The BC Care Providers Association (BCCPA) released a paper earlier this month outlining several approaches to strengthen and sustain BC's home health care sector. While we agree with their "made-in-BC" plan's four key themes: (investing in funding, investing in seniors, fostering innovation, investing in quality) we do not agree with all of the recommendations of the plan and have highlighted some of our concerns below.
"RECOMMENDATION 1: That the BC government establish a permanent Joint Committee on Home Health Care (JCHHC) consisting of the BC Ministry of Health, Health Authorities, service providers and BCCPA to deal with the unique and considerable challenges facing the publicly funded home health care sector."
This recommendation suggests excluding the front-line workers and their organizations from the conversation. Not only do health care unions and front-line workers need to be included in a Joint Committee on Home Health Care, but it should also be expanded to include consumer groups or those who utilize the system. Strong seniors' advocates from groups such as the Council of Senior Citizens' Organization
(COSCO) should also be included in the conversations and planning as well as educators involved in training and continuing education support.
One of the mandates of a Joint Committee like the one outlined in the BCCPA plan could be to create an overarching and meaningful aging at home strategy for BC (which currently does not exist) with particular attention given to planning for professional and coordinated publically funded home support services.
It should also be noted that the current recruitment and retention challenges were created by the bodies named in the recommendation by underfunding wages and benefits for a decade and a half.
"RECOMMENDATION 2: That the BC Ministry of Health undertake an independent and immediate review of home health care funding in order to ensure fairness, and sustainability."
This review must also consider the costs of not improving home care – increased emergency and other acute resources being among them.
"RECOMMENDATION 4: That the BC Ministry of Health develop provincial guidelines in coordination with a public awareness campaign whereby the province funds or offers preventative home health care visits to people 75 and older on a proactive basis (i.e. before they are requested), in order to prevent pre-mature frailty and ensure that seniors are provided with the necessary care as soon as possible."
This is a costly and counterintuitive recommendation, as recommendation #7 prioritizes seniors' quality of life. Prevention can be woven into existing programs and services. The current model integrating health care services in communities and primary care homes is a more reasonable, cost effective and progressive approach.
"RECOMMENDATION 6: That the BC government explore further the appropriateness or feasibility of the care credit model including its limited phased introduction in the home health and long-term care sectors."
This exploration must be independent with a clear mandate to deliver better services as well as client choice. "Client choice" has not been linked to superior outcomes or reduced usage of acute health services when compared to simply giving cash. The extent of these expected results should be examined by the independent review.
"RECOMMENDATION 8: Develop a made in BC quality assurance model in the home health care sector, with a focus on implementing standards to ensure quality across the sector, specifically to support agencies providing privately paid services, as well as helping seniors and families make informed choices about care."
While we agree with developments around quality assurance and standards, many already exist (albeit are fragmented) in the public health sector specifically related to service delivery in public health and home and community care. There needs to be a parallel to ensure that information is accessible to seniors and their families. There also needs to be a cohesive program to help consumers navigate the complexity of the system and understand the processes for raising concerns and complaints when quality assurance falls short and standards are not being met.
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