April 15, 2011

CANADA: Private home care fills big service gap for seniors

TORONTO, Ontario / The Globe & Mail / Business / Seniors / April 15, 2011

By Tavia Grant

The signs began to surface a few years ago. Bill Mosdell noticed his elderly mother, Joan, wasn’t the same after the death of her husband of 53 years. She began to live in the past, eat poorly, drink more than usual. It took a year to get a diagnosis: frontal lobe dementia.

Nada Deluca, a nurse with private health care provider Nurse Next Door, helps her patient Joan Mosdell in her Mississauga home.
For The Globe and Mail.

Her son realized he couldn’t keep caring for his 81-year-old mother in their Mississauga home while holding down a full-time job. And the waiting list for a nursing home was three to five years.

So he sought help from Nurse Next Door, a provider of in-home health-care services. A caregiver now spends three full days a week with Ms. Mosdell, allowing her to stay in the comfort of her home and reducing her son’s stress level. But it comes at a steep price: While the provincial government funds four hours of care a week, the three days are paid for from money left by her late husband.

The Mosdells’ story is familiar to a growing number of Canadians. As the country’s population ages and the public health system bursts at the seams, more families are turning to private home-health care – an industry that has seen revenue double to about $6.8-billion since 1999.

That growth began with a trickle of mom-and-pop companies a decade or two ago. Now those firms as well as larger brands such as We Care Home Health Services and Omaha-based Home Instead Senior Care number in the hundreds. They’re all fighting for a piece of a sector that can’t keep up with demand: Ontario has more than 10,000 people on wait lists for home-care services, according to a report last week by the Ontario Health Coalition, and that trend is echoed throughout the country.

Companies are expanding to fill in the cracks. Nurse Next Door, for example, has doubled its number of customers every year for the past three years, and will expand into the United States in the next few months, says Vancouver-based co-founder John DeHart.

And Jeanie Burk, who runs the Halifax-based franchise of Home Instead, says the sector is “recession-proof.” Her company brought in $2-million in revenue last year, its eighth year in operation.

The sector spans services – from registered nurses who provide in-home medical treatment, change dressings and end-of-life care, to personal support workers who help with shopping, meal preparation, bathing, companionship and managing medication dosages. It can be around-the-clock care or a few hours a week. The rates can also vary, from $22 to $27 an hour for a nurse to $12 to $20 for a personal support worker.

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It’s a price more families seem willing to pay. Yet as the industry thrives in Canada, critics say it is doing so in grey territory. It isn’t part of the Health Care Act. It isn’t regulated. Companies can ensure they're up to national standards through Accreditation Canada, though that's largely voluntary outside of Quebec. And the issue has gained little attention in this federal election campaign, though polls show Canadians consistently say health care is their No. 1 priority.

Less than four per cent of overall expenditures go to home health care. Meanwhile, two million family members are acting as informal caregivers, saving the system $25-billion, said John Schram, president-elect of the Canadian Home Care Association and chief executive of We Care. “But they problem is, they burn out and wind up with a medical condition or stress. So that’s where governments have to step up to the plate and pay more attention to this.”

Challenges for the industry loom. One of the top problems many executives cite is finding and retaining workers in an industry with long hours and high burnout rates. Part of the issue might be pay – private home health-care workers typically have more part-time, precarious or casual work, the OHC says.

But the bigger problem is oversight. Health care economist Erin Strumpf of McGill University is one of many who would like to see the sector more closely scrutinized. “If someone’s going to come to your house and do things to you in your house that no one’s around to see, it’s certainly the sort of situation … where there’s scope for regulation,” she said.

As long as the private home care isn’t regulated, that concern will linger – even in the sector itself. “Our industry needs to grow up,” said Nurse Next Door’s Mr. DeHart. “There are no standards in Canada. Anybody can start a home-care company and do literally whatever they want. That’s pretty scary.”

For Ms. Mosdell, the benefits are clear, and she seems at ease with the arrangement. She enjoys playing solitaire on the computer, watching Family Feud and eating the desserts her caregiver, Nada DeLuca, prepares. Sometimes, in the afternoons, they dance around the house.

“She makes my meals. She’s very nice. She gives me a shower and we often go for nice walks,” Ms. Mosdell says.


Percentage of services in the home health-care industry that are offered by private companies.

Percentage of people providing informal care to seniors who say they’re experiencing distress.

Percentage increase of national health-care spending in each year over the past five years.

Percentage of Canadians who care for a seriously ill friend or relative each year, with a fifth of them missing work to do so.

Percentage of Canadians who said in March that home care is important.

Priority ranking of health care for Canadians in recent election-related polls.

Sources: Canadian Medical Association, Nanos Research, Canadian Home Care Association, Ontario Health Coalition, Canadian Institute for Health Information, Health Council of Canada, Conference Board of Canada.

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