In the healthcare industry, no one joins without a deep sense of caring and a genuine desire to help others. The challenges of long hours, low wages, and both emotional and physical stress quickly weed out those not committed to making a real difference for their patients.
“Not everything that can be counted counts,
and not everything that counts can be counted.”
However, alongside this altruism, we must confront the harsh reality of the infrastructure and numbers that can push our compassion to its limits. Whether in the ER, hospitals, long-term care facilities, or home care, the lack of resources, support, and system efficiency leads to burnout and stress for healthcare workers. This, in turn, leads to patients perceiving poor care, creating a vicious cycle that further strains the system.
The Numbers Game: Understanding the 1/31 Problem
Let’s delve into some critical numbers, starting with the 1/31 problem. Among the 195 countries globally, 38 belong to the OECD group of economically advanced nations. Canada ranks #1 in healthcare spending but stands at 31 out of 38 in healthcare outcomes. With $13.3 tax dollars out of every $100 going to healthcare, we are far above the OECD average of $8.2.
How can we be spending so much to achieve such poor healthcare outcomes?
The Scope of the Problem
Let’s understand the magnitude of the issue:
- Today, Canada has more citizens aged 65 and older than those aged 14 and under. The number of people aged 65 and older is set to double by 2029.
- The average per-person spending on healthcare in Canada is $2,700 per year for those aged 64 and under, and over four times higher at $12,000 per year for those aged 65 and older.
- In 2019, the 198,000 long-term care (LTC) beds in Canada provided care for 302,576 people, with 77,448 on waitlists. By 2031, over 606,000 Canadians will require the type of care provided in LTC facilities.
- The 73,000 hospital beds across Canada are already at their limits, with 14% occupied by patients designated as Alternate Level of Care (ALC) who don’t need hospital care but have no LTC beds or sufficient home care funding to go home. What will happen as the population ages further?
The Need for Radical Change
These numbers paint a grim picture. A system already stretched to its breaking point will be pushed even further in the coming years. Simply spending more on a broken system, making incremental changes, or leaving the problem to local leaders won’t work.
Building and spending our way out of this problem will not work. A new hospital bed costs anywhere from $500K to $1.5M to build as a capital expense. A long-term care bed costs about $320,000 to build. And if we do try to build enough new beds to meet the needs in the next few years, we will find them underutilized as the baby boomer generation passes on, creating a debt overhang for years to come.
Radical change in how we approach healthcare, combined with strong leadership, is essential. A groundswell of change is needed, with all participants in this complex ecosystem learning to work together to make a substantive difference.
What is required is comprehensive healthcare at home, where homecare becomes the foundation of healthcare, and not the footnote that it currently is.
Learning from Other Countries
Looking at other countries can provide some guidance. Within the OECD countries with both lower spending and better health outcomes, a common factor is the amount spent on home care. Canada spends about 0.4% of GDP on home care, less than $15 billion last year. The OECD average is 0.8%, meaning if we increased home care spending to $30 billion, Canada would just meet the average.
To match Denmark, the best place to grow old by many measures, we would need to double the home care budget again to $60 billion.
Adjusting how long-term care is offered and allowing more choice for long-term care in the community or at home not only offers better outcomes for citizens but also reduces overall healthcare costs. Studies by the Fraser Institute and Canadian Medical Association show that more funding and support for home care could save Canada several billion dollars annually on our healthcare budget.
The Benefits of Preventative Care
Preventative care, which can be provided through more in-home care support and technology, is crucial. For instance, Ontario has one of the highest rates of lower limb amputations due to diabetes-induced peripheral vascular disease, with more than 85% preventable through regular screening, patient education, and consistent wound care management.
Moving Forward: Practical and Immediate Changes
Beyond petitioning for more budget targeted for home care, consider these practical improvements:
- 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 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 workforce to make home care a respected profession.
“You can’t manage what you can’t measure.”
A rigorous, transparent review of home care in Canada is needed to better understand the human impact and the hard numbers to make better decisions. The urgency for this has never been greater.
From the Desk, and Sincerely:
Robert Stanley, CEO of Stay at Home Nursing.
Supporting the New Health and Supportive Care Providers Oversight Authority (HSCPOA)
At Stay at Home Nursing, we are committed to ensuring the highest standards of care for our clients. We are proud to support the Health and Supportive Care Providers Oversight Authority (HSCPOA), a new initiative by the Government of Ontario designed to enhance public protection through the registration and oversight of Personal Support Workers (PSWs).
What Employers Need to Know:
Starting December 1, 2024, PSWs in Ontario will have the option to register with HSCPOA. This registration process will validate their qualifications against established education, training, and competency requirements, ensuring that those who care for Ontarians meet the highest standards of safety, quality, and ethics.
Why We Support HSCPOA:
We encourage all PSW employees to apply for registration with HSCPOA. Registration not only benefits the PSWs by recognizing their skills and dedication but also provides employers with a trusted resource to verify that the PSWs they hire are qualified and committed to delivering exceptional care.
How We Can Build Awareness Together:
· Please convey the benefits of becoming registered with HSCPOA and encourage your PSW employees to register
· Add a link to HSCPOA.com on your website
· Contact HSCPOA to include an article in your next newsletter
· Subscribe to HSCPOA News for important updates
· Share these info sheets/handouts with employees and your network:
The HSCPOA Public Register of PSWs
Employers: Why Encourage PSWs to Apply
PSWs: How Can I Apply to Register
The HSCPOA PSW Visual Mark: Trust at a Glance
HSCPOA Code of Ethics: Ensuring Safe, Quality Care
By supporting the HSCPOA initiative, we are collectively working towards a safer, more accountable healthcare environment that benefits everyone—employers, PSWs, and most importantly, the clients we serve.
Thank you for your help in support of public protection. Together, we are stronger!
