Home care and long term care are important personal and health care services, and are used primarily by older adults. Therefore, access to such services is an important consideration for many Canadian seniors. This is particularly true for women, who are much more likely to require these services during their lives, and for those living on low incomes, who may experience barriers to access.
Both home care and long term care are considered ’extended health services’ in Canada and as such are uninsured services to which the rules of the Canada Health Act do not apply. Because of this, payment arrangements for home care vary widely, and a mix of public, for-profit and not-for-profit organizations deliver home care in Canada. In Ontario, the Ministry of Health and Long Term Care provides some funding for long term care, but the remainder is paid by the resident as a ’co-payment’.
In 1994-1995, 522,900 Canadians over age 18 received home care.
The use of home care is far more prevalent in older Canadians. Sixty-four percent of those who received home care were over 65 and 22% of Canadians over age 80 receive home care.
Since 93% of Canadians over 65 live in their own homes, home care is an important factor in helping them to stay there.
The most frequently received services are nursing and housework, followed by meal preparation, personal care and shopping.
Two thirds of home care recipients are women, reflecting the association between being female and requiring assistance with activities of daily living, living longer and having a chronic condition.
Home care recipients are also more likely to live alone.
Co-payments for personal care and homemaking services vary across the country. In some provinces such as Ontario and Manitoba, there are no co-payments, however in Alberta there is a $5 per hour charge for home support other than personal care. In New Brunswick, the family is responsible for the full cost of home care, with the government contributing based on financial need.
In Canada, there is an inverse relationship between income and the receipt of public home care services. Even when health status, smoking and the presence of numerous chronic conditions are controlled for, public home care is used 1.6 times more by lower income seniors than those with a higher income. The most likely explanation for this difference is that higher income individuals are paying for private home care services. Even those who can afford to pay for private services may find this financially straining. The following quotes are from interviews with seniors from British Columbia who were discharged from their Provincially funded home care programs.
"The effect has been a financial burden. I used to pay privately, but I couldn’t manage because it was too expensive."
"I have a little money so I’ve purchased help but I don’t know how long I’ll be able to do it as my rent just went up over $900 a month."
Public home care services are often limited in terms of the amount of service they provide. A survey of just under 300 service agencies providing home care in Canada cited funding, human resources and coordination with other parts of the health care system as top Provincial issues in home care. Perhaps because of shortcomings in these areas, 56% replied that the publicly funded home care services they provided were fair or poor. In addition to concerns about the quality of public home care, more than half of Canadians who need assistance with activities of daily living, are not receiving any home care services (over 136,000 people).
**Please note - this is not meant to be a critique of the state of home care in Canada. Rather, it is meant to highlight some of the pertinent realities in Canadian home care services and the impact these have on Canadians of limited financial means.
6. Ontario Ministry of Health and Long Term Care. Seniorsâ care: Long term care homes. Available at: http://www.health.gov.on.ca/english/public/program/ltc/15_facilities.html#3. Accessed August 2005.