What Direction Should We Take?
“We are all in this together”… could not be a more appropriate phrase for our healthcare situation. Whether it is our partner, our parents, our child, or ourselves, we will eventually be faced with ageing, or a chronic condition, or recovering from a medical issue.
For those of us in Canada we will be experiencing this eventuality in a country that is ranked as the highest spending country as a percentage of GDP amongst OECD countries, but is ranked 31 out of 38 in terms of health outcomes in the same group.
This situation will get worse. Consider these astounding stats from the just-published (Feb. 2024) McMaster University whitepaper “The Impact of Ontario’s Aging Population on the Home Care Sector”:
- In the next five years the over-age-65 population growth rate will be much higher than the 20-year average, at 3.5% per year.
- Over the next 6 years, Ontario’s over-age-65 population will grow by over 650,000 persons – a growth of about 110,000 individuals per year, or a total of 23%.
- The cost per capita for medical care for those over age 65 is 347% more than that spent on the underage 65 population – $20,407 per capita versus $5,884 per capita.
This is an unprecedented demographic bulge, with massive implications for our healthcare system, and for our own respective healthcare experiences.
With an already over-stretched healthcare system how will we deal with this “silver tsunami”?
Even if we started a massive re-investment into physical healthcare facilities, they will not be ready in time. And we would create an oversupply of facilities (and debt-overhang) that future generations would need to deal with.
More importantly, it is not directly addressing the problem.
“The Problem is the Problem”
The pandemic laid bare (and accelerated) our fundamental understanding that it is our entire “supply-chain” of healthcare that needs to evolve.
Our current model, of institutions first with poor care transitions from home, to clinic, to hospital, to home again, and the experience delivered to patients is cumbersome and inefficient.
We need to eliminate this waste from inefficient cycles and reduce the overall burden on our existing infrastructure. A major step in this is to recognize the ability to deal with many of these cycles and manage ageing or medical recovery from our homes.
Consider this 2018 study that found the cost for acute care and 30-day post discharge for specific care was 67% less cost overall with home care involved than without – and with better health outcomes. Global study after study shows the same thing repeated – homecare properly integrated in the healthcare supply chain reduces costs and improves outcomes.
The Canadian healthcare system needs to re-examine the priority it places on homecare in our budgets. Looking again to OECD countries for guidance the average spend on homecare is 0.8% of GDP – in Canada where we spend more on healthcare to get worse results, our spend on homecare is 0.2% of GDP. t
This is astounding – if Canada quadrupled its homecare budget from $12bn in 2022 to $48bn today, we would just be average with other OECD countries. And all the evidence shows that spending increase would reduce our overall $350bn healthcare budget significantly.
In the face of all of this, our healthcare system needs an Uber moment. In 2009 Uber did not decide to build a better taxi company – they recognized that the millions of cars in any area were unutilized assets, and that by putting them to use they could deliver a better experience in almost every way – to both the drivers and passengers.
In the face of our strained system, facing an even greater burden in the next 10 years, we don’t need to invest in more taxi companies – we need to recognize that the homes our seniors live in are existing infrastructure where they overwhelmingly prefer to age gracefully from, or recover from a medical issue in.
To help people stay at home will require some significant changes and improvements, including:
- More efficient integration of home care into the overall supply chain, with better transition planning, supported by a Health Care Navigator
- Running tests and rolling out improved technology including virtual care and remote monitoring paired with AI in home to build “virtual hospital wards”
- Ensuring continuity of care with better health team communication and data sharing
- Improving working conditions and opportunities for our healthcare field force to turn homecare into a profession and not a transient gig
“It’s not about ideas. It’s about making ideas happen.”
It is no longer viable or even possible to build our future healthcare environment without comprehensive healthcare at home. The demographics, the economics, and the recognition that another “black swan” epidemic is highly conceivable, make the need for change irrefutable.
So, let’s recognize this critical moment for healthcare and shape our future in the way we know we want it: With our center…our passion…our home as the foundation for our healthcare experience and support.
My Thoughts – Sincerely,
Robert Stanley
CEO Stay At Home Nursing
