Entire system needs an overhaul and care is often of 'poor quality and fragmented', according to the Institute for Research on Public Policy
The problems in Canada’s long-term care (LTC) system have been well-documented, and the entire system needs an overhaul, according to the Institute for Research on Public Policy (IRPP).
“Most older Canadians have only limited access to care that is often of poor quality and fragmented. There are long wait times for admission to LTC institutions, and many who receive care at home report having unmet needs,” it said.
One of the things that could help is allowing people to age in their own homes by providing a cash-for-care benefit option, said Colin Busby, research director of IRPP, in an interview with Canadian Occupational Safety.
“From a government perspective, the advantage of having people age more in their homes is that not only do you give people what they want, but also it allows you to keep pressure off the hospital system and keep pressure off long-term care institutions, which tend to be very expensive places to receive, even to deliver, long-term care services.
“And of course they tend to be in very much limited supply; there are very few hospital beds, there are very few long-term care home beds. So the idea is to take pressure off of those [institutions] so they can keep delivering services to the community.”
The objective of the cash-for-care benefit option is to give people more options when deciding where they receive care. Under the plan, when a person reaches a certain level of disability and qualifies for a certain amount of long-term services, they can choose to get those services from formal caregivers or choose to get those services in the form of cash and purchase those services from informal caregivers. They can also distribute some of that money to family members serving as their informal caregivers, said Busby.
“It gives them a broader array of choices in terms of how they organize and [receive] their home care in a way that they want. Because, of course, governments are not going to have all the information that they need in deciding what kind of care we would get. It depends on people’s circumstances, the availability of informal care or not...”
Informal caregivers
Unpaid, informal caregivers can also benefit from the option, said Busby.
“The plight and the challenge of informal caregivers, it’s probably not documented enough, but it deserves to be repeated at every opportunity...And in Canada, we vastly underappreciate and [under-]acknowledge the contributions of informal caregivers who, let’s face it, perform and deliver the majority of long-term care services in this country. And they do it without getting a paycheck, without being… recognized for doing that work.”
“And the big challenge for informal caregivers is balancing the stresses in their lives. So they’ve got commitments to their family, they’ve got their commitments to their jobs and then they’ve got commitments to normally their parents, let’s say… So by offering cash benefit… a person who receives it could hand it over directly to their family caregiver or to their informal caregiver.”
But there are also a lot of things to consider when allowing informal caregivers to take on all the responsibility, as it could potentially force them to quit their job and leave the labour force to focus exclusively on providing care.
“If that’s the case it’s something that we have to be concerned about and cautious about. On one hand, it’s a good thing in a sense that we would more formally acknowledge informal caregiving responsibilities and [reward] them more accordingly to how important they are to society and their functions as individuals. But also, if people are going to leave the labour force, what about things such as job protection legislation? Should we be increasing that and strengthening that? Should we be paying for their cash and pension plan benefits if they decide to take a year off work to provide caregiver services to their parents?”
Bigger picture
However, the cash-for-care option is just a part of the bigger solution that the entire system needs, said Busby.
“So as part of a broad, long-term overhaul, we have to have a very specific focus on recruitment, on training and on retention. And really talking about significantly expanding the number of people that we have working in the sector and making it a viable option. And that means workplace wellbeing. It means wages and compensation. These things all have to increase and improve in order for us to have a chance, really, at fulfilling the immediate needs of an ageing population.
“Standards and auditing procedures for long-term care institutions and for home care services need to be established, put in place, and there have to be more rigorous ways for governments to ensure that a minimum quality of care is being delivered in either institutions or at home. And the way in which we go about setting standards and the way we go about enforcing them has to be the top of the agenda in terms of the broader long-term care overhaul agenda.”
The problems in Canada’s long-term care (LTC) system have been well-documented, but Busby pointed out what probably is the biggest of them all.
“I really think that the bigger issue here is inaction and preventing inaction. Because that existed pre-pandemic too long, and I think there has to be an emphasis on action now. And moving quickly. I really think that has to be the top priority.”
