The critical issue of funding home care

After promising during the election campaign to inject $3 billion into home care, the Liberals’ first budget did not deliver.

“Why are Liberals abandoning their promise to invest in home care when this money is so badly needed?” asked NDP health critic Don Davies in Question Period on March 24.

A discussion about home care is timely because, for the first time, there are more Canadians aged 65 and over than there are under the age of 15, according to Statistics Canada. “It’s an obvious demonstration that the population is getting older on average,” said Laurent Martel, the chief of the demographic analysis and projections section at Statistics Canada.

It’s a challenge to meet the demand for home care services from Canada’s aging population, says Davies. But home care services could keep many elderly people out of hospital “which will result in less costs for the health care system,” says Chris Kuchiak, the Manager of Health Expenditures at the Canadian Institute for Health Information.

Currently, 29 per cent of Canada’s health care spending is allocated to hospitals with most of that devoted to salaries for doctors and nurses.

Where do Canada’s healthcare dollars go?

Source: Canadian Institute for Health Information

In its platform, the Liberal government made a promise to fund home care. “As an immediate commitment, we will invest $3 billion, over the next four years, to deliver more and better home care services for all Canadians. This includes more access to high quality in-home caregivers, financial supports for family care, and, when necessary, palliative care.”

Prime Minister Justin Trudeau also made mention of this promise in the mandate letter to the Minister of Health, Jane Philpott, which instructed her to “engage provinces and territories” to develop a multi-year health accord. That accord would consist of a funding agreement that would support and improve access to home care and palliative care.

The 2004 health accord, an agreement between the provinces, territories, and federal government that gave the provinces funding and sets national standards, expired  in 2014.

Five months after the election, there still is no money. Budget 2016, released on March 22, recognizes the need for home care services. “While Canada’s health care system has served Canadians well, it must be strengthened to better meet the needs of patients as changes in demographics… continue to shift the delivery of care into homes and communities.”

There has been some progress towards a new health accord. According to Sylwia Kryzszton, a representative from Health Canada, the federal, provincial and territorial (FTP) ministers of health met in January 2016, and they plan to meet again in mid-2016 to discuss “next steps” toward creating a new health accord.

Some think that with a new health accord, the $3 billion investment in home care will come.

While the federal government has started to talk about a new health accord with the provinces, it remains unclear how, and under what conditions, the $3 billion will be dispersed among the provinces – if the promise is still to be kept.

Currently, the federal government transfers funds to the provinces by means of the Canada Health Transfer. According to Budget 2016, funds will increase to $36.1 billion in the coming year.

Canadian Health Transfer (CHT) over the years

Dr. Cindy Forbes, president of the Canadian Medical Association highlighted this issue in her organization’s  pre-budget recommendations.  “The limited availability of publicly-funded home and long-term care is hurting quality of care of our patients and the efficiency of the health care system,” says a CMA report.

The CMA is advocating for an equal transfer of funds on a per-capita basis due to the fact the Canadian health transfer currently does not account for population segments with increased health needs, specifically seniors. The CMA recommends a $1.6-billion boost in funding for all federal money to provinces for health.

Spending on seniors

NDP health critic Davies thinks that this money is a good start, but it will prove to an “insufficient amount to make a good dent” due to the significant number of Canadian seniors needed home care services in the coming years.

Davies, who has participated in the federal provincial health accord meetings, thinks that federal transfers to the provinces should be conditional, based on the provinces meeting specific targets with measurable outcomes. Therefore, he says, the government could require the provinces to use federal money in specific areas, such as home care.

“When you give money, you have the ability to incentivize that money should be used for certain targets. I think when it comes to home care and community care, the federal government should do that,” says Davies.

Front Page Photo and Header Ⓒ Veronica Green