Enhanced home care could better match seniors' needs, report says

More than 20 per cent of Canadian seniors who go into residential care might have been able to stay at home with supports, according to a new report.

There are currently 2.6 million people in Canada aged 75 or older, about seven per cent of the country's population. These seniors tend to rely heaviest on health-care services, and their ranks are expected to more than double over the next 20 years, from 2.6 million to 5.7 million, the Canadian Institute for Health Information says.

The institute released its report, Seniors in Transition: Exploring Pathways Across the Care Continuum, on Tuesday.

The report's authors found that after an initial assessment, about one in five (22 per cent) individuals who enter residential care (also known as long-term care) with round-the-clock nursing supports resemble their peers in the community and might have been able to be supported in home care.

After considering seniors who could have delayed or avoided admission to residential care with community-based supports, the ratio increased to about one in three or 30 per cent.

"There is significant opportunity to match care needs and care settings," said Steve Atkinson, the institute's manager of analytics and special projects in Victoria.

The intention isn't to fault seniors as being in the wrong place at the wrong time, Atkinson said. Rather, it's to illuminate opportunities to ensure the sustainability of health-care systems.

Greater independence

Typically, seniors who could be accommodated with home care might need light help with activities such as meal preparation and transportation. They generally have no cognitive impairments or early signs.

Seniors often say they prefer to live in their own home, Atkinson said. Having home care services that match their needs could allow greater independence.

The report's authors said their analysis raises questions about what supports and services are needed to allow individuals to stay in the community longer. The solutions are likely regional or jurisdictional, Atkinson said, noting there is no uniform standard for home care and residential services.

"Using existing resources effectively and efficiently — without compromising care quality, timeliness and outcomes — is what health organizations across the country are striving for," the report's authors said.

Atkinson said there could be "profound savings" by supporting an individual in the community for two or three months more. For instance, delaying entry by just one month to a health system with 30,000 residential care beds and an average length of stay of 20 months would allow the system to serve nearly 1,000 more people.

The authors found various factors influenced admission to residential care after an initial assessment:

• The need for extensive physical assistance.
• Moderate cognitive impairment.
• Wandering behaviour.
• Living alone.
• A caregiver who is unable to continue providing assistance.

The authors said there are innovative approaches being introduced across the country to meet client and caregiver needs in the home. Atkinson pointed to the potential of new technologies such as video visits with care providers and clinicians to monitor the health of people at home.