Seven days a week, Margo Algie can’t get out of bed before noon. Not of choice. She has amyotrophic lateral sclerosis (ALS), a debilitating neurodegenerative disease, and needs a domestic worker to help her start her day.
But after someone arrives to move her to a wheelchair, put her on, and help her with the toilet, Algie often has only an hour – sometimes two – before another caregiver arrives to get her back to bed. at 4 p.m.
“Being bedridden is not great for my body, my skin or my psyche,” said the Toronto woman, who is gradually losing her ability to do all the basic activities of life.
But the home care company says “that’s all that’s available,” she said.
At least once a week, she receives a call to say that a home care worker is not available at all.
“I’m horrified when they say I can’t get help,” said Alji, 63, who said she was completely dependent on the care she received.
A home care worker helps Algie transfer to her wheelchair. (Norm Arnold / CBC)
Alji is not alone when it comes to complaints about poor home care. Recent CBC Marketplace investigation caused hundreds of stories from home care clients and their families across the country complaining about missed visits, shortened visits and the inability to receive visits at all.
Complicating the problem, the number of people relying on home care is expected to increase by more than 50 percent in less than a decade, according to the Canadian Medical Association (CMA).
A recent report estimates that more than 1.1 million Canadians receive home care and that by 2031 that number is likely to rise to 1.7 million. On top of that, the report estimates that annual spending on long-term care and home care in Canada will double from $ 29.7 billion to $ 58.5 billion during this period.
“This problem is getting worse,” said CMA President Catherine Smart. “There is a real risk that in the coming months and years we will see our systems begin to fall apart.
This is a grim prognosis that should not come true, said Dr. Samir Sinha, director of health policy research at the National Institute on Aging and director of geriatrics at Sinai Health and the University Health Network in Toronto.
Geriatrician Dr. Samir Sinha says more investment in home care is needed to prevent a financial crisis with long-term care after a decade. (Tiffany Foxcroft / CBC)
“The problem we had in Canada was the notion that if you can’t take care of someone at home, they have to go and live somewhere else,” Sinha said. “And so we have this real culture of institutionalizing people.”
Sinha said what was needed was not rocket science. The provinces need to invest more in home care to help people grow old on the spot.
“Currently, about 200,000 Canadians live in long-term care homes,” he said. “About a third of them – 60,000 or 70,000 people – could stay in their own homes with adequate home care support.”
Meanwhile, he said, at least 50,000 Canadians are waiting to go to bed for long-term care, but there is no room. Many have no choice but to wait in hospitals for a place to open.
WATCH The system this clinician says he faces:
“It breaks my heart,” says the Canadian geriatrician
Dr Samir Sinha says Canada’s home care system often robs his patients of their dignity. 0:30
But Xingha said making a fundamental change to invest more in home care is hard to sell.
“Our politicians are living a four-year political life cycle and are just trying to focus on re-election – instead of figuring out how to create a sustainable health system for the future,” he said.
Smart says action time is running out.
“I think there has never been a more urgent time to change our health care system.
“This is a real example of when the government needs to go beyond politics and understand that Canadians need this system. It must be functional. And that’s not the case right now.
Look at Denmark, the geriatrician insists
The way forward is to take a page from Denmark, said Sinha, who traveled to the Scandinavian country to study its long-term care strategy and returned last month with a crew from the CBC Marketplace.
In the late 1980s, Denmark – which, like Canada, has an aging population and publicly funded home care – slowed the growth of new nursing homes and instead used the money to invest heavily in home care.
In Ringsted, Denmark, older homes without stairs are available for rent. Here the elderly receive home care and live independently. (Katie Pederson / CBC)
Now, according to the Organization for Economic Co-operation and Development, approximately half of all long-term care costs in Denmark are based on home care, while in Canada only about a third of the cost goes to home care.
Funding means that people in Denmark can receive from 20 minutes to 10 hours of home care per day, depending on their needs.
When Danes turn 80, they automatically receive a home visit from a nurse to assess how things are going and whether they need any support to help them grow old at home.
“We’re talking about whether they lost their husbands or wives and what it’s like to be alone,” said Camilla Hove Lund, who runs a home care program in the municipality of Ringsted, 70 kilometers southwest of Copenhagen.
“We’re talking about their network – do you have friends?” Any family? Do you have activities that you go to? ”Said Howe Lund. “And if we hear they need a little help, we give it to them.”
Camilla Hove Lund runs the home care program in the Danish municipality of Ringsted. She says focusing on prevention protects the elderly from long-term care beds. (Katie Pederson / CBC)
It may sound like a warm and vague approach, but make no mistake, Sinha said. “This is actually a deliberate strategy to keep the entire health system sustainable.
When the Danes find that they are struggling physically – they may no longer be able to bathe – they are registered in the so-called “recovery” program.
“We offer them the bathroom,” said Howe Lund. “But we also offer training with our workers to bathe themselves again.”
WATCH Enter a house in Denmark:
“The goal is to strengthen his legs,” said the Danish PSW
Johnny Olsen is doing rehabilitation exercises with trained support staff as part of the Danish home repetition program. 1:07
This is a very different approach from home care, which is provided most often in Canada, Xingha said.
“The small home care we provide to Canadians is often what we call ‘reactive’ home care,” he said. “Someone falls, he needs to take a bath, we send people to help. While [in Denmark] has this idea of preventive home care. “
In the rural suburbs of Ringsted, 72-year-old Johnny Olson, a former farmer, is battling Alzheimer’s disease.
He receives six home care visits a day, including physical therapy twice a week to strengthen his arms and back and try to keep him from falling.
Alzheimer’s Johnny Olsen, pictured here with a regular home care worker, receives six home care visits each day in Ringsted, Denmark. (Katie Pederson / CBC)
“It works,” he said as he diligently followed his domestic worker’s instructions to raise and lower his legs.
In Denmark, all home care workers are trained in preventive physiotherapy to try to keep people in place on the spot, while in Canada it is not standard practice for home care workers to receive rehabilitation training and physiotherapists are in high demand.
“We have a large group of older people who need much less help if we rehabilitate them,” said Howe Lund.
Those receiving rehabilitation also have their progress tracked.
“The results are very important to us,” said Howe Lund. “We need to show our politicians that this works. You need to give money for it.”
Lonni Bensadon is standing next to one of the many electric vehicles provided to personal support staff in the Danish municipality of Ringsted so that they can make home care visits. (Submitted by Samir Sinha)
It’s all a deliberate effort to help people grow old at home – and it’s far from being delivered back home, Sinha said.
“We have to say that we do not have a system that is currently working as well as it could,” he said. “These are not pie ideas in heaven – we see them physically here in Denmark.”
He promises to invest more in home care
In 2018, the Conservative government of Ontario hired Xingha to develop a strategy for adults – a plan for long-term care for the aging population of the province.
He presented a report calling on the government to build fewer long-term care beds and invest more in home care.
But he said the Ford government had largely postponed his report and had instead pledged $ 6.4 billion to build 30,000 new long-term care beds by 2028. This is in addition to its annual budget of $ 6 billion. for long-term care and $ 3 billion for home care.
Ontario Prime Minister Doug Ford talks on February 1, 2022 about allocating $ 6.4 billion to build 30,000 new long-term care beds by 2028 (CBC)
“They chose the solution, which is frankly much more expensive for taxpayers, but works very well for developers,” Sinha said.
“It really bothers me because we don’t understand the basics here. No one really wants to end up in a nursing home. But to the public, it’s like, “We’re doing this big thing to take care of this big problem.”
But earlier this week, in a surprise announcement, the Ontario government said it planned to invest an additional $ 1 billion over three years in home care if re-elected in June.
“This significant investment will ensure that Ontario residents can receive the care they need in the comfort of their own homes,” said Health Secretary Christine Elliott.
This is a step in the right direction, Sinha said. “This investment will help solve fundamental problems [the Ontario government] set up after four years of deliberate starvation of the Ontario home care system. “
The Ontario government said this week it plans to invest …
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