'Throwing money' at home care doesn't solve crisis, says geriatrician

Home Care Ontario has asked the province for $600 million in additional funding to fix demand issues, but a University of Waterloo professor said throwing money at the issue may not be the best solution.

"I think arguably more money is needed but I would argue first and foremost we need to integrate the clinical stake holders," said George Heckman, a Waterloo professor and a physician specializing in aging and cardiovascular disease. 

Heckman is referring to Ontario's siloed health care system, which separates services such as family medicine, home care and emergency response into different sectors. 

"We can throw money at a problem … but throwing money at a sector which is disjointed and not fully integrated with other sectors may not achieve what we want."

• Home Care Ontario asking provincial government for additional $600M in funding

• 'Crisis in care': Ontario looks to tackle hospital bed crunch

Heckman said the various health care providers, like home-care givers, family doctors and physiotherapists "need to share data, share information, communicate and try to make those dollars go further."

Recommendations to improve home-care

On Wednesday, Home Care Ontario, an organization representing home-care service providers, released a report with 14 recommendations about how the province can improve home-care.

"We are seeing more and more demands for home care because we are seeing more and more people getting older and living with chronic illnesses," said Sue VanderBent, CEO of Home Care Ontario.

"We are seeing overcrowding in hospitals," said VanderBent. "Home care isn't helping as we should (and) we aren't getting the right funding."

Home Care receives five per cent of the provincial budget. They are asking for a one per cent increase, which would raise their funding to $600 million.

John Hirdes also works at the University of Waterloo, and he agrees that sharing information is critically important.

He said if "clinical information is not shared with (other health care providers), that's an underuse of an important resource."

Ontario spends most on home-care

Hirdes also said an increase in funding may not be the best answer, considering Ontario spends more than any other province on home-care.

The national average expenditure for home-care is just over two per cent of the budget, whereas Ontario is spending five per cent.

He noted that in the report one of the recommendations was to increase wages for home-care providers, but he questioned if the wage hike is the reasoning behind the requested bump in funding.

"A recommendation in the report is to increase wage, but to do that they either need more money or to cut services … I think there are other choices that can be made with that money and thinking about increasing wages is only one way to address the issues."

VanderBent said the lack of funding has caused some home-care providers to compensate by reducing home visits from hours to mere minutes, down to 15 minutes at the most extreme.

Need more time

Heckman, whose family was looked after by home-care, said there are pros and cons to the services.

"When time is given, you get a very thorough treatment and get a lot of needs met, but the nature of the beast in 2018 when you're frail and older is that you need more time spent with you," he said.

"Reducing visits to 15 minutes is likely to cause problems because you're not just not getting services you need, but it may be so brief that the care provider misses the fact that a person is developing a medical issue."

Heckman said the best solution is to look at the data everyone in the health care industry has and identify the greatest needs and find the needs that aren't being met.

"I think we need to think about whom we are servicing, what needs aren't we meeting and could we mobilize existing resources to meet the needs? If not then we have a good argument for more money."

Integrating health care

Heckman maintains that should there be an increase in funds, it should be used to integrate the health care system.

"Imagine your mother fell, broke her hip and is back home, she is going to need support for taking a bath and getting dressed," said Heckman, illustrating how an integrated system would work.

"What if we used the home-care to share information about the terrible pain she still has – that the physician may not know about because she doesn't go to the doctor," he explained.  

"We could then treat the pain, we can get her physiotherapy, so she came become more independent and therefore her outcomes are better and her needs are reduced and she may not need support like home-care."