(Chapter 8, pg 174)
Looking ahead, there is every reason to assume that the demand for home care services will increase. That demand will be driven by a number of factors including:
• New advances in treatments, medications and technology that make it increasingly possible for people to be treated at home rather than in hospital or in other institutions;
• New primary health care models that enable teams and networks of health care providers to manage and monitor people’s health at home and in their communities;
• A growing elderly population that wants access to home care;
• Increasing pressures on informal caregivers;
• Continuing trends for early discharge from hospital;
• The overall cost-effectiveness of home care;
• Improvement in the quality of life resulting from home care;
• Accelerated healing times; and
• Ethical considerations around providing specific care in certain settings.
Given these trends, it is important to address current disparities in home care services across the country. The extent of regional variations in home care has some Canadians wondering if they should move to areas with better programs in their later years of life so they will have access to the services they need. When differences in health care coverage and services across the country have this effect on Canadians, it suggests something must be done. Disparities across the country also mean that many people have significant home care needs that currently go unmet. Finally, provincial and territorial spending on home care will continue to grow as this becomes an increasingly important component of the continuum of care provided for Canadians. For these reasons, the first critical steps should be taken to integrate home care into the publicly funded health care system and include priority home care services under a revised Canada Health Act.
(Chapter 8, pg 175/6)
The estimated costs (excluding prescription drugs) would be as follows:
Home mental health case management and intervention $568.1 million Post-acute medical care $117.7 million Post-acute rehabilitation $204.6 million Palliative home care $ 89.3 million Total $979.7 million
(Chapter 8, pg 177)
As the average age of Canada’s population increases, the number of people with dementia and Alzheimer’s disease is expected to increase. Currently, people with these illnesses remain in their own homes as long as possible, but the burden of care on their family is enormous. With case management support, family members and the individuals involved would have the support they need in terms of assessing changing needs, providing the necessary care, and planning for a time when these individuals may no longer be able to remain in their own homes.
(Chapter 8, pg 179)
Problems with lack of access to palliative home care are likely to increase in future as Canada’s population ages. A 1997 Angus Reid poll found that approximately 80% of Canadians prefer to die at home (CACC 2001). The percentage of hospital deaths peaked in 1994 at 80.5% and, by 1997, it had dropped to 75.3% in a steady trend-line (Wilson et al. 2001). Notwithstanding this trend, the Canadian Association for Community Care reports that home-based palliative care is “often not possible because of the lack of home-based palliative care services” and that “only about 10% of Canadians have access to palliative care services.”