We need to place higher value on home care to unlock many challenging health and social problems

Increased public and private investment in home care is key to unlocking many of the problems facing the Canadian health and social systems. Services delivered in the home can prevent unnecessary visits to urgent and primary care.? Sufficient home and community support can facilitate faster discharge from hospital, and importantly, help prevent unnecessary readmissions. Home care and services can also have a very positive impact on intergenerational stress, loneliness and isolation.??

The scope of services offered by homecare companies is vast, including nursing, live-in care, caregiver relief, specialized care (OT, PT, social work). Some companies also offer home services - from companionship, to meal preparation. Others provide specific language or culturally specific care. And the very innovative companies have forged partnerships with adjacent industries and services, such as estate planning, wealth management, wellness training and transportation.??

There are so many other societal and individual benefits to providing care and services in the home. Most people want to age in place, where home and community are familiar. If clinically possible, aging at home extends and improves overall quality of life. Care at home helps postpone and sometimes avoid institutionalization and premature decline, in part by encouraging independence and self-care. Ultimately, home care allows individuals to stay in charge of their own lives for as long as possible.

Given all of these benefits, why isn’t it valued higher - by individuals, our health system and investors???

There are some phenomenal examples of investment and innovation in tech to support home care. For operators, there are systems to optimize scheduling ,?geolocation of routes, and billing .

The employee experience has also been the focus of great innovation from recruitment through to retirement, and this has helped drive engagement, better communication and retention, which is essential in this very human focused business.??

From a provider and patient perspective, new technologies in the home with remote patient monitoring (RPM)/ home health monitoring (HHM), video chat, reminders and proactive education have had tremendous impacts on quality and access to care. And when there is data integration with acute care, primary care, home care and pharmacy, we are seeing improved collaboration among care providers, patients and families. This has been especially beneficial for those with complex, chronic conditions.?

So while we’ve seen great innovation and investment in tech in this sector, the complexity of funding appears to be a primary barrier to service adoption. The fee structure for home care in North America remains primarily fee for service (either paid by government or by the consumer). Public funding for homecare in most jurisdictions in Canada has been decentralized in an effort to ensure that regions and communities - who are closer to the care being delivered - can appropriately flow dollars to the areas where there is the most need. In the United States, there is a trend towards value-based payment models in all parts of the healthcare system, but this is still in process for home care. Global best practice for home care includes a “vouchering” system where cash-limited payments are allocated to clients to use with the service of their own choosing. Pilots of this model have been tried in Canada with excellent outcomes .

In 2021, only 6% of Canadian households used homecare services. I would argue that if homecare was more valued, and funding more transparent and available, this statistic would grow exponentially. We would see more insurance companies offer home care as an employee benefit, with flexibility to use these funds to support your aging parents or spouse who is recovering from surgery. We would be more willing to budget out of pocket funds for this critical service. And importantly, we would insist that a greater percentage of our public health care dollars be allocated to this essential area of the health sector.?

There is so much evidence that home care can have a more significant, positive impact on patients, families, providers and the health system. It’s time to increase how we value home care as core to the strategy of tackling health and social problems in Canada.