Restructure home support, Seniors Advocate tells her bosses
VICTORIA – BC Seniors Advocate Isobel Mackenzie is urging the provincial government to undertake a fundamental restructuring of home support services after a second review finds the program is not keeping pace with the needs of a growing seniors’ population and the service remains unaffordable to a large number of seniors.
“When we examine the five-year trends, we find client complexity and frailty is rising, care hours are not growing to meet this need, and more of the care is being shifted to family caregivers who continue to experience high levels of distress,” noted Mackenzie.
Overall, the report noted funding has increased 42 per cent over the past five years and the number of community health workers who provide home support services has increased 25 per cent, but the hours of home support delivered have only increased 5 per cent.
The report also examined the number of seniors who receive home support relative to the growth in the population and found the number of home support clients per 1,000 of population of seniors 75+ decreased by 10 per cent, and seniors 85+ decreased 5 per cent over the last five years.
The report also examined the affordability of the program for the average senior and found most provinces do not charge for home support services. Of the provinces that do charge, BC is the most expensive.
“If you are a senior in BC with an income of $29,000 a year, we will charge you $9,000 a year for a one- hour daily visit of home support and this is simply not affordable on top of other costs such as food, shelter, medications and health care supplies,” stated Mackenzie, who has raised the issue of home support affordability in past reports. “The cost barrier to home support is one reason why 61 per cent of seniors admitted to long-term care are not receiving any home support 90 days prior to admission and why BC’s rate of newly-admitted long-term care residents with low care needs is twice as high as Alberta and Ontario who do not charge for home support. We must recognize the cost barrier to home support is causing pressures in other parts of the system as we see increased wait times for long-term care and crowding in emergency rooms.”
The review includes survey responses from over 6,000 seniors who receive home support and found people who receive service have high regard for the staff who provide their care and do not feel they are subject to discrimination. However, 30 per cent fewer home support clients are prepared to rate their home support as excellent compared to five years ago. Almost one third of home support clients need additional services such as housekeeping, meal preparation and laundry, which are no longer provided as routine home support services, than five years ago.
Key findings from the review include:
- The Province spent $693 million on home support in 2021/22, a 42 per cent increase over the last five years.
- 40,000 BC seniors received almost 9 million hours of home support in 2021/22 which is a 6 per cent increase in clients and a 5 per cent increase in hours over the past five years.
- 55 per cent of home support clients are at high or very high risk of admission to long-term care, up slightly from five years ago with a 7 per cent increase in clients with moderate to severe cognitive impairment.
- 59 per cent of clients receive less than an hour per day of home support, up slightly from five years ago.
- Hours of care provided by family caregivers increased 11 per cent over the last five years and family members are providing five hours of care for every one hour of home support.
- Overall, 34 per cent of family caregivers in BC are in distress and this rises to 57 per cent when looking at clients who are receiving less than an hour per day of home support.
- Fewer than 2 out of 10 caregivers of home support clients were provided in-home respite in each of the past three years.
- The majority of provinces do not charge for home support services. BC does charge and is the most expensive.
- A senior with an annual income of $29,000 in BC must pay $9,000 a year for a one-hour daily visit of home support.
- 61 per cent of seniors moving into a long-term care facility had no home support 90 days prior to admission, similar to five years ago.
- BC’s rate of newly admitted long-term care residents with low care needs is twice as high as Alberta and Ontario who do not charge for home support and is 34 per cent higher than the national average.
- It would cost government $14,000 per year to provide one hour of home support per day and $60,000 per year for a long-term care bed for a senior with a $29,000 annual income.
There are five recommendations for the provincial government:
- Eliminate the financial barrier for accessing home support.
2. Increase respite care.
3. Standardize and set targets for all aspects of service-delivery.
- Modernize care plans.
5. Measure, monitor and report on performance.
The complete report can be found at: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2023/02/OSA-HOME-SUPPORT-REPORT-2023-