There is such misunderstanding about home care services across Canada. For decades now, most government home care programs in Canada work in partnership with private service provider organizations to deliver home care services under contractual agreements. The government typically provides the same rates for services to all providers, whether they are private, not for profit, or one of the many religious organizations providing care. The requirements for a standard of quality service and adherence to contractual obligations are the same across all providers.
Public home care programs (either directly under provincial governments or through regional health authorities such as Alberta Health Services or Community Care Access Centers in Ontario) set the standards. The services are prescribed by case managers, employed by the publicly funded home care program, after they do a client assessment and determine needs from the home care program. Service provider agencies whether private, not for profit, or religion-based, do not make decisions on the amount of care clients receive, the type of services that will be provided or the level of care provider, such as a nurse or a health care aide. These decisions are the responsibility of the case manager who creates the care plan and services to be provided, best done in consultation and collaboration with the client and family.
All government funded service providers across Canada are expected to provide a high quality of service in accordance with the established care plan. Many service provider organizations are accredited and have proven quality standards. Research has shown that the status (private, not for profit, religion-based) has no bearing on the quality of care provided. This is the case in long-term care homes as well. Misinformation is perpetuated by folks poorly informed about service delivery. I witnessed evidence of this recently in newspaper articles and social media posts informed by different organizations including the Nova Scotia Nurses Union. Misinformation is nothing more than fear mongering and, generally speaking, it frightens an ill-formed public when it comes to home care.
Governments (health ministries) set standards and regulate the services clients receive. Service delivery has been, and will undoubtedly continue to be, effectively delivered using a variety of options including not for profit, religion-based, private, and public providers across Canada. Speaking about Nova Scotia specifically, as at the time of this writing, they were in the process of tendering for a broader range of home care providers, Nova Scotia would do well to consider a variety of home care service delivery providers for Nova Scotians including private services.
The fundamental issue that continues to get overlooked when the public versus private debate ensues, is that home care is grossly underfunded in most provinces in Canada. Service providers, regardless of type of organization structure, have no say whatsoever within the current home care landscape on a) the volume of services provided, b) the type of services delivered, or c) the type of provider (personal support worker, health care aide, licensed practical nurse, or registered nurse) providing them. Nor should they make these decisions in my opinion. Those decisions should remain within the responsibility of case managers, with appropriate levels of education and support, with the public home care program.
Home care, its services, and its processes are not easily uncovered. It is imperative that Canadians are informed on what home care is and what it isn’t. Blaming various providers for insufficient funding and inflexible services will not move the fundamental issue forward. If organizations such as the Nova Scotia Nurses Union you want to encourage a letter writing campaign to MLAs let it be about the right issues: more funding for home care, re-direct funding from some acute care to community, more funding into health promotion and prevention and importantly—much more recognition, support, and programs to meet the needs of the 8 million family caregivers who are providing billions of dollars worth of care and support in the home across every Canadian province. If we really care about improving home care and increasing support for home care recipients and their family caregivers, a unified voice pushing for the right solutions for Canadians receiving home care is paramount!!
PS I posted much of this on facebook a number of months ago and was so encouraged by the comments I received. It will take much more targeted advocacy and political action to make home care better for Canadians and family caregivers around the globe!
