Question Period Note: HOME CARE

• Home care services help people receive needed care at home, rather than in a hospital or long-term care facility, and to live as independently as possible in the community. Home care usually includes professional services at no cost to the client (e.g., physiotherapy, nursing, and occupational therapy) and home support/personal care (e.g., personal hygiene, dressing, feeding, and toileting), which is income-tested in most PTs.
• There is evidence that COVID-19 had a negative impact on access to home care services during the pandemic, including both professional services and home support/personal care. This situation increased social isolation of seniors and led to a higher burden for family caregivers.

• The COVID-19 pandemic continues to highlight longstanding challenges that vulnerable populations face in accessing the health care services they need, including access to home care services.
• Our government increased funding to provinces and territories to help protect these populations as part of our pandemic response, which included providing $740 million through the Safe Restart Agreement. In the case of home care specifically, that additional funding built on the $6 billion we are already providing over ten years to support better home and community care, including palliative care.
• Budget 2021 recognised the need to support people at home, with a $90 million investment over three years to launch the Age Well at Home initiative led by Employment and Social Development Canada. This will assist community-based organizations in providing practical support to help low-income and otherwise vulnerable seniors age in place.
• Most recently, Budget 2022 proposed the creation of an expert panel to study the idea of an Aging at Home Benefit. The panel will report to the Minister of Seniors and the Minister of Health.
• In the Speech from the Throne, we committed to strengthen our healthcare system and public health supports for all Canadians, especially seniors, veterans, persons with disabilities, and vulnerable members of our communities. This care can include care at or close to home, to help them live longer where they want to be.

IF PRESSED ON ADDITIONAL SUPPORT PROVIDED BY THE FEDERAL GOVERNMENT…

• The Public Health Agency of Canada has published infection prevention and control guidance to help prevent COVID-19 infections among workers and individuals in home care.
• Up to $3 billion in federal funding was provided in 2020 to support provinces and territories to increase the wages of low-income essential workers, which could include front line workers in home care settings, hospitals, and long-term care facilities.

Home Care in Canada
• Healthcare is a shared responsibility between the Government of Canada and provincial and territorial governments.
• While the federal government provides financial support to the provinces and territories for health care services, the responsibility for matters related to the administration and delivery of these services, including home care, falls within provincial and territorial jurisdiction.
• Home care is not publicly insured under the Canada Health Act.
• While not mandatory, every PT offers home care programs and services, with variations across each PT.

COVID Impacts on Home Care
In July 2021, the Canadian Institute for Health Information highlighted the following impacts COVID-19 has had on home care services:
• Home care clients placed their services on hold to limit contact with people outside their household.
• In April 2020, the number of screening assessments declined 25% compared with March 2020.
• In April 2020, the number of full assessments completed declined by 44% compared with March 2020. This trend continued in June 2020.
• Home care assessments were transitioned to being completed by phone. Between April and June 2020, there was a 53% increase of phone assessments.

The 6th wave of COVID-19 will likely continue to impact seniors’ services in a similar way to previous waves. Many provinces and territories are experiencing health care staffing issues due to workers being exposed to or testing positive for COVID-19.

Budget 2022
Budget 2022 proposes the creation of an expert panel to study the idea of an Aging at Home Benefit. The panel will report to the Minister of Seniors and the Minister of Health.

Other Relevant Budget 2021 Commitments
Budget 2021 committed to:
• supporting retirement savings for personal support workers, through funding of $27.6 million over three years for my65+, a Group Tax-Free Savings Account offered by the Service Employees International Union Healthcare. The funding will support incentives for worker participation;
• increasing Old Age Security for seniors 75 and over, beginning in 2022; and,
• establishing a new Sectoral Workforce Solutions Program ($960 million over three years, led by ESDC). The purpose of the program is to help employment sectors design and deliver relevant training, and connect Canadians with the training they need to access good jobs. For the health sector, this program will help to address the need for more skilled personal support workers who provide care for Canadians at home.

FPT Home and Community Care bilateral agreements
The Federal Budget 2017 committed to $11B over 10 years targeted to improve home and community care ($6B), and mental health and addictions ($5B).

In August 2017, FPT Health Ministers agreed to the Common Statement of Principles on Shared Health Priorities, in which they committed to:
• Priority areas of action in home and community care, and mental health and addiction services
• Reviewing progress on the objectives and commitments annually
• Developing and reporting on a focused set of common indicators (with CIHI and stakeholders)

The Government of Canada and the Government of Québec agreed to an asymmetrical arrangement.

Shared Health Priorities Indicators for access to home and community care (Canadian Institute for Health Information)
• Hospital Stay Extended Until Home Care Services or Supports Ready
• Caregiver Distress
• New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home
• Wait Times for Home Care Services
• Home Care Services Helped the Recipient Stay at Home
• Death at Home/Not in Hospital

PT Action Plans for the Home and Community care bilateral agreements
Provincial / territorial action plans are identified in bilateral agreements, which are all posted publicly, and lay out the initiatives that each jurisdiction will take to meet the needs of each jurisdiction’s population. For example,

Integration of Care in the Community
• Through the YK Home First and Complex Client Supports initiative, Yukon clients will be provided enhanced services at home, with the goal of keeping them out of long term care
• SK is establishing Community Health Centres and teams to shift the delivery of care from hospitals into community settings
• To allow people to remain in their homes as long as possible, QC is making a wide range of care and services more readily available in the community (including nursing, nutrition, rehabilitation).

Investing in Digital and IT Infrastructure
• PEI, NWT, YK and NS are implementing various care assessment tools (InterRAI), which allow clinicians to identify issues and develop care plans, and monitor home care client/LTC resident progress
• NL is expanding remote monitoring of dementia patients through the use of e-consults

Support for caregivers
• Better respite services for caregivers (NL, NS, NB, ON)
• Expanding the Caregiver Benefit (NS)
• Plans to introduce a paid family/community caregiver option (NWT)

Palliative Care
• MB and BC are investing in afterhours access to resources for palliative care clients and their families;
• AB is enhancing palliative home care programming to rural, remote parts of the province
• NB will implement standardized assessment and monitoring tools, and develop a physician model for integrated community-based palliative care

Initiatives aimed at specific population groups
• PEI is developing culturally appropriate information regarding programs, services and training specific to First Nations continuing care needs

KEY FACTS
• Health Minister Mandate Letter
The Government of Canada has committed to work in partnership with provinces and territories to strengthen our universal public health care system and public health supports, so all Canadians can get the care they need no matter where they live. Collaboration with provinces and territories will be key to ensuring the primary care system is positioned for the future, including accessible health system data, as well as working to improve the quality and availability of long-term care.
• Specific commitments include:
o Negotiating agreements with provinces and territories to support efforts to improve the quality and availability of long-term care homes and beds. This includes working with provinces and territories to improve infection prevention and control measures, identify shared principles, and develop national standards and a Safe Long-Term Care Act to ensure seniors get the care they deserve.
o Work with the Minister of Employment, Workforce Development and Disability Inclusion and provinces and territories to train up to 50,000 new personal support workers and raise wages.
o In this, the UN Decade of Healthy Ageing (2021-2030), promoting seniors’ physical and mental health to enable them to live longer at home, including by supporting the Minister of Seniors in their work to establish an expert panel to provide recommendations for establishing an Aging at Home Benefit.