“My Perspective”
Robert Stanley – CEO of Stay At Home Nursing Care Services.
There is an enormous, relatively slow, yet unstoppable wave of legislative change further solidifying our homes as a critical, arguably foundational component of healthcare. In many ways this is inevitable, and overdue. In the coming decade with the baby boomer bulge, and post pandemic ripples, Canada can choose to desperately try to build new hospitals and facilities to care for our loved ones, institutionalising and infantalizing them, only to find a massive overcapacity as the “silver tsunami” passes by. Or we can invest in keeping people at home, where they feel safe and comfortable, whether they are aging gracefully in their chosen community, or facing medical recovery at home surrounded by loved ones.
To break this down, start with understanding that homecare services are not publicly insured through the Canada Health Act in the same way as hospital and physician services are. Provincial, territorial and municipal governments are funded from the federal level, but this means homecare is not integrated in the over all supply-chain of healthcare, leading to disjointed and underfunded services. In fact if Canada decided to quadruple the $12 billion spent on homecare to $48 billion it would just get us to the global OECD average of developed nations – we woefully underfund this critical aspect of healthcare. There is growing recognition this must change.
Consider the Ontario Healthcare System as an example. The Convenient Care at Home Act of 2023 will make Ontario Health Teams responsible for connecting people to home care services starting in 2025. In its own words this means a more efficient and fluid exchange and handoffs between providers, with one patient record and care plan at its heart. If the day-to-day implementation by Ontario Health at Home coordinating all home care services across the province via Ontario Health Teams is realized, we will see much better health outcomes.
There is similar legislation across Canada, and while the above initiatives are admirable, we should see the bigger picture: That when we are met with a health challenge we naturally want to deal with it at home, in a safe familiar environment. Not only is this what most people prefer, but it drives better health outcomes and lowers health system costs overall. There is plenty of research validating homecare throughout a health issue improves satisfaction and health outcomes here in Canada, and many more examples overseas in countries such as Denmark, New Zealand, Norway, and Belgium which all demonstrate how homecare as the foundation of care improves healthcare overall and reduces costs.
If in fact we were to increase homecare budgets to the OECD average of $48 billion, we would undoubtedly see patients with higher satisfaction in the healthcare system. Simultaneously, the Canadian total healthcare cost is all but guaranteed to go down, with reduced visits to the ER and hospitals, and less crowded long-term care facilities.
Increasing budgets and legislating home care into the healthcare supply-chain is a good start, but more is required. At the heart of homecare, it is, and always will be, about people. We need to step up and recognize that caregivers or “PSW’s” are a massive, critical sector that lack formalized recognition as a trade and service. Being a hairdresser or barber has more structure and licensing requirements than home care professionals providing critical support. This formalization and structure needs to encourage, and not restrict growth in the PSW profession, and help transform this critical role from a transient gig to a respected career.
This new era recognizing the opportunity for Comprehensive Health at Home has never been more pronounced. The pandemic and its after-effects accelerated this, but understanding and formalizing homecare and its foundational role will drive improved health outcomes. It takes pressure off hospitals and primary care. It frees up beds. It lowers cost across the healthcare ecosystem.
It is integral to our health management and experience because there is nothing more personal than our health, and there is nowhere as safe, dignified, personalized and comfortable as our home.
Let’s continue to advance this evolution of healthcare at home – it is not only personal to our loved ones, but also figures in each and every one of our own futures!
