCPA paper highlights the need to fund new home health care models that reduce acute care pressures including alternate level of care (ALC) days and better integrate home health with acute and long-term care. For example, to address these critical areas as well as to increase access to end of life care, the BCCPA advocates for $20 million in annual funding to support the adoption of new home health care models across the province.

Likewise, with respect to funding, the paper advocates the BC government explore further the appropriateness or feasibility of the care credit model in home health care including its limited phased implementation within the continuing care sector. This concept was discussed in detail in the 2017 BCCPA paper Strengthening Seniors Care to provide seniors with greater opportunity into their care choices.

With respect to the fourth theme on quality, the BCCPA believes more must be done to improve quality of care and quality of life for seniors. Building on an earlier recommendation, the BCCPA recommends that a new Seniors Quality of Life Fund (SQLF) be established with designated funding to support seniors living at home and in congregate settings.

As outlined in the latest paper, the SQLF with $25 million per year in funding could increase access to much needed recreational therapy, occupational therapy, physiotherapy, nutrition, culturally appropriate care as well as music and art programs. Likewise, it could assist in reducing social isolation through important Adult Day and similar programs; as well as enable the long term care sector to work more collaboratively with local home health providers to improve quality of life for seniors in the community.

Finally, the paper also recommends the development of a made in BC Quality Assurance model in the home health care sector. This would focus on implementing standards to ensure quality across the sector as well as helping seniors and families make informed choices about care. This is an initiative that the BCCPA has already begun work on but will likely require additional resources to realize its full potential.

In summary, further investments are critical to meet the needs of BC’s aging population and to strengthening BC’s home health care system so that the best and most appropriate care can be delivered to seniors. By focusing on implementing the recommendations in the paper, including approximately $110 million per year in targeted funding, the BC Government, Health Authorities, BCCPA, service providers and other partners can create dramatic change in the quality of life and quality of care experienced by seniors accessing home health care services.

In anticipation of the upcoming provincial budget, now is the time to invest in seniors and to strengthen home health care … it is only with such action that health can truly begin at home.