A University of Western Ontario nursing professor has dared to offer her assessment of home care service in Canada.
“Manitoba offers the best home care services, in my opinion,” Dorothy Forbes told a rural nursing conference in Saskatoon Oct. 21.
“Ontario has the worst system.”
Forbes said the problem with Ontario’s service is that a centralized body assesses the needs of all potential clients and then contracts out the required services to competing, for-profit agencies.
Besides the lack of continuity of care and the uncertainty of work for home-care nurses and aides, she said the Ontario system is also limited. It focuses on clients recently out of the hospital and has “little capacity to serve those with chronic, long-term conditions.”
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In contrast, Manitoba home care works to keep people out of hospital, independent and living in their own homes as long as possible.
A member of the audience criticized Alberta’s service, saying most of the work is done by unregulated aides, the clients receive a maximum of two hours a week of care and some rural regions do not offer home care.
Forbes said the Alberta situation is not unusual. Statistics Canada data shows that rural home-care services were more likely to be housekeeping rather than health care.
She said concerns over surgery waiting lists have led governments to put more money into hospitals instead of chronic care for people with disabling conditions.
“What new money that is coming into home care is for technology”, she said.
For example, telehealth systems link a nurse in a remote location with a doctor in a hospital or clinic.
Forbes said the problem will worsen because by 2021, one in four seniors will live in a rural setting, which is higher than expected seniors numbers in urban areas. Meanwhile, fewer health staff will be available to care for the growing number of seniors. She said that in rural areas the nurse to home care client ratio was 1:37 in 2001 but is expected to increase to 1:100 by 2046. For home care aides, their 1:17 ratio in 2001 will fall to 1:45 by 2046.
Forbes said the answer is to set up a national home-care system with the same standards applied across the country. She said the system needs to be an integrated model serving clients as they move between home care, nursing homes and hospitals. Paid staff must also work with informal caregivers who are often friends or family of the ill person.
Because most rural nurses originally came from a rural area, Forbes said the answer to the home care staff shortage is to recruit rural people.
Keeping staff will require improved working conditions and communities that make new people feel welcome, she added.
