Susan Hagar hears daily from seniors who need help living at home. When she asks if they have home care, most say no.
“Living at home and living independently is the goal for people,” said Hagar, who has more than 40 years of nursing experience. “However, our system isn’t set up to support people as much as they need.”
Hagar is the founder of Nurse on Board, a company that helps seniors and their families navigate the health-care system. She regularly sees people’s physical and mental health improve when they receive home care, which is care typically provided by nurses or personal support workers, rather than relatives or friends.
But the obstacles to getting home care are numerous. “[The system is] in such bad shape,” Hagar said.
A recent Statistics Canada report paints a picture. It says that, in 2019-2020, 46,000 seniors over the age of 85 did not receive home care services when they needed them at least once in the prior year.
Hagar and others say this number is likely an understatement. But increasing access to home care will require many changes.
“It’s not going to be fixed with one thing,” said Danielle Turpin, founder of the Home Care Workers Co-operative, an Ontario home care provider.
Aging at home
The Statistics Canada study looked at seniors aged 85 and older living in their communities, rather than in long-term care homes or retirement homes.
“A better understanding of the Canadians aged 85 years and older could help target programs aimed at assisting people to age in their homes and remain living outside of an institutional setting,” said study co-author Md Kamrul Islam.
Surveys from the National Institute on Ageing have shown most seniors want to age at home. Research also indicates home care is more cost effective than long-term care or hospitals.
Yet, aging is often seen as a medical problem, says Turpin.
“We tend to medicalize aging, as opposed to just understanding that it’s just a part of life,” she said. Just because a senior wants help with tasks like having a shower does not mean they are unhealthy, she says.
But a lack of home care can make it difficult for seniors to stay healthy and remain in their homes.
Missing out
Provincial governments fund some home care for eligible individuals. But these programs do not always provide sufficient or reliable care.
At the same time, many people cannot afford private home care, which is costly.
In Ontario, a personal support worker costs between $20 to $35 an hour, while a home nurse costs between $45 and $80. This puts the cost of around-the-clock home care at between $10,000 and $20,000 a month.
Private insurance plans can cover some costs for home nursing, says Hagar. In her experience, many patients and government coordinators are unaware of this coverage. Hagar and her staff often help clients fill out doctors’ forms for insurance companies and teach clients what to ask insurance companies.
“I certainly would like the topic of third-party insurance to be one that happens with every patient in the community, to be sure that nobody is missing out,” she said.
‘Valued’
To boost home care access, the sector needs to address staffing challenges, sources say.
Nurses and personal support workers often leave the sector because of low wages. The federal government is negotiating funding agreements with the provinces to raise personal support workers’ wages.
Turpin says pay must be only one part of a broader retention strategy.
“We’ve got to start with making sure that community support workers are valued [and] they’re paid well,” she said.
Family caregivers need to be better valued too, she says. Often, people take leaves from work — or quit altogether — to care for relatives.
Some provinces have small programs to pay family caregivers. “We need to open up the options for [more paid family caregivers],” she said.
Addressing loneliness
Loneliness among seniors must also be addressed, sources say, noting that loneliness often contributes to people requiring home care.
“Loneliness, helplessness and boredom are the three top unmet needs for seniors,” said Hagar.
Without opportunities to engage with others, seniors’ health can decline significantly.
“Loneliness can lead to poor health through a lot of different biological pathways,” said Rachel Savage, a scientist at Women’s College Hospital in Toronto.
According to her research, lonely senior women are more likely to require home care for six months or more, or to be admitted to long-term care.
“It’s very possible that the loneliness [a senior’s] been experiencing — especially if they’ve been experiencing it chronically, over a long, prolonged period of time — could be worsening their health and then leading to them needing home care services,” she said.
Nancy Dahdah sees this regularly. Dahdah is the president and founder of Ideal Caregivers 4U, a caregiving company of personal support workers and companions for seniors.
Companions are trained to develop relationships with seniors and include them in daily activities. For example, a companion would ask the senior to help them make lunch together, instead of just making it for them, Dahdah says.
Social isolation worsens health, she says.
“People just revert when they’re isolated and they’ve got no one to talk to,” she said. “They just decline in their health, and it’s rapid.”
According to Savage’s research, home care workers may want to provide more social support for seniors, but are not able to because it falls outside their job description.
Savage says there should be more ways for home care workers to connect seniors to community programs.
“Programs that can build bridges between … health-care organizations [and] social care organizations can be really powerful in addressing complicated issues like loneliness,” she said.
Turpin advocates for more PACE programs, which cluster medical care and social support in one location. This allows seniors to live at home, but with support nearby.
“It’s not really up to one sector alone to solve,” Savage said.
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