Now is the time to reform home care for seniors

You can find the full paper on this topic from the StrategyCorp Institute of Public Policy and Economy here.

For the first time in Ontario, seniors account for a larger share of population than children, and among seniors, the older age groups are expected to grow the fastest. The impending “silver wave” coupled with the devastating impacts of the COVID-19 pandemic on the elderly population have illustrated the urgent importance of reforming the seniors care segment of the health care system.

Home care is often regarded as the poor cousin of the health sector, accounting for less than $3 billion of annual health care spending, or roughly five per cent of the total health care budget in Ontario. Without a reformed approach to home care to empower seniors to age in place, the government will continue to scramble to build more long-term care (LTC) beds for an unending demand.

The Government of Ontario took a step toward changing the home-care system just before the pandemic hit in February 2020 when it announced the Connecting People to Home and Community Care Act, which became law in July. The legislation promotes integration between sectors of health care and ensures care is more responsive to patient needs by including greater usage of virtual-care solutions. The new framework allows for adaptable care co-ordination within the new Ontario Health Teams — teams that bring together providers from different sectors, including hospitals, primary care and community care — by permitting them to deliver more innovative models of home care.

As the government attempts to move past COVID-reactive policy toward the new normal, it is time to leverage the new home-care legislation and systemic changes to the health-care system to reform home care in the province.

Start acting now with pilot approach

For the foreseeable future, pandemic management and vaccine roll-out will continue to dominate the health-care agenda for all three orders of government. Under this circumstance, one may ask, is this the right time to reform home care?

We say yes: Given the importance of this system in relation to acute care and LTC, and how significant the under-investment has been over the years, now is the time. Urgent action is required to care for and support seniors more appropriately and alleviate undue pressure on the acute-care and LTC systems.

In the context of this all-consuming pandemic, a targeted approach should be adopted for reforming home care. We propose that a pilot approach be employed, focusing on high-risk communities that would immediately benefit from increased services and funding. In such a pilot, it is vital that leaders in the home-care sector, non-profit agencies and the academic community partner to formulate a long-term, sustainable plan for home-care reform.

The reform of the home-care sector should address three core areas:

• The right leader: The health sector transformation with Ontario Health and Ontario Health Teams (OHTs) is shifting the delivery of care to an integrated, patient-centric health-care system. Accordingly, it seems reasonable that leadership for home-care reform should rest with OHTs, especially given the recent legislation that permits OHTs to deliver innovative models of home care. Given that existing social service and health infrastructure varies widely from community to community, putting OHTs in leadership positions would maximize the skills and expertise available, and foster innovation in reforming the delivery of home care.
• Critical elements for immediate action: Given the size and scope of the problem, it is evident that the province must clearly state its preference for aging in place as a core policy principle and objective. Creating such a foundational principle without proper investment would be pointless. Therefore, a significant investment is needed in strategies such as: access and support for physical improvements to homes of seniors; virtual care adoption; financial assistance for family caregivers; and additional types of home care, hours of care and ease of access to care. Secondly, the personal support worker position should be established as a key professional position in the health-care sector and their remuneration should be the same whether they work in home care, acute care or in the LTC system, to ensure that each sector is equally attractive to workers and thus adequately staffed. Finally, there is a need for a laser focus of leadership from Ontario Health and OHTs to ensure that the reform of home care is not done in isolation. Program and funding incentives must be promulgated to promote integration of health and social services, in providing holistic support and care to seniors.
• Measuring success: Meaningful, sustainable reform of the whole home-care system will take time and money. Governments will immediately ask — and rightfully so — what is the most effective and cost-efficient way to achieve it? Given the existing inequity issues in the health-care system in terms of accessibility, priority should be given to high-risk communities. Taking a pilot approach allows for an immediate infusion of resources and testing of new services to support seniors, while at the same time providing vital learnings on implications for expansion to other communities, and eventually the whole home-care system. Having the OHTs lead a pilot can determine baseline information about services, such as the population of seniors, the network of social services and home-care agencies, the current types and levels of services being provided, and the gaps and unmet requests for services and support. Such a service map would inform the development of an investment and delivery strategy to improve the provision of home care in the community as well as give OHTs something to measure results against.

Now is the time for fundamental reform grounded in the principle of aging in place. Deliberate and purposeful new directions are required to integrate the three systems of service and care. Some critics may say that as the pandemic has not yet subsided, the government’s only priority at this time should be crisis management and dealing with overdue underinvestment in the LTC system. But this is the right time to pilot innovation on a community-based approach in specified high-risk areas: not just for the important learnings it would yield that could be implemented across the province, but because it would immediately benefit seniors in the pilot communities who deserve better.