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| Strengthening home care — Can it save money and improve quality of care? | 2009-02-18 15:45:47 |
Strengthening home care — Can it save money and improve quality of care?
For many people with chronic health problems such as diabetes and heart disease, home care makes a lot of sense. Most people prefer to stay in their own environment as long as possible.
And there is good evidence from Canada and other countries that home care saves health care dollars without sacrificing quality of care.
Even when the cost of informal caregivers is factored in, home care costs less than does care in an institution. And, with the right supports in place, home care can reduce the use of hospital services, an indication that people’s health care needs are being met at home.
In 2003/04, public (government-funded) spending on home care services across Canada amounted to $3.4 billion, about one-quarter of the $12 billion we spent on nursing homes. It’s hard to get a handle on exactly what we spend on home care in Canada because services are mixed between public and private providers, and between health care and supportive services like housekeeping and meals.
Can we do more to shift the balance between home and institutional care for people who would benefit?
In Denmark, a comprehensive program of home care services in the 1980s and 1990s reduced nursing home use by 30% among people 80 years and older, and the overall cost of care for this age group dropped by 12%.
But there are challenges. Home care is time-consuming for the nurses and other professionals who must sometimes travel an hour or more per visit. And patients at home receive fewer hours of care than they would in a hospital or long-term care facility.
Some provinces are using technology to help home care providers be in several places at once – with excellent results. In fact, some patients who are able to use technology to monitor their own conditions do better than other home care patients – including the frail and elderly.
In New Brunswick, patients in a “remote monitoring” program get a small portable device to track their own vital signs such as blood pressure and oxygen levels. The information is transmitted electronically once a day to the central office, where a nurse reviews it and follows up on any concerns. Instead of seeing their patients a couple of times a week, the home care nurses are able to see them, virtually, every day.
The vast majority of people enrolled in the program – 93% – found they were better able to manage their health conditions. As a result, they had 85% fewer hospital admissions and 55% fewer visits to emergency departments, compared to a similar group of people who were not in the program.
Not only do these patients feel better, but their personal success means that hospital beds and emergency department staff are available for others who need them.
What do you think?
1) What could be preventing more home care programs, like the one described in this story, from being created across Canada?
2) If you had the need, would you want to be able to monitor your health conditions at home, like the patients described in this story? What if it meant you saw the home care nurse less often – say, once a week instead of three times?
3) Not all prevention programs provide great value for money. Looking purely at the cost of program delivery and the potential savings to society, some effective prevention programs cost much more than they pay back. What kinds of value should we consider when there are opportunities to help a small number of people but at a high financial cost?
For more information:
Read
o Prevention does not always cost more than treatment (p. 33), and chronic diseases consume a lot of health care resources (p. 43 – 44). See the Health Council of Canada’s paper, Value for Money: Making Canadian Health Care Stronger.
o A profile of New Brunswick’s successful experiment with remote monitoring in the Health Council of Canada report Fixing the Foundation: An Update on Primary Health Care and Home Care in Canada.
Watch a video on high-tech home care: Technology overcomes geography (telemedicine in Ontario).
| Your responses |
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| barriers JennJilks Posted: 2010-01-29 07:32:36 There are many: lack of professionals available, transportation issues in rural Canada, lack of trained and qualified PSW or health care aids, adult caregivers being daughters (25%) women with jobs and families, and the assumption that families will do the work. Financial barriers limit as well. |
| Looking at just the pieces jessem Posted: 2009-12-08 20:10:12 I am a fourth year nursing student currently
in a rural home care office as one of my clinical placements. After performing
some of my own research on the subject I thought I might be able to shed some
more light on the topics presented. I found that for the most part the cost
effectiveness argument for home care is far from conclusive 1.
Much of the research does not look at all three areas of homecare which are
disease prevention and health maintenance, as a substitution to acute or
hospital care, and as a substitution for long term or residential care 1,3.
For example, the arguments above look solely at homecare as a substitute for
long term care. However, for a population to age healthily in place the other
two components of homecare must also be in place. Shorter hospital
stays and higher quality of life and end-of-life are also important aspects
that must be considered. Although cost effectiveness is hard to
comprehensively review, especially with regards to unpaid or family caregivers
(of which one article reported there are some 2.1 million of in Canada3),
the one overwhelming positive to home care is a higher quality of life reported
by the majority of the recipients1,3. The research also supports the
idea that home care is underfunded and yet the demand continues to grow1,2,3.
However I think that it is important to note that this is a phenomenon that is
being seen in every aspect of health care. This deficit is more noticeable in
home care because the gap between need and funding is more substantial that in
other areas of the health care system1,2,3. One thing that is largely forgotten in the
debate over home care is that it is a part of the larger health care system. I
do not think that its benefits can be looked at individually because it is not
an individual entity. The more important point to examine is: are
the health care systems that include universal, comprehensive home care systems
as a part of their larger health system more efficient? This efficiency should
not be looked at in terms of finances alone, but also in terms of client
outcomes and overall population health. I think that by compartmentalizing the
health care system into acute care or long term care or preventative health or
home care and looking at the effectiveness of any one component alone is naive.
Without one the others could not function. This is one of the major reasons why
it is so difficult to implement change. We want to look at each component
separately, but our health care system does not function that way. Sources: 1) Home Care in 2) Home Telehealth. Retrieved from
http://www.fp.ucalgary.ca/telehealth/02-01-Alberta%20Home%20Telehealth%20Analysis-HTUSRF.pdf 3) Home and Community Care in |
| UTILIZE LEVELS OF CARE APPROPRIATE TO CONDITION WHERE PATIENTSâ NEEDS CAN BE MET BY OTHER THAN ACUTE HOSPITAL INPATIENT SERVICES. FACILITATE SEEMLESS PATIENT FLOW BETWEEN LEVELS OF CARE. Eric Odell Posted: 2009-03-27 12:37:54 For less than the average daily cost of caring for a patient in an acute bed, quite extensive support can be provided through in-home support, preferably, or in a sub-acute care facility when the needs are beyond those that can be practically met in the home. Multiple levels of care within the same complex facilitates the individualâs care to be adjusted to needs without transfer to another strange facility. Visualize a couple entering an assisted living facility, one of them later needing a higher level of care; both being able to stay in close contact |
| bigger picture grateful Posted: 2009-02-28 14:30:39 The definition of "home" must be looked at. In this country much of our urban, and rural, development is structured as this: single family homes here, apartment buildings there, longterm care institutions along the major roads. Many, many Canadians stay in their homes longer than they should because there are no other options in their communities. When someone becomes ill and is admitted to hospital they can not return "home" because home is inaccessible and without supports. There must be more quality housing options for those who can no longer manage in the family home before the crisis hits and the person is faced with being "placed". Give more options for the elderly and disabled to chose the "place" in which they live. Clustered living would also make the delivery of home care services more efficient. The March of Dimes model is worth exploring. The solution is in changing the model of health care, not in changing how we work within the current model. |
| Home Care Judy Posted: 2009-02-27 01:14:01 Home care can improve quality of service. Currently I am using home IV treatment in Alberta. The advantages are: no travelling time for patient (although there is travel time for nurse for set up); if health is fragile, helps to prevent possible falls/injuries while travelling to hospitals for treatment especially during winter seasons; opportunity to do work/chores while at home vs. sitting in uncomfortable chairs sitting in hospitals while IV treatments going on. Currently the main disadvantage is that if you go to the hospital costs are covered by Alberta Health Care while home care costs patients 25% of the costs. Depending upon financial situation, that could become onerous. |
| Home Care Marjorie Cheng Posted: 2009-02-26 23:51:07 Why is family member excluded from being pay to provide care in keeping the sick person living at home? I can see there needs to be accountability in place to ensure there is no abuse of the fund and the care is being perform. A public awareness promotion of what home care giver 'look-like' would encourage more people to see the work as a career. |
| smaller "group" home style settings are needed realist Posted: 2009-02-24 15:50:10 I agee with Larry on all points. In Canada, where there are often large geographic distances for health care workers to travel from patient to patient it makes more sense to have smaller "group" homes rather than institutional settings. Say for instance, aging friends could get together and stay in a home set up for 3-8 people with a nurse connected in some way and with a caregiver whose fees could be covered by the group. Institutions tend to be very impersonal. Patients able to stay in a smaller home like setting would have companionship and a sense of home and better quality of life. |
| Planning for Future Needs Larry Waldron Posted: 2009-02-24 13:25:13 As the closest family member, who is the primary personal support worker for my father, who suffered a stroke about a year ago, I can say that strenghthening home care is going to need to happen as our population ages. We can't keep raising the percentage spent on health care above the 40% of Gov't revenues and expect to the status to remain the same. We will have more people needing care and fewer people paying for it in their earning years. More of the costs will have to be borne by the individual, much like retirement funding, which is a mixture of gov't assistance and retirement funds a person has put away. As a Long Term Care Insurance Specialist, I meet with people every day to educate them on Long Term Care and their options. You can either self fund them or purchase insurance (if you qualify). The majority of people have no plan in this regard and most have never talked to their spouse or children about who will look after them when they need it. I think there needs to be more education on care planning. In most cases people don't wake up to the problem until they have a personal experience which then necesitates a sometimes shortsighted or panic response. I'm not sure at this point how this education should take place or where but it might help in the long run. |
| Informal care givers need care too EpiResearcher Posted: 2009-02-23 14:22:49 You state in the post that after considering the costs of informal care givers, home care is still cost effective. However, there are many 'hidden' costs of informal care giving that fall on the care givers, care receivers, employers of care givers and society at large that must be considered. For instance, often care givers have costs in terms of time away from work, or restructuring of work hours which are also costs for their employers. In addition, there are emotional and physical costs on care givers and care receivers which can strain relationships and in the worst case result in neglect or abuse. (See for instance, Fast et al; Journal of Family and Economic Issues, 1999.) If home care becomes a fixture of the Canadian health care system it will be vitally important to provide support systems for both care givers and receivers, especially options for allowing care givers/receivers to take temporary breaks from home care (ex short term institutional care, or more intensive community nursing support on a temporary basis) and options for emotional and social support of all involved. I think the remote monitoring program in New Brunswick sounds like an excellent program, but it should be combined with support for informal care givers. Having a family member requiring care takes and an emotional, physical and financial toll and the support needs of people closest to the patient should also be considered. |
| stay at home Christinel Posted: 2009-02-23 13:03:04 I work in a nursing home and I can say for sure that home care should be preferred to any institutionalisation. Many elderlies feel as if they are left behind and dismissed when they enter a nursing home. It doesn't matter the amount of care they receive; anyone working in this environment could tell. Some will argue that staying at home is dangerous for most. The fact is that losing their independence almost entirely sometimes years before they pass is a small death in and of itself. Home care may seem like a big challenge but in reality 1 out of 2 workers in institutions would much prefer caring for people at home. The only reason it is not so is a lack of will from the governments and health care system. Knowing that it also makes sense economically makes one wonder why there would be such a resistance to home care. I believe that no matter the possible challenges of changing the system, if it is done everyone will benefit in the end. As far as the electronic monitoring, even if I see the practical side of it, I think that more should be done to give people a personalized care so that they'll feel confident that they are safe in their own homes instead of chosing institutions just because they or their families are scared of the consequences of staying at home. |
| Great value pfezziwig Posted: 2009-02-23 12:28:04 I've seen home care first hand for my mother, after she was diagnosed with cancer. The services were amazing and she stayed in her home until the last days, which is what she preferred. Most of the workers that visited were amazing too, great positive attitudes. Can you blame any senior for wanting to stay at home instead? Most long term hospital facilities are as warm and inviting as a Russian prison, most of them are truly horrible and depressing. Staff, HealthcareReviews.com |
| I don't know The Hawk Posted: 2009-02-23 11:50:27 I don't know enough about this topic to answer except that it is intuitive to say yes. |
| Improve Home Care Eileen Ellis Posted: 2009-02-23 09:04:49 I do believe strenthening home care can save money and improve quality of care. Having worked in both home care and hospital environments, I have seen many situations that could be improved upon. I think having a more aggressive, focussed home care team at the hospitals would be a first step.There are numerous patients in the hospital that are awaiting placement at nursing homes and discharge home, with home care support. A lot of the time the patient has been given options as to where they want to go and they are not happy with the nursing home made available to them, so they are allowed to stay at the hospital, with an added fee, until a bed is found, that is suitable. The fee is a pittance compared to the cost of the hospitalization. We all know that if they get into a nursing home, chances of moving to another one that is better liked by them, is near impossible. More interrum beds would help. |
