by Healthy Living Magazine

There is a general myth that if you live long enough, you will end up in a nursing home. Institutionalizing seniors is actually a relatively new phenomenon, one that has grown tremendously with urbanization. Long before the advent of nursing homes, seniors were primarily cared for at home by family members. However, with the changes in social and economic dynamics, home care has evolved, and although family members still play a major role, there are many more types and sources of home care than in the past.

Why Home Care?

• Home is where the heart is. Home has such positive associations. When we are feeling ill, we go home. When we are feeling well, we enjoy the sanctity of our residences and the joy of being with our loved ones.
• Living at home keeps the elderly independent. None of us wants to be totally dependent and helpless. With some assistance, seniors can continue to function as viable members of society.
• It promotes health and well-being. Seniors who live at home are less likely to acquire infections and other complications that they would normally pick up while living in a group setting.
• Individuals are allowed the maximum amount of freedom. Nursing homes and other institutions offer more regimented, regulated environments. Care at home takes place in an individualized, familiar setting.
• Personalized care is delivered one-on-one. Home care is tailored to the daily needs of the family and the individual, whether they are as simple as having a companion or as complex as personal care. There is also no “waiting for one’s turn” when care is needed.
• It does not require an initial major commitment or decision. Home care is flexible and does not involve any major life changes (like moving or selling your house).

What is Home Care?

The two most common types of home care service are:

• Homemaking and personal support services
• Health professional services

However, other specialized services are available for seniors in their homes. These include:

• Wheelchair accessible transportation
• Foot care services
• Meal delivery (e.g., meals on wheels)
• Emergency response (e.g., Lifeline)
• Professional hairdressing
• Home maintenance (e.g., snow removal)
• Security checks/reassurance
• Friendly visiting

In addition, there are also community-based services for seniors living at home. These services are almost exclusively provided by not-for-profit organizations and include:

• Adult day programs. These programs consist of structured and supervised recreation and physical activities for seniors who need care and support. Meals and transportation are usually provided.
• Congregate dining programs. Meals are offered in a dining hall for a group of seniors. Transportation is generally available to and from the facility.
• Shopping trips and outings. Transportation is provided to supermarkets, malls, etc. at specific dates and times.

Homemaking & Personal Support

Most seniors can continue living at home independently for a long time if they have assistance with activities of daily living. Such activities include:

Homemaking

• House cleaning
• Laundry
• Shopping
• Paying bills
• Preparing meals

Personal Support

• Personal hygiene care
• Assistance with transfers
• Eating
• Toileting
• Escort to appointments

Health Professional Services

Health professional services are offered by nurses, physiotherapists, occupational therapists, social workers, dietitians and social service workers. They are provided temporarily if one is recovering from hospitalisation, or on an ongoing basis if one needs continual help because of an illness, chronic condition or injury.

Who Provides Home Care Services?

The Provincial Government
Among other things, Community Care Access Centres (CCACs) coordinate health care services for seniors and people with disabilities who need help living independently.

There is no charge for home care services that are offered by CCACs, but like everything else, these resources are limited. Eligibility is based on need and is determined by an assessment. CCACs will also direct clients to not-for-profit or private services in the community.

Recipients of home care services through CCACs cannot select the company that provides the care or the caregiver assigned, and generally cannot choose when they receive service.

Not-for-Profit Organizations
These organizations are community based and provide a range of homemaking and personal support services. Many also offer meals on wheels, community dining, adult day care programs, and transportation to doctor’s appointments.

Not-for-profit organizations charge for their services, though some of them are subsidized.

Unlike private companies, not-for-profits cannot offer flexible scheduling, choice of caregivers, etc.

Private Companies
Some private for-profit companies provide specialized services such as wheelchair accessible transportation or meal delivery. The majority, however, are home care agencies that boast a wide range of homemaking and personal care options. Some homecare agencies also offer limited health professional services (e.g., physiotherapy and nursing).

Private Individuals
Due to their limited resources and/or lack of flexible options, CCACs and not-for-profit organizations cannot meet the demands of everyone who requires home care. Where alternate or supplementary care is required, many families will consider hiring private individuals for cost effectiveness, rather than working with a reputable agency. A poll by the Ontario Home Care Association (OHCA) in 2010 showed that 65% of respondents were either unaware or unsure of the risks inherent in directly hiring an individual to provide care.

The decision to purchase care should be made as carefully as the decision to purchase any other service. Some of the key advantages of hiring an agency over a private individual are:

• Selection: A homecare agency will only recruit staff with the proper training, qualifications and temperament. They will ensure that candidates are legally entitled to work in Canada, do reference and background checks and verify personal identification and credentials.
• Supervision & Education: Job descriptions, ongoing education, and training on tasks specific to an individual’s needs are essential for all caregivers, especially in a home setting. An Agency will work with the family to develop a plan of care. They will also have policies and procedures in place to prevent senior abuse.
• Financial Reporting: The onus of ensuring tax obligations falls on the employer. A reputable homecare agency will follow the reporting requirements, make the requisite employee deductions and submit the appropriate filings on a timely basis.
• Coordination of Care: Care needs can change frequently. Home care agencies can increase or decrease the level of service at short notice and are responsible for covering unexpected personnel absences (sick days, vacations, etc.) thereby ensuring seamless caregiving support. Homecare agencies also have ready access to medical equipment, healthcare providers, including CCACs, and other professionals if required.
• Staff Liability Coverage: Guarding against injury to staff and maintaining appropriate workers’ compensation insurance are critical, as caregiving tasks often include lifting, transferring or bathing and OHIP does not cover workplace injuries. Reputable homecare agencies also ensure that their workers are bonded in the event of theft. Other legal issues such as human rights complaints against wrongful dismissal are also the responsibility of the home care agency.

When seeking help with home care, it is wise to choose reputable organizations that guarantee a high standard of service provision. By choosing a homecare agency, families can minimize their workload, mitigate potential threats, and spend more quality time with their elderly loved ones.  

Opal Rowe, MSc, MBA, CPCA is Director of Living Assistance Services, GTA North.