Shifting Towards Autonomy: A Continuing Care Model for Canada

For many seniors, their greatest health concern is the ongoing care that many of them will need as their ability to cope with the routine tasks of daily life declines. Due to various chronic health problems or just old age, supportive services for seniors – often referred to as continuing care – encompass a wide range of needs, from help with daily meals in patients’ homes to institutional care for those with major cognitive or physical disabilities. On this score, many Canadians have expressed concerns about affordability and access to care in their desired location. The state of continuing care in Canada is troublesome on a number of fronts, including the rising stress on caregivers, long waits for nursing home beds, and unmet homecare needs. More than one in four Canadians provide care to family or friends, and among this group one in 10 provides more than 30 hours weekly, often with significant disruption to their paid work. It has been estimated that more than 15 percent of all acute-care hospital beds in Canada are filled every day with patients waiting for care in a location outside a hospital, costing provincial governments slightly under $3 billion per year. And although there has been an increase in subsidized care in people’s homes in recent years, the provinces appear to be well behind the international trend in this regard and will struggle to keep pace with rising demand. Canada’s provinces can learn important lessons from the debates and reforms in other developed countries. A number of them have faced the same challenges but have been much more proactive in establishing a framework for supporting greater independence among the elderly. In doing so, they have recognized that shifting more services to the home and community is a key goal. The experience abroad shows several countries, such as France, Germany and recently Australia, have implemented self-directed models of care delivery, boosting patient satisfaction by giving individuals and families a greater say in their care packages. Two of the biggest challenges for governments contemplating more cash-based, self-directed benefits for continuing-care services are impact on government budgets and quality assurance. All countries we studied have, however, managed to overcome these challenges, at least to some degree, through restrictions on the size of the subsidy to those with substantial means or available family help and by establishing oversight in the use of the cash subsidies. In the study, we sketch a provincial continuing care model that would draw on these countries’ experience. Establishing a new comprehensive self-directed model along the lines we propose will require: • an assessment system; • means testing; • a funding mechanism that is based on need but controls government costs; • an oversight system to ensure quality and enforce restrictions on use; and, • establishing who will oversee, coordinate and be accountable for care. The time to adopt new systems of supportive services for the elderly is now – before many more retiring babyboomers start drawing heavily on them.