Manitoba faces financial crunch as home care demands expected to soar

Manitoba needs to find an extra $572 million over the next 20 years as home care admissions are expected to soar due to aging baby boomers.

A report released Thursday by the provincial government says that investment will be necessary just to provide basic services for home care clients. To make matters worse, it is expected that less funding will be coming from the federal government.

"Provinces across Canada are struggling with the increased costs of health care associated with aging populations and chronic disease," said Health, Seniors and Active Living Minister Kelvin Goertzen.

"Manitobans deserve high-quality health care and home care services, and our government is reviewing this report and considering the recommendations. The task will be made significantly more challenging by proposed federal changes to the Canada Health Transfer, which will take $39 million from Manitoba's health care system in 2017-18."

The report, and Goertzen's comments, come as the Progressive Conservative provincial government continues to critcize the federal government over its plan to limit how quickly health transfers increase.

• Manitoba launches ad campaign critical of health plan
• Manitoba premier vows to stay course on health demands

The then-NDP government commissioned the report in response to a 2015 review of Manitoba home care services by the Office of the Auditor General.

That review recommended steps be taken to improve quality, timeliness and consistency of home care services. In all, it made 28 recommendations on how the province should deliver home care and personal care in Manitoba.

• Auditor report finds major issues with home care program
• Care homes not only answer to seniors boom: study

Home care services in Manitoba were established in 1974 with the primary goal of allowing people to remain at home for as long as possible. In 1997, the newly established regional health authorities took over responsibility for home care services.

The new report also noted that Manitoba needs to find a better way to recruit and retain home care personnel, which has become a constant challenge. At any given time there is a vacancy rate around 10 per cent, the report said.

• Hundreds of seniors wait in hospital for care home beds
• 'The system let us down': Manitoba family speaks out about horrendous home care experience
• Home care not intended to 'do everything for people': WRHA

For the past number of years, home care has annually served about 39,000 clients each year, according to Thursday's report.

"Reductions to health transfer funding by the federal government will have a significant impact on our ability to deliver health-care services for Manitobans," said Goertzen.

"We will keep advocating for the federal government to contribute its share to health care for all Canadians, and continue to make appropriate investments to improve this service relied on by so many Manitoba families."

Key findings from the review include:

• Family and informal caregivers are an essential component of home care but may be a diminishing resource in the future.
• Home care is not standardized across the province to the degree it should be.
• Home care is under continuing pressure to facilitate the discharge of patients from the hospital. This has the effect of pushing home care in the direction of a health/medical service model.
• Self and Family Managed Care (SFMC) program is growing and seniors, in addition to younger adults with physical disabilities, are making increased use of it.
• The complexity and acuity of client need is continuing to increase.
• Nurses are delegating more tasks to home care attendants (HCAs).
• The lack of continuity in the assignment of HCAs and insufficient time allocated to complete the assigned task remains an issue.
• The Continuing Care Branch (CCB) is unable to fulfil its assigned role due to insufficient resources.
• Recruitment and retention of home care personnel is a constant challenge — at any one time there is a vacancy rate of 8 to 10 per cent.

Recommendations from the review include:

• Endorse the foundational components of the future home care services as outlined in the report: purpose, objectives and service delivery structure, basket of core services and ongoing role of family and informal caregivers.
• Develop a single standardized list of core services.
• Develop a caregiver care plan separate from the client care plan at the time of the needs assessments.
• Outline a partnership relationship between the client/caregiver and home care, and put less emphasis on the word "supplemental" which has become too limiting a term.
• As the needs of clients increase ensure training and education opportunities are available to the caregiver with funding attached to allow for implementation.
• Ensure home care and acute care work together to develop deliberate and effective discharge plans and sufficient personnel are in place so that home care does not increasingly become a health care/medical program only.
• Set a timeline to complete the amalgamation of home care services in each of the rural/northern RHAs.
• Provide the CCB with the appropriate resources for it to fulfill its defined leadership role.
• Develop a comprehensive central policy manual that reinforces consistent province-wide home care services.
• Post provincial performance/clinical data online once available.
• Develop a detailed financial projection for the next 3-5 years.
• Efforts should continue undiminished to ensure that all HCAs in home care are certified.
• Develop a system-wide human resource strategy for home care that would include, but not be limited to, strategies that are designed to attract and retain millennials and immigrant workers in the workforce.
• Develop a standard provincial curriculum to be followed by all provincial institutions — public and private — when educating HCAs.
• RHAs provide mandatory education/training for all direct service workers (DSWs) on dementia, managing challenging behaviour, mental health and other emerging health issues.

The review process involved broad consultation with the different levels of home care personnel, clients, family and informal caregivers and stakeholders, including an online opportunity for public input, demographic/clinical data analysis, and a review of the professional literature and internal documents.