Home care is a group of services that allows people with health problems to live as well and as independently as possible, in their own homes and communities. Home care designed to give caregivers a break is called respite care. Palliative care offers nursing care, home support and/or respite for people with a terminal illness and their families.

The care provided at home can come from a number of sources — family members, friends, neighbours, community volunteers, health professionals, paid care workers, government-run and volunteer-run community health and social services agencies and private care agencies. A new and growing source of home care is tele-home care or telehealth, which uses information and communication technologies to deliver patient care at home.

Most home care services are publicly funded but a growing proportion is paid for by private insurance plans, charitable organizations and by individuals out of their own pockets. Patients and families also bear the indirect costs of lost employment opportunities, lost wages, unpaid family labour as well as the psychological, social, physical and economic burdens.

Successful home care:

• delays or eliminates the need for care in a hospital or long-term care institution
• provides preventive medicine
• assists in relieving caregiver stress
• encourages a high degree of participation by the person receiving care
• depends on an informal network of family and friend caregivers

Types of Home Care Services

Professional Nursing and Therapeutic Services
Clinical or specific care provided by registered health care professionals

• nursing care
• physiotherapy
• occupational therapy
• speech therapy
• social work
• nutrition counselling

• intravenous antibiotic therapy
• home chemotherapy
• dialysis
• life support systems
• ventilator assistance
• tube feeding

• Seniors — the main recipients of home care — are living longer with chronic illnesses, disabilities and dementia. The current trend is for seniors to receive care at home instead of being placed in long-term care or chronic care institutions.

• More and more people are receiving at home the kinds of care that used to be provided in hospitals.
  • acute care — for acute illness and recovery from surgery
  • chronic care — for chronic physical illness and functional disabilities
  • outpatient services — physiotherapy, occupational therapy, counselling
  • palliative care — for the terminally ill and dying
  • specialized medical services —chemotherapy, antibiotic intravenous therapy
  • technology-dependent care — home oxygen therapy, dialysis, respiratory therapy

  This is a result of governments' health and social services restructuring which has resulted in fewer hospital beds, shorter hospital stays, outpatient surgery and care as well as the release of chronically and mentally ill people into the community.

  • Families that traditionally provided care and assistance with the activities of daily living are now expected to provide a more sophisticated level of care and manage the various care services provided at home to family members.
  • Extra caregiving demands are being placed on families at a time when fewer women — the traditional family caregivers — are at home full-time to provide care.
  • Long-distance caregiving has become more prevalent now that family members live at greater distances from each other.
  Finding good home care is a challenge.
  • There is no uniformity of service
    Home care is not covered under the Canada Health Act. Home care in Canada is a patchwork quilt of programs and services managed by provincial and territorial governments and delivered by local, regional and municipal authorities. Each has its own definition of home care, its own menu of home care services, its own set of eligibility criteria and its own built-in time limits and/or funding limits for the provision of services.

  • The quality of care varies widely
    There are no national standards for home care. Professional services delivered by doctors, nurses and other health care professionals are covered under the Canada Health Act and these professionals are governed by their regulatory bodies. However, personal care services which used to be supplied by trained nurses, are now handled by a variety of home care aides, attendants and home support workers who may have little or no formal training in health or home care work. Also, imposed time restraints can prevent care workers from fully attending to their clients' needs.

  • Good help is hard to keep
    Many home care workers earn little more than minimum wage, work irregular hours, often under difficult conditions and do not qualify for benefits. Yet they are being asked to perform increasingly complex tasks. Many workers leave home care for more lucrative employment in hospitals and long-term care institutions.

  "Home care is underfunded, undervalued and overstressed." Putting A Face on Home Care, CARP's Report on Home Care in Canada, 1999)
  
  

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