The Rising Cost of Home Care: Will We Be Able To Afford It?
A report by the consulting firm Deloitte estimated home-care costs could rise by a whopping $73.4 million by 2021.
This would mean $272.6 million a year will be spent on home care by then. The review commissioned by the Department of Health and Community Services and released last summer said the province spent $175 million on providing home care to over 7,100 clients in fiscal 2014-15. Government-subsidized home care is mainly provided to some seniors, certain adults with disabilities and children with disabilities receiving the special child-welfare allowance.
The report looks at three models, all of which project a spike in home-support costs by 2021. The low-data model sees costs increasing to $222.1 million a year; the medium-data model has home support increasing by $53.4 million or $252.6 million a year, while the high-data model projects costs will rise to $73.4 million at a cost of $272.6 million yearly.
With the fastest aging population in Canada, it is not surprising that seniors account for the greatest numbers and therefore cost the most. The number of seniors receiving government-funded home support was 3,752 in October 2015. This is projected to increase to 4,660 under the low model, rise to 5,124 under the medium and increase to 5,657 under the high.
The report warns “…In order to keep costs stable in this Program, significant policy changes and/or operational improvements will be required.” Given the cuts to home support in last year’s budget where home-making services were capped at two hours a day and the maximum client contribution rose from 15 per cent to 18 per cent of net income before a person was eligible for a subsidy, it is unlikely government will want to throw money at this, in fact throwing money may be the least likely option. Steve Kent, Opposition health and community services critic, said in a March 10 interview that “reliable sources” within the health and finance departments told him over $100 million will be “slashed” from the province’s health budget this year. The statement was dismissed as “inaccurate” by a spokesperson for health and community services. There was no response from finance.
The Deloitte review listed a number of measures that would allow clients and would-be clients of the province’s home-support program to remain in their homes and communities at a cost that could be better accommodated by government. These include enhancing the clinical assessment process which would keep people out of institutions and decrease stays in acute care as well as delay and decrease admissions to long-term care facilities, streamline financial assessments or simplify the application process for faster approval and allow clients more say in the manner in which hours and subsidies are used. The report also states that access to the program may not be uniform within the province.
Both Kent and NDP Health and Community Services Critic Lorraine Michael condemned the cuts made by the Liberals to home care. Kent wants to see a reversal of the two-hour-a-day cap on home-making services as well as an introduction of the measures outlined by Deloitte. “Decisions can’t simply be based on dollars when it comes to people’s well-being,” he said. “After the cuts that were made in the past year, our constituency offices received lots of calls from people who no longer felt comfortable, even safe in their own homes.” Michael advocates for a system that’s “universal and needs-based. Too many people have found themselves cut off from, or denied, the help they need because of being a few dollars over the income limits set by health authorities,” she said. Like Kent, she says it is cheaper to provide adequate care at home than have people end up in hospitals or doctors’ offices for what Michael termed “minor medical procedures like dressing changes and foot care.” She also described the province’s long-term care facilities as “overcrowded.”
The province’s home-support program was given a high grade in a Deloitte telephone survey of 131 clients although “adults with disabilities” were less likely to be satisfied than others, the report said. Health Minister John Hag- gie confirmed “…there are opportunities for improvement.”
The home-support budget this year is around $200 million, according to Steve Kent. In a side deal negotiated with the federal government last December we were allocated $87.7 million to be spent on home care over 10 years. The money will become available April 1. When the deal was negotiated, Premier Ball said “…if any other province or territory reaches an agreement with the Federal Government that includes better financial terms, our province will have those terms applied to us as well.” By March 10 the territories and all but one province had signed off on it. And there were more generous allocations than ours. So does that mean we can go back and get more? Mr. Ball certainly leads you to think that.
It was a bad deal Dwight Ball cut. While it may make it easier to plead for a bailout on Muskrat Falls, our most vulnerable could end up short-changed, yet again. If that is so, then shameful is merely a euphemism.
When Steve Kent said over $100 million will be cut from this year’s health budget, he asked, “so what impact will that have on home care?” Brutal, I suspect, and now I’m being euphemistic.
With the fastest aging population in Canada, it is not surprising that seniors account for the greatest numbers and therefore cost the most.