Home Care in Canada:  Part 2

Home Care in Canada’s two most western provinces looks quite similar: It’s quality of life focused and it’s bursting at the seams. An aging population, aging work force, fewer therapists in the hospital, and early discharge, coupled with the close of hospitals has created a redistribution of care.

In Alberta the caseload has doubled from 4000 to 8000 in ten years while comparable increases in hospital beds have not occurred. In British Columbia more elderly people are arriving attracted by the moderate climate, but the young people – a source of informal care – are leaving in search of career related opportunities. Also impacting Home Care is the decrease in residential beds and the challenges of recruiting and retaining staff.

In the Home Care system, nurses provide assessment, case management, coordination of services, teaching, treatments, counseling, monitoring and referrals. Physiotherapists and occupational therapists provide a continuum of services to promote and maintain optimal functional independence. Services are provided in the client’s home or place of residence and nursing clinics. Anyone may refer to the various programs under the Home Care umbrella that includes home nursing care, long-term care, community rehabilitation, nutrition, and hospital liaison. The exception is the quick response program that was established to prevent hospital admission, provide crisis intervention in the home, and facilitate early hospital discharge. Referrals to this program are from health care professionals only. Despite the desire to deliver a seamless service to all those needing it, Home Care in both provinces suffers from regionalization issues related to Health Authority budgets and designation of funds.

New ways of delivering services are being examined. Mobilizing people to a clinic setting allows more clients to be seen in a timely manner and permits consistency of staff and health care delivery. Creative staffing models are needed to deal with quality of working life issues and isolation. Family physicians are linking with other physicians to form part of interdisciplinary care teams. In BC the chronic disease management iniative is alive and well. It is demonstrating a shift in how health care is seen and how professionals can work together. It remains to be seen how the role of consumer advocates will be factored into the new model of Home Care delivery.