Spend less, get better home support

Seniors advocate Isobel Mackenzie has released a deeply troubling report on home support services. Mackenzie found that the program, which provides home-based assistance with such basics as dressing, bathing and nutrition, is unaffordable for most seniors. It also fails to meet the requirements of high-need clients.

The affordability problem is self-evident. The program is income-tested, but fees climb so steeply that a senior making $26,000 has to pay $7,300 for a once-daily visit. That is far beyond the reach of many, and the highest fee rate in the country.

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One result is that elderly folks who could remain at home with the necessary support end up going to a residential care facility. From a humane perspective, this makes no sense. Why rob seniors of the independence and comfort that comes with staying in their own home when an alternative is available?

Financially, it makes no sense either. The cost to taxpayers of subsidizing long-term care beds averages $57,500 a year. Yet two hours of daily home support costs just $27,740. Since 4,200 seniors occupy residential care beds who could remain at home, the province would save $125 million by helping them do so.

The same problem crops up in hospital admissions. Due to the lack of adequate home support, family physicians are sending their patients to hospital as the only available alternative. It's estimated that about 15 per cent of hospital beds in major centres are occupied by patients who don't belong there.

This is also financial lunacy. The average cost of a typical seven-day hospital stay is about $7,000.

But many seniors remain in hospital for weeks, waiting for a residential care bed. This is a far more expensive option than providing home-based support.

Then there is the reality that a third of family members who have become the primary care giver for elderly parents are at their wits' end.

How did this state of affairs come about? One reason is that home support workers are the lowest paid of the auxiliary health occupations. Many need second jobs.

That tends to cause gaps in service, as staff members miss appointments because of other commitments. There is also the reality that housing costs in regions such as Greater Victoria are unaffordable to many low-income workers.

However, these are merely symptoms of a larger failing. For decades, home support has been the orphan child of our health-care system. Far too often it is out of sight and out of mind, as managers wrestle with more immediate difficulties such as rising drug costs and the shortage of family physicians.

This must stop. It's not just that we owe seniors and their families a better life. There is no other area in health care where savings are so readily available if we reorganized our priorities. The first step is to increase the wages of home support workers.

This can be done either by raising their hourly pay rate, or by guaranteeing them full-time work, because large numbers can find only part-time employment.

No doubt this is easier said than done. There will be union ramifications. Yet what is the alternative?

And fee levels for low-income seniors must be reduced to levels that are genuinely affordable. This, too, is easily said. Clearly there will be cost implications.

But against these obstacles must be set the benefits of helping elderly residents remain in their home, and just as important, keeping them out of hospital or long-term care.

It's not uncommon to hear advocacy groups claim that spending more money on social services will create savings down the road -- savings that rarely materialize.

But this is one instance where the status quo is visibly more expensive than an available alternative -- more and cheaper home support.

-- Victoria Times Colonist

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