Cascading health care cuts are resulting in significant problems for home care patients and their families, seriously undermining the main defense the government makes for its policy of hospital and long-term care cutbacks. With hospital cutbacks …Continue reading
With hospital cutbacks and a virtual freeze on long-term care beds, home care and unpaid caregivers must now take care of sicker and sicker patients. This change in home care has been sudden and dramatic, as demonstrated in the graph below from the the Ontario Association of Community Care Access Centres (the OACCAC represents the public sector organizations which manage home care for the government).
The OACCAC estimates cost pressures of about 5% per year to offset demographic changes and for the absorption of patients that would otherwise have been treated in hospitals or long-term care. The OACCAC adds that funding has fallen short of that level in recent years, reducing care.
- Among patients with moderately severe to very severe impairment in cognitive abilities, 54.5% had caregivers who were distressed.
- When patients needed extensive assistance with or were dependent in some activities of daily living, 48.7% had distressed caregivers.
- When patients were at the two most severe levels of health instability, 56.1% had caregivers who were distressed.
- Those who had Alzheimer’s or other forms of dementia increased to 28.6% from 19.5%
- Those with mild to very severe cognitive impairment increased to 62.2% from 38.1%
- Those experiencing moderate to very severe impairment in ability to perform activities of daily living such as washing their face or eating increased to 44.5% from 27.6%
- Those with slightly to highly unstable health conditions associated with greater risk of hospitalization or death increased to 43.2% from 27.3%
- The patients averaged a year and a half older than in 2009/10, increasing from 77.4 years to 78.9 years.
- On average, patients whose caregivers experienced distress received 31.5 hours per week of care from those caregivers, compared to the 17.1 hours per week received by patients whose caregivers were not distressed.
The home care patients are much sicker than they were only a few years ago, increasing the burden for the unpaid caregivers. The result for the unpaid caregivers — usually women — is increasing distress, anger and depression, with a significant portion unable to continue. More paid hours for PSWs and other home care workers is obviously part of the solution.
The study — released by the government sponsored organization Health Quality Ontario — does not specifically connect this “perfect storm” to the ongoing health care cuts. But it is clear those cuts are driving sicker patients to home care and unpaid caregivers — and now we know those women caregivers are basically being thrown under the bus.
The main government response to the cuts in hospital and long-term care is to suggest that they are doing more in home and community care. This study suggests this response has big problems.
Update May 16, 2017: A new study published by the New England Journal of Medicine and funded by the Canadian Institute of Health Research, the Ontario Academic Health Science Centre, the Ministry of Health, and the University of Toronto also shows major problems for caregivers. Specifically, in this case, very high levels of depression among caregivers (who were mostly women) of patients who survived a critical illness.
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