The Ris­ing Cost of Home Care: Will We Be Able To Af­ford It?

The Compass - - Ed­i­to­rial - Pat Cullen So­cial Af­fairs Pat Cullen is a jour­nal­ist who lives in Car­bon­ear. She can be reached at 596-1505 or

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.

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