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July 28, 2012

Home, community health care services should top premiers' list

Kimberlyn McGrail and Linda Silas

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Provincial premiers will be meeting as the Council of the Federation at the end of July in Halifax and health care is almost certain to be on the agenda.

The first report from the first ministers’ health care innovation working group will be presented at the meeting, and was promised to address health human resource and service delivery issues with a national lens.

The meeting will also present the opportunity to identify the next set of priorities for the working group.

The front-runner on the priority list should be home and community care. Here’s why.

Home and community care is the collection of services that people receive outside of hospitals and doctors’ offices. This includes nursing homes, as well as home health care, personal support services (like help with bathing or housekeeping), other community care services and, of course, care from family and friends.

Ideally, all care providers will work together to create a comprehensive approach to home and community care. When they do not, it is costly, both to the health of individual Canadians, and to the public health system at large.

When home and community care fails, patients end up in hospital emergency rooms, often long past the point at which preventive care measures may have provided a solution. Many then get admitted as in-patients — the most expensive form of health provision. They may then stay far too long in the hospital, awaiting a spot in a nursing home or for other appropriate community-based services to be arranged. One in every nine hospital beds is occupied by a person over age 65 who could receive appropriate care elsewhere.

When emergency rooms and hospital beds are full, patients receive care in hallways. Care and work conditions are jeopardized, which increases the likelihood of infections, medical errors and readmissions.

The interconnectedness of different parts of the health care system is not lost on Mike de Jong, British Columbia’s Minister of Health. De Jong recently told the Fraser Health Authority that they have 150 days to improve hospital care in several key areas including less hallway care; quicker movement from the emergency room to an actual bed if in-patient care is needed; and a lower average length of stay.

Fraser Health is not unique in B.C., and B.C. is not unique in the country. Health ministries across Canada are all trying to address overcrowding in acute care. In many cases, they are employing similar initiatives to improve care and reduce the need for emergency rooms, acute in-patient care and nursing homes.

But what individual provinces alone cannot address is the broader need for a comprehensive and consistent approach to home and community care for all Canadians.

All provinces provide some public funding for home and community care services. But these services are not mandated by the Canada Health Act, which means that the extent of coverage, the eligibility for care, and the extent of subsidies are determined by the provinces and territories on an individual basis.

The result: vast differences across the country for the type of care delivered, and who receives care.

For example, there are far more nursing home beds in Manitoba than elsewhere in the country. The proportion of seniors who receive publicly funded home care services ranges from six per cent in P.E.I. to 18 per cent in Ontario. Residents in nursing homes can pay twice as much for care in P.E.I. compared to Alberta, and the process of deciding how much public subsidy an individual receives is different everywhere. Even the approach to care, including in important areas such as dementia, can vary considerably.

There are compelling equity and efficiency reasons to reduce the stark differences in access to home and community care services across the country.

A first step would be to define a standard set of services to be provided; to determine how these areas of care should be funded; and to understand what models of care currently in place have been shown to provide high quality care and support independence.

The premiers have a chance in July to seize this opportunity and rise to the challenge.

Kimberlyn McGrail is an expert adviser with, assistant professor at the University of British Columbia and associate director of the UBC Centre for Health Services and Policy Research. Linda Silas is president of the Canadian Federation of Nurses Unions. (Troy Media/

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