Why proper home care should be a cornerstone of how our health system looks after seniors

Expanding established home-care models would take pressure off the health system, while helping Canadians age in safety and dignity, writes Elizabeth Niedra.

Expanding established home-care models would help older Canadians age in safety and dignity

At-home care for a frail older person costs the health system an average of $103 per day, according to a recent report from the National Institute on Aging, compared to $201 for long-term care, and $703 for those admitted to hospital while awaiting a place in an institution. (Getty Images/Cultura RF)

This column is an opinion by Dr. Elizabeth Niedra, a care of the elderly physician, writer, and lecturer in family medicine at the University of Toronto. She does home visits for older adults with SPRINT House Calls. For more information about CBC's Opinion section, please see the FAQ.

The pandemic is shining an interrogative floodlight on the face of Canada's elder care system. Specifically, it has brought close scrutiny to the highly publicized circumstances in which long-term care residents have accounted for a gut-punching 55 per cent of COVID-19 related deaths in Ontario alone — 3,730 as of Feb. 18.

This data we already know; it has been the constant horror music playing behind society's collective pandemic trauma this year. The older person in long-term care has become the divisive and central figure of our pandemic response and its shortcomings. In them, we see the heart-wrenching sadness and exhaustion of this crisis writ large upon frail human form.

However, now we also understand how much attention and thoughtfully allotted resources it really takes to give our seniors the comfort and dignity they deserve. A lofty goal, when this year has felt like a panicked scramble to keep them, at bare but difficult minimum, out of emergency rooms and safe from COVID-19.

Outside of long-term care homes, much of the community response to the pandemic has focused on virtual care. This buzz-wordy concept shifts patient assessments from in-person care to telephone-, video- and app-based interactions.

These might be promising solutions for a subset of healthy, technologically literate patients, but for thousands of seniors with multiple health conditions and sensory impairments, virtual care often serves only to exacerbate their unique vulnerabilities. To say nothing of the immense work involved with elder care; the work of actually knowing an older person, understanding their needs and accompanying them on their aging journey.

For our aging older adults in crisis, virtual care is not a silver bullet.

In the space between long-term care and virtual care, however, there is home-based care. Though underfunded and understaffed, it already exists in the publicly funded health system — and it works.

WATCH | Geriatrics specialist Dr. Samir Sinha explains some advantages of home care:

Dr. Samir Sinha says most Canadians want to age at home for as long as possible

3 years ago
Duration 0:34
Featured VideoGeriatrics specialist Dr. Samir Sinha says boosting the level of home care and sending fewer people to long-term care facilities is both cost-effective and the right thing to do.

The model of multidisciplinary home-based care — involving teams with a mix of specialists, such as doctors, social workers and physiotherapists — is specifically designed to help older adults age in place. These are seniors who are comparable to the long-term care population, on the metrics of age and medical disease, yet proper home-based care allows them to stay safely and comfortably in their own residence rather than moving into an institution.

A good home-care team coordinates nearly all of an older person's chronic and complex health needs, and delivers them within the safety of their chosen home. It can respond to urgent patient needs the same day, and also provide 24/7 at-home palliative care support to those who are at the end of life.

Historically, this model has helped two-thirds of its referred patients age at home, and has been shown to help reduce their re-admission to hospital by up to 29 per cent.

Home care also matters for the happiness and well-being of patients. According to a recent report from the National Institute on Aging, nearly all older people surveyed in Ontario would prefer to age in their own home rather than in a care facility.

High-quality home care also makes financial sense. At-home care for a frail older person costs the health system an average of $103 per day, according to the report, compared to $201 for someone in long-term care, and a whopping $703 daily for older adults admitted to hospital to await a permanent place.

LISTEN | Disabled rights activist Jonathan Marchand discusses a Quebec pilot project that will give him access to at-home care services: 

And yet, home care remains in the shadows of our provincial elder care strategy. It's often viewed culturally as an old-fashioned and folksy form of medicine, or else a fantasy approach outside the reaches of possibility for standard clinic-anchored care teams.

Housebound older people who don't have access to proper home care, for their part, are too often forgotten as a large group of vulnerable, high-needs patients. And they are unfairly viewed as burdensome crises once they do appear at the doors of the emergency room when, due to lack of proper ongoing care, their needs become acute.

In short, the care of the elderly in Canada has not failed this year because there is no solution. Excellent home-based care is a ready answer to our elder-care crisis.

However, we must radically expand upon these established models if we are to help older Canadians age in safety and dignity. Indeed, we must rewrite our health-care culture to sustainably invest in older people and address the tragedies of the threadbare elder care system that have been splashed across the headlines in recent months.

Bluntly, we must ask ourselves and our leaders whether we will elevate home care to be a cornerstone of elder care. Even more critically, will we keep the needs of the frail older person front-of-mind when they are no longer dying in heartbreaking numbers from COVID-19?

These may not be the most commonly asked questions of the current elder crisis, but they should be.


Dr. Elizabeth Niedra is a care of the elderly physician, writer, and lecturer in family medicine at the University of Toronto. She does home visits for frail older adults with SPRINT House Calls.