Home Care

Home care services offer a targeted, strategic response to complex needs of seniors who want to remain otherwise self-reliant and independent, most often in the house and neighbourhood they are familiar with. Services help seniors with a variety of activities of daily living, allowing them to age at home, or in some cases in a retirement residence. Aging in your own home is the first choice of many seniors, and there are a number of ways seniors can avail themselves of home care providers, either through the government or through private service providers.

Home care is expected to be a growing industry as the baby boom generation continues to age. In 2015, there were 5.4 million Canadians 65 and older, with an additional 6.5 million between the ages of 50-65. By the year 2025, over 20% of the Canadian population will be 65 and older, according to estimates¹. This generation will want to age in place and will require home care services. With advances in technology and changes in culture will come many changes and improvements in home health care products, services and societal infrastructure that facilitates aging in place.

People generally seek out home health care on the advice of others, often a social worker or a family member. When you hire a home care worker you have the assurance of having someone come into your home on a regular basis to take care of whatever you require. Finding the right home care for yourself or your family member can be a painstaking process, though. When you find good care, however, it offers tremendous relief and peace-of mind to families and seniors.

Family members may have taken on caregiving, but for many there comes a time when the workload becomes too great. When the time comes to turn to professional home care, this can mitigate a variety of potential problems and (unfortunately) even threats. Turning to professional care services allows family members to restore or free up time to spend in a proper family relationship with elderly loved ones.

Before you inquire about a service or a provider there are a number of things to bear in mind.

When the time is right:

Family and seniors should consider hiring home care under any of the following circumstances:

• Having difficulty coping with the tasks of daily living, detailed further below.
• Feeling isolated at home.
• Personal care needs taking up too much time
• Becoming reclusive because it is such a struggle to get out of the house
• Shopping, banking and other errands becoming challenging or insurmountable
• Housekeeping and home maintenance deteriorating
• Family and other caregivers feeling overburdened
• Ending up in a hospital emergency room over chronic health issues that are not being addressed daily

Home care services include government supported health care services and other community-funded home care services. These can also be augmented with professional, privately funded home care support and services.

Privately run programs are more likely to be professionally staffed, to adhere to the highest standards and offer features and care excellence that may not be available in government-run services. The old adage, that you get what you pay for, likely applies when it comes to finding proper home care for the elderly.

Home care service rates vary, depending on the type of care provided, as well as a variety of other factors.

In the past, Comfort Life has done an in-depth comparison, focusing on the costs of aging at home vs. moving into retirement care. While home care helps people retain independence and is certainly useful as a focused solution for some care needs, there can come a time for many families when it is financially wiser to move into a retirement home. Monthly costs for long-term care homes can start around $1550 per month in Ontario and Alberta, certainly less expensive than hiring 24 hour live-in care. Homes also offer short stays where residents can get some nursing care, and get a taste of what retirement homes are like today; many are pleasantly surprised at how enjoyable living there can be.

Home care costs for dementia
The cost of home care for dementia patients is higher than it will be for others, as in-home dementia care is more demanding, and home care workers have more specialized training. The following table surveys the cost of dementia care at home, with samples from Canadian provinces.

Government-supported home care is available in all jurisdictions across Canada, with some limitations. Home visits by nurses, physiotherapists, occupational therapists and social workers are typically available to cover an acute short-term need. This care may be available on a less frequent basis for those with longer-term chronic health conditions. It is assumed that family will still provide care and the publicly funded system supports this care. Anyone can request an assessment for eligibility from the government. When a senior requires more daily care and household operations a live-in caregiver can be hired through Human Resources and Skills Development Canada (HRSDC)'s Live-in Caregiver Program. Bear in mind, that regulation of home care workers is scattered (read more).

Be sure that you are taking advantage of all the free and subsidized home health care services available through your provincial government, other government services and local charities. There are many other services that are not free or may require your name on a waiting list, or other considerations. Some tasks you may be able to find help with include lawn and snow care, meal preparation or home cleaning. There are a variety of home care services provided by local communities and funded by a number of government levels and non-profits like the United Way.

Government-funded home care assistance offered in some jurisdictions may include the following:

• Household maintenance like laundry, shopping, gardening, housekeeping, and handyman services.
• Transportation to and from appointments and programs
• Subsidies for home modifications like grab bars in the shower, ramps to avoid or minimize the use of stairs, or even installing new bathrooms on the ground floor
  
• Personal care like dressing, bathing, feeding, or meal preparation.
  
• Day programs that address isolation and need for socialization during the day, while providing a break for caregivers. These are closely related to the home care services industry in many provinces. Some day programs are primarily social, while others provide limited health services or specialize in disorders such as early stage Alzheimer’s. Read more below about day programs for adults.

You can learn more about these home care solutions and find government contacts in our senior care advisor, under Support Services.

Many of these community services rely on charitable donations in order to keep going and government funding of programs is always subject to change, as well.

As is widely reported, demand for home care frequently outpaces government resources available, and organisations like the Local Health Integration Network are forced to restrict the hours of care provided per week or to place patients on waiting lists for care services.

Privately funded home health care providers are a perfect way to augment community-funded services. These companies come into the home and provide elderly community members with tactical help in areas that may not be covered by other services listed above. These companies offer outside help solutions for seniors that are accountable and professionally handled and are customized directly the individual senior’s needs. Services include regular companionship and visits that may include help with shopping and errands and even Alzheimer's Care, as well as dependable, reliable care in areas such as housekeeping, meal preparation and transportation.

These companies can also be used by people living in a retirement home who want to extend services they receive. Consult with the companies listed here to learn more about what they offer.

An Overview
Government-funded home care services are staffed with caring, professionally trained people. The volunteer-based Ontario Community Support Association provides essential-care services to 750,000 Ontarians yearly, and their community support services benefit those with chronic-care needs at half the cost of care in other facilities (the estimated value of this volunteer labour to the Canadian economy as early as 2003 was in the range of $20 to $30 billion). However, many people in both the private and public health care sectors admit that inconsistent funding undermines care provided. Government-funded services may also be subject to income testing and/or a co-pay depending on the jurisdiction, and there may be a variety of reasons for limits as to the amount of service that can be provided. Home care service providers are often contracted privately to deliver the additional hours that support and complement the publicly funded care. Even when there is strong family support close by, it can be extremely helpful to have a home care provider assisting with the caregiving responsibilities.

Private service providers offer a fuller suite of services, more accountability and a stronger guarantee of dedication when it comes to any form of senior care. For example, when it comes to long-term care homes, there are often waiting lists to get into the best care homes, and wait times to find the proper care can be one, two years, and even longer. Hiring a reputable, professional in-home care is one way of guaranteeing proper care for loved ones. As reported in Comfort Life as early as 2003, the 80-plus demographic is "the fastest-growing segment of the country's population" and is now well over 1 million people. As we reported then, government home-care spending has not kept up with the increase in population, holding steady at only four per cent of Ontario's health-care budget. In addition, only about 15 to 20 per cent of Ontario's health care funding goes to chronic geriatric home care. All of this means that the private home health care sector may be a safer bet, whose benefits you may need to consider.

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Caution against hiring private individuals
A survey of Canadian families in 2010 showed that more than half of respondents (65%) were unaware of the risks inherent in directly hiring a non-professional, non-certified, non-accredited individual to provide private home care. Some families hire personal care for an elderly family member, based on a personal job interview and a few references. Senior home care is difficult, challenging work and under many circumstances should never be undertaken by any untrained, unqualified people (this also includes family members, as well).

Accredited home care organizations that belong to an association such as the OHCA have a number of measures in place to ensure quality and professionalism.

These include:

• Selective recruitment. Some organizations claim a hiring rate as low as 8%: 1 in 15 PSWs who apply end up getting hired. This comes from an understanding that this is often stressful, demanding work and is not suited to everyone.
• Supervision and accountability. Organizations with a chain of command encourage responsibility and internal discipline that helps ensure the quality of care given. In addition, there are occupational hazards that include the potential for injury (for example, due to lifting and other caregiving tasks). The Liability Coverage offered by professional organisations ensures that your caregiver will be safeguarded, and should something happen, other workers will be ready to step in and continue caring for your loved one.
• Ongoing education. Many care workers are required to upgrade skills and training on at least a yearly basis.
• Labour practice accountability. When workers are compensated fairly, they feel greater accountability to do an excellent job of caring.
• Care coordination. Professional home care services are better situated to respond to changing needs with flexibility and timeliness. For example, if a senior has bouts of incontinence, these are handled in the most professional and proper manner conceivable.

Even when hiring a professional caregiver, there are questions that will help you find the right care for your family and loved one.

Sue VanderBent, Executive Director of the Ontario Home Care Association, has provided a list of questions families and seniors need to ask about services, emergency procedures and the reputation of the home care service provider. Consider these concerns:

• How many years has the home care agency been serving your community?
• Does the agency offer printed material describing its services and costs?
• Is the agency accredited? This means that their quality of care has been surveyed and approved by an outside accrediting organization (such as Accreditation Canada, CARF Canada, ISO).
• Is the agency a member of a home care association and/or a member of a provincial association that has standards of care?
• What is the agency's screening process for applicants?
• What good are reviews or online ratings of the home care agency?
• Does the agency supply a written agreement outlining the proposed services and the costs?
• What are the costs for services and what services are provided?
• Will the agency help access insurance policies and/or government-funded services?
• How does the agency handle billing?
• Will the agency provide a list of references?
• Are agency caregivers available 24 hours per day, 7 days a week?
• Does the agency have a nursing supervisor on call and available 24 hours per day?
• Is someone available to answer questions or respond to a crisis?

About Staff:

• What are the qualifications of the staff?
• How does the home care agency ensure confidentiality?
• How are employees hired and trained?
• Does the agency require criminal record background checks and communicable disease screens for its employees? 

About Quality:

• What is the procedure for resolving issues that may arise between the patient/family and home health care staff?
• Who can you call with questions or complaints?
• What happens if a staff member fails to make a scheduled visit?
• Will the same person visit regularly?

When choosing a home care agency, you should ensure that all the staff are certified Personal Service Workers (PSWs) who hold a standardized certification. Also be sure to verify that the agency does a police check and employees are bonded. Some home care agencies also provide staff with palliative training, as well as training in Gentle Persuasive Approach (GPA), a program designed to help caregivers assist, understand and care for Alzheimer’s and dementia patients.

Home care agencies and the PSWs they employ provide an important service to individuals who need assistance in their homes, as well as to retirement communities who may need to bring in extra support staff to ensure their residents have the best possible care available to them.

Acquiring help with home care, whether it is through the Local Health Integration Network or the private sector, is a difficult process all along the way, as is well-documented.

Hiring and working with home care workers
The process of working with a home care service or agency also includes an initial assessment by the agency; this looks at safety in the home, ensuring that all needed supports are available within the home. The assessment also ensures that the caregiver and client’s personalities are sympathetic, and that the relationship is founded on an understanding of mutual respect and trust. There is a very close connection between caregivers and their clients. Companionship (sometimes called senior companion care) is part of the relationship, as it should be.

Personal Service Workers (PSWs) also provide observation if there is a risk of falling or if seniors need support after returning home from the hospital. Often they help seniors with home making and ensure follow-through on medical routines, such as physiotherapy and medications. That said, nothing is set in stone. Everything a PSW does is based on the wishes on the client and the client's family.

There’s nothing like having Audrey back at home like it used to be. We’re a lot happier.

Alan hired home care for his wife

These structured programs benefit seniors and other adults with disabilities or other support requirements, offering them programs that facilitate community, interaction with others in a safe, supervised environment. Adults get out of the home and participate in any of a wide variety of activities. Elderly people in the community interact with their peers for a few hours daily, while remaining independent in the larger community, in their own homes or wherever they live. This provides an environment where caring people can keep in touch with seniors, and facilitates remaining independent, the ongoing wish of so many seniors.

Programs may be offered by municipalities or other public bodies, but privately run programs may meet more regularly; while privately run programs may require fees, they also have increased availability and reliability.

These day programs may offer therapeutic programs, assistance with personal needs, meals and refreshments, and a variety of other services that meet the needs of seniors who are otherwise living alone. There are programs that offer a wealth of activities that include board games, card games, bingo, puzzles, gardening, baking, cooking, pet visiting, crafts, fitness and exercise, movies and social interaction including reminiscing -- and making new memories. Adult day programs offered by community organizations are often staffed by volunteers, and these can — for the most part — be adequately run, engaging and a great outing.

In the case of seniors with dementias including Alzheimer's Disease (as well as Parkinsonian and/or Lewy Body dementias), this type of program can have a number of healthful benefits and presents an environment where professionals can monitor the dementia and its progress. For families worried about sundowning, late afternoon programs can improve your peace of mind.

We offer further information about program offerings, types of care, regulation and admissions, in a more extensive overview, adult day programs and services.

As of 2016, the home care industry is not duly regulated in Ontario, and only nominally so in other provinces including Alberta and British Columbia. For example, Alberta's Protection for Persons in Care Act focuses on care homes and facilities and includes a poorly defined provision for "any person designated by the regulations as a service provider." Private home care providers in the province of Ontario admit that the industry has little government regulation, except for what is provided for under other laws. The Home Care and Community Services Act in Ontario focuses on providing and promoting access to services, not so much on regulation of providers. It is also not regulated under the Canada Health Act⁵.

The Ontario Home Care Association (OHCA) is "the voice of home care in Ontario," a strong association "dedicated to promoting the growth and development of the home and community health care sector by helping to shape health care policy, supporting members to excel, and being a leading source of information on home and community care." OHCA members are typically concerned about practice standards and engaged in achieving excellence in all aspects of service. The majority of its members are accredited through Accreditation Canada, CARF Canada, and/or registered with the International Standards Association (ISO).

These accreditation bodies are a strong indication of credibility, but they do not legally regulate the industry. This lack of authoritative regulation may change as the industry grows, but in the meantime, seniors and families need to take great care in choosing a provider.

Notes
¹Satistics Canada demographics
²http://pialberta.org/content/moms-private-care-costs-shock-family-action
³https://www.sunnet.sunlife.com/files/advisor/english/PDF/Completereport-LTC-Costs-AB.pdf
⁴http://novascotia.ca/dhw/ccs/FactSheets/Home-Care-Fee-Structure.pdf
⁵See The Canada Health Act

When it's all over you want to be able to look back and say, 'I did the best that I could, I took care of my mom and dad as well as I could.'