Canada’s Home First and Home Care Programs
As Canada’s senior population grows and lives longer, the healthcare system is working to care for older adults who need long-term care (LTC) services after hospitalization for an illness or injury, even as the demand for beds in LTC facilities grows. Sometimes, seniors learn they need LTC care just before hospital discharge, when there may not be much time to visit facilities, get on wait lists, or make such a major decision.
The solution that’s gaining ground is to transition seniors from hospital to home and then provide in-home LTC services until a bed in a facility is available—or to simply continue those services at home. It’s an approach that suits seniors who want to remain at home or who face long wait times for an LTC bed, and it usually costs less than care administered in a long-term care facility.
The Home First initiative
The best known of these transitional care programs is Mississauga Halton Community Care Access Centre’s Home First programs, available to all adults with Ontario Health Insurance Program (OHIP) coverage and a physician referral. Since 2007, the program has arranged home care for seniors before their hospital discharge, provided a safe transfer back home, and provided the appropriate level of care—either until an LTC bed is available or permanently in the home.
The Home First model includes 3 components—the Wait at Home program of daily living, errand, and social support; the enhanced Wait at Home program that includes as many as 56 hours per week of personal support for seniors who need more help; and the Stay at Home program to help seniors delay or eliminate the need for LTC placement. This approach benefits seniors and their families in several ways:
- Seniors get the care they need while they and their loved ones make a decision about whether or not to move to an LTC community.
- Seniors who decide to make the move can wait safely at home, rather than in hospital, until a spot is available to them.
- Seniors who decide to remain at home after returning from hospital can work out a care plan with the CCAC to make that possible.
- The Home First approach takes the pressure off family members to serve as full-time caregivers when an older relative is recovering from sickness or surgery, and it ensures that seniors without family caregivers are safe at home.
The Canadian Home Care Association trade group has found that Mississauga Halton CCAC’s has reduced the amount of time seniors spend in hospital, reduced return visits to the emergency room after hospital discharge, and has allowed more seniors to age at home.
Wait-at-home services in other provinces and territories
Other provincial and territorial health ministries are moving toward the home-instead model for senior care as well. While not every province and territory has a program specifically dedicated to post-hospital home support, all territories and provinces do provide home care services for qualified seniors in need.
Alberta is implementing age-friendly community features, as it expects seniors to make up at least 20% of the province’s population by 2031. One of the components of the plan is an emphasis on aging in place, including home living services that can be accessed by self-referral or a referral by family members or healthcare providers.
In British Columbia, all 5 health authorities have been implementing the province’s Home is Best/Home First model of care for seniors since 2013, after pilot programs showed a 25% reduction in senior trips to the emergency department and 30% less acute care use.
Manitoba has long been at the leading edge of home care services for seniors and other residents. The province’s Home Care Program was founded in 1974 and is available in many forms, such as in combination with private care services or family-provided care, to help seniors live safely at home whenever possible. The Long Term and Continuing Care Association of Manitoba can help seniors and their families evaluate and choose from the available care options.
New Brunswick, which has a high percentage of over-65 residents, has also adopted the Home First approach to senior care. Since 2013 the province has worked to coordinate case management and make the system easier for seniors and their families to navigate. The New Brunswick approach includes the establishment of more senior centres for health and wellness programs, in-home care services for seniors returning home from hospital, a new home-based palliative care strategy, and expansion of the health department’s Quick Response Home Care services, and a broader network of referrers to encourage use of the provincial Extra-Mural Program for home-based health care.
Newfoundland and Labrador
Long-term care and community support services in Newfoundland and Labrador include home health services for seniors who are recovering at home after hospital stays. Home support services include homemaking, respite, and personal care services designed to assist family and hired private caregivers. Seniors with special health needs may receive durable medical equipment and supplies as part of the Special Assistance Program. Other programs may be available through the province’s regional health authorities.
The Northwest Territories’ 2014 strategic framework for elder care focuses on aging in place, in part due to demand from seniors for at-home services and in part due to the fact that the territories’ senior population growth is outpacing all other age groups and outstripping the available LTC facilities. Current priorities include:
- promoting fitness and health, including fall prevention and elder abuse prevention.
- developing a broader, customizable array of home health and social services, including transportation and multi-language services.
- streamlining care transitions for seniors and improving communication among caregivers.
- increasing respite care options and other support services for family caregivers.
- increasing access to buildings and transportation for mobility-impaired seniors.
- raising awareness of the resources available to seniors and their families.
In March 2015, the Northwest Territories Senior Society released an updated 93-page Seniors Information Handbook that includes information on home and community care, community and aboriginal health services, housing, emergency assistance, and other resources.
Live Well at Home is the name of Nova Scotia’s umbrella program for aging in place. Home care services for seniors in Nova Scotia are supplemental and include personal and nursing care as well as palliative home care for hospice patients. Other supports include loans for durable medical equipment, discounts on personal emergency response systems, affordable respite care, and benefits for family care providers. The province also provides home care services for registered, on-Reserve First Nations seniors through the Aboriginal Continuing Care program.
In Nunavut, the Home and Community Care program (HCC) provides in-home assessments of senior health care needs upon request for anyone enrolled in the Nunavut Health Care Plan. Services may include homemaking, nursing and personal care, rehabilitation services, and respite care for family caregivers.
Prince Edward Island
Health PEI provides home care services for Prince Edward Island seniors returning from hospital who wish to remain at home or who are waiting for a long-term care placement. PEI’s home care services include therapy, daily activity help, counseling, nursing care, and transport to adult day programs, along with other services as needed. Seniors and their families can access the Home Care program by self-referring or by getting a referral from their family doctor.
Home care support services in Quebec are designed to ease the transition from hospital to home and to avoid or reduce future hospitalizations. Local community service centres are the contact points for seniors and family members. Among the available services are home medical, therapy, nursing, and counseling; personal care and social services; and medical supplies and equipment. Family caregivers may also be eligible for counseling and respite care through the home care support program.
Saskatchewan’s senior home care services are designed to reduce or prevent hospitalizations. Based on an assessment by the nearest regional health office, seniors may be eligible for in-home nursing care, case management, housekeeping, meal delivery, friendly visitor programs, and more. Seniors who wish to stay at home rather than move to an LTC for care may qualify for individualized funding, which can be spent on certain home care services chosen by seniors or their families.
Yukoners who are covered by the territory’s health insurance plan can self-refer or refer covered family members for continuing care services, in Whitehorse and in communities across the Yukon Territory. These include home care for seniors who need assistance with activities of daily living, mobility, or chronic health condition management; therapeutic services; respite care services for family and friends caring for loved ones; and home-based palliative care.
For seniors preparing to come home from hospital and their families, contacting these resources is the first step to getting the help you need at home while you decide whether and when to transition to a long-term care home. And for seniors and caregivers who aren’t dealing with hospitalization, getting in touch with these programs now can help prevent emergency department visits, hospital stays, and caregiver burnout later on—all while keeping seniors safer and healthier at home.