Directions for Change
• Use the proposed new Home Care Transfer to establish a national platform for home care services.
• Revise the Canada Health Act to include coverage for home care services in priority areas.
• Improve the quality of care and support available to people with mental illnesses by including home mental health case management and intervention services as part of the Canada Health Act.
• Expand the Canada Health Act to include coverage for post-acute home care including medication management and rehabilitation services.
• Provide Canada Health Act coverage for palliative home care services to support people in their last six months of life.
• Introduce a new program to provide ongoing support for informal caregivers.
(Chapter 8, pg 171)
Because home care has become a partial substitute for care that was previously provided primarily in hospitals or by physicians, and because of the value of effective home care services both to individuals and the health care system, a strong case can be made for taking the first step in 35 years to expand coverage under the Canada Health Act. As outlined in Chapter 2, the Commission recommends that the definition of what is covered under the Canada Health Act should immediately be expanded to include medically necessary home care as well as diagnostic services (discussed in greater detail in Chapter 6).
This important step reflects the views expressed by many Canadians as part of the Commission’s consultations. The Commission repeatedly heard that our definition of “medically necessary” should not be confined to hospital and physician services. The definition should be based on need, not where the service is provided or who provides the service. Because of the significant costs that would be involved in including all home care services under the Canada Health Act, priorities should be placed on the most pressing needs. There is little doubt that effective home care support is vitally important to people with mental illnesses, to people who have just been released from hospital, and to those who are in their last months of life. These three areas – mental health, post-acute care, and palliative care – should be the first three home care services to be included under a revised Canada Health Act.
(Chapter 8, pg 172)
Eligibility for Home Care Services
There also are differences in eligibility requirements. As a result, people living in one province may be eligible for certain services while people in other provinces with similar circumstances are not. With the exception of British Columbia, where eligibility can require 12 months of residency, general eligibility requirements for home care across the country include:
• three months residency
• a health insurance card
• a health or medical need for care
• a suitable home for care (safe, with adequate family, social, or community support)
• a physician referral (in some provinces and territories).
Within these general eligibility requirements, some provinces and territories provide complete coverage for certain services while others provide more limited home care services according to acuity of illness, financial means, dollar limits or other criteria.