Care comes to you at home

 

Wanting to live at home means that older adults have access to high-quality home health and social care services. Currently, unpaid family caregivers provide 75 per cent of care at home across Canada. Over the past decade, the shift has begun toward more home-based and community care and more formal caregiving at home by professionals.

Home care

The most recent statistics (2018) indicate that about 3 million people in Canada receive some form of care at home to cope with a long-term health condition, physical or mental disability or problems related to aging.

Home care is an array of health and support services provided in the home, retirement communities, group homes and other community settings to people with acute, chronic, palliative or rehabilitative healthcare needs. Services include assessments, education, care, personal assistance with daily living activities and carer respite and support.

A set of Harmonized Principles articulates the values and fundamentals of home care in Canada. This was developed in consultation with over 350 stakeholders from government and providers by the Canadian Home Care Association.

Nurse bringing a meal to an aging woman in her home.

Person-centred care

Person-centred care focuses on the whole person, engaging caregivers and family in shared decision-making and, ideally, co-creating a tailored personal health plan to improve health outcomes. At its core, this model recognizes that care is relational and needs to be tailored to the older adult’s capacity. This empowered, person-centred approach is explored in a 2019 summit report with several Canadian examples of innovation for better aging at home:

Relationship-based model

Relationship-based home care is a model promoted in Europe to help older adults navigate the health system while living at home. This outcomes-based, preventative philosophy organizes home care by trained professionals around the needs of the older adult and their family, rather than around the completion of a predefined set of tasks. It recognizes that the needs of older adults continuously change and focuses on:

  • Caring for the emotional and physical needs of the older adult

  • Supporting families and caregivers in their relationship to the older adult receiving care

  • Enabling co-ordination across the whole care team, including family and healthcare providers

Australia applies this concept in a national Home Care Packages Program, a consumer-directed care approach to help ensure support matches an older adult’s needs and goals.  

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Integrated service

Older adults living at home continue to rely on caregivers for a wide range of daily tasks, including meal preparation, shopping, medication management, driving, bathing, snow shoveling and companionship. Integrated programs that help co-ordinate and increase access to social and community supports can greatly help older adults navigate service-providing organizations on a short-term or ongoing basis:

Veterans Independence Program,
Veteran Affairs Canada

Mixed care models

Mixed care models that combine home care services and caregiving roles have been shown to help reduce the burden on family caregivers. The keys to success for this approach are a high level of collaboration and quality interaction to support caregivers with:

  • A sense of empowerment driven by a strong, supportive relationship and managed expectations

  • Knowledge sharing to adapt to the ever-changing needs of the older adult

  • Trustworthy, predictable and flexible service information and education about conditions and practical self-care skills

  • A shared approach to care, characterized by a shared sense of responsibility and collaboration

Innovation for change

Across Canada and around the world, innovative approaches fueled by big ideas and grassroots action are helping people age well and safely in their communities. Check out these initiatives that are leading the way.

 

Designing the future

Research shows that shifts in home care, driven by a focus on engaging older adults and their families in care and innovative approaches, have brought many benefits:

Relationship-based care

  • Reduced health and social care costs

  • Better co-ordination and communication across the care team

  • Enhanced emotional well-being for older adults

  • Increased trust and comfort in care giving — especially in caring for older adults with dementia

  • Greater peace of mind for families

  • Greater job satisfaction for professional care providers

Primary care at home, including virtual care during COVID-19

  • Positive system impacts with lower levels of emergency visits, hospital stays and admissions to long-term care

  • Increased personal health, reduced blood pressure and reported levels of care and more appropriate medication use

  • Better screening for common geriatric conditions and vaccination rates and engagement in end-of-life discussions

  • Better individual and caregiver quality of life and satisfaction with care

 

Integrated supports

  • Better transition from hospital to home with lower readmission rates and higher patient satisfaction

  • Better nutrition and socialization, enabling the ability to remain at home

  • Better co-ordination and access to social and community supports and ability to navigate the services available to meet needs

  • What helps?

    • Client-centred, relationship-based or consumer-directed care approach. An understanding of personal and family circumstances and goals is foundational to an approach that confirms the older adult as a whole person and co-creates a personal health plan based on an older adult’s capacity.

    • Integration with existing social and health services. Home care services are in an ideal position to form an integrative bridge between the older adult and what they need. Maintaining strong and seamless connections between such services as housing, primary care and rehabilitation is key.

    • Choice. Putting choice into the hands of older adults and families in determining caregivers and providers or timing of care visits to suit their needs is a key element in person-centred empowered models.

  • What hinders?

    • Capacity issues. Gaps in human resources and capabilities are barriers noted in many of the models, including capacity issues to meet needs in the home, delays in transition from hospital or access to services due to staff shortages, physician workload or lack of volunteers.

    • Technology. Barriers in the use of technology were noted in technology-dependent models, including remote access to clinicians during the pandemic or programs requiring remote monitoring.

    • Funding. Almost 90 per cent of total funding for seniors’ care in Canada is directed to institutional care. This creates capacity issues in the shift to the community-based care and supports required for people to stay at home and in community as they age.

Food for thought

  1. What does person-centred or empowered care mean to you? What choices are important to you in being able to age safely at home?

  2. As someone receiving care at home or involved in caring for an older adult, what do you hope that healthcare professionals fully understand about you, your family or your situation?

  3. Thinking of basic daily needs, what are the services in your community that could potentially help older adults remain at home longer? Which ones are not currently being accessed for this purpose, and what might be done to change that?

  4. Community paramedicine started as a grassroots movement by providers who saw a need to support adults at home and reduce emergency visits. How might this model be scaled and spread into the wider healthcare or social support system?

  5. Considering the Buurtzog and Long Live the Elderly models developed in Europe, how might we adopt the values or core components in our own communities in Canada?

Additional resources

The Path Forward for Aging in Canada discussion paper

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