What Happened to the National Home Care Program?
By Donna Vogel
In 1997, after wide consultation across the country,
the Liberal government's National Forum on Health
concluded that home care should be considered an
integral part of publicly funded health services. A
year later, the National Conference on Home Care
identified home care as a vitally important component
of a responsive and sustainable health care system.
Numerous studies have come to the same conclusion:
home care is key to the modernization of Medicare.
Nevertheless, national standards are still nowhere
to be seen in home care. The Liberal government
abandoned the dream of national home care in this
summer's negotiations with the provinces. The result?
Funding, eligibility criteria, services covered and
delivery structures vary widely depending on where you
live. Home support programs can be eliminated by a
policy shift at any level. And the growing gap between
the care people need and what they can access in the
public system is creating new opportunities for large
for-profit corporations to gain more ground in our
health care system.
Our research on home care in BC reveals some very
troubling developments. Hospitals have been downsized
without a parallel investment in home and other
community-based care. Hospital stays declined by 46
percent in BC during the 1990s. But the number of
patients receiving home support dropped by 19 percent,
and people assessed at the lowest level of need lost
78 percent of their home support hours. This at a time
when the number of elderly people in BC who were 70 years
or older--the primary users of home care--increased by
25 percent.
Cuts to home care mean less access and higher user fees
for some of the most vulnerable members of our society--
low income women, people with chronic ailments and
disabilities, and seniors living in poverty. In 1998/99,
four out of five single seniors applying for home care
subsidies had annual incomes below $20,000. Fully 94
percent of home support applicants with disabilities had
incomes under $10,000 a year.
Lack of home care creates serious problems for patients,
family members, care providers and the health system. These
include: declining patient health due to poor nutrition,
stress and isolation, and higher out-of-pocket costs;
hospitalization; higher injury rates among workers; lost
work time for relatives; the potential for falling standards
of care; loss of continuity of care; and the denial of
people's basic human right to live at home and participate in
their community.
Cuts to home care also hurt our entire public health care
system. This year, Canada ranked a distressing 30th in the
World Health Organization's survey of 191 national health
systems. The reason for our poor showing? According to WHO
director Dr. Julio Frenk, our poor showing reflects the
erosion of our universal health care system by more out-
of-pocket costs. With only 70 percent of total health
expenditures being public, Canada ranks the lowest of the
G-7 industrial nations after the United States.
Private spending on health care grew by 50 percent in the
1990s. A recent study by the Dialogue on Health Reform
found that about half the increase came from the shifting
of services covered under the Canada Health Act to sites
of care that are not subject to the funding conditions of
the Act----in other words, homes. International research
clearly shows that private, for-profit health care leads
to inefficiencies, higher costs, increased regulation and
barriers to coordination of all sectors of the health care
system. More privatization will increase the cost of health
care over the long term.
It's high time we brought our politicians up to speed with
what Canadians need, want and deserve.
Home care must be publicly funded, publicly delivered and
administered, and not-for-profit. We need a strong
legislative framework that guarantees the right to quality
care no matter where health services are delivered. That
means extending the conditions for federal funding to cover
all sites of care, beginning with home care. Dedicated
federal funding--like the money recently targeted to
primary care--and national standards for home care are
essential. Now is the time to invest in ourselves and, with
a ballooning federal budget surplus, we need to hold our
politicians to account on why they continue to drag their
heals on a national, public and non-profit home care plan.
--30--
Donna Vogel is a researcher with the Canadian Centre for
Policy
Alternatives--BC Office, and co-author of a forthcoming CCPA
study on Community and Continuing Care in BC.
www.policyalternatives.ca
---------------------------------------
Seth Klein
Director, BC Office
Canadian Centre for Policy Alternatives
[log in to unmask] CCPA-BC
tel. (604) 801-5121 1400 - 207 West
Hastings St.
fax. (604) 801-5122 Vancouver, BC V6B 1H7
ccpa webpage: http://www.policyalternatives.ca
caw 3000
The CCPA is a non-partisan, non-profit research institute
dedicated to
producing and promoting progressive economic and social policy
research
of importance to Canadians and British Columbians.
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**************************************************************
Dennis Raphael, Ph.D.
Associate Professor
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
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Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
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e-mail: [log in to unmask]
Our Web Sites have information and reports from all of our
Quality of Life Projects!
http://www.utoronto.ca/qol http://www.utoronto.ca/seniors
*************************************************************
In the early hours I read in the paper of epoch-making
projects
On the part of pope and sovereigns, bankers and oil barons.
With my other eye I watch
The pot with the water for my tea
The way it clouds and starts to bubble and clears again
And overflowing the pot quenches the fire.
-- Bertolt Brecht
**************************************************************
Dennis Raphael, Ph.D.
Associate Professor
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 308
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail: [log in to unmask]
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