The Evidence Is In… It’s Time to Act on Homecare

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Pat Armstrong

Almost five years after the last Commission on health care recommended the federal government and the provinces establish a Canada-wide homecare program as an urgent priority, Canadians are still waiting.

Too many Canadians, mostly women, are left with nowhere to turn when a parent can no longer care for themselves, or a disabled child requires their full attention around the clock every day without a break—a real example of the 24/7/365 work world. With little recognition, no pay, and with almost no outside support or training, the toll of caring increases with every passing year.

In spite of wide recognition of the problem and the solution, there has been no response. So, why the delay?

Could it be that we simply don’t have enough solid research to support the move to homecare? The answer is clearly no. We know more about homecare and the consequences of being without a system than we know about most things government spend millions on.

Hundreds of studies and research reports have been produced. Dozens of surveys, roundtables, focus groups have been conducted. Taken together they paint a picture of a costly problem that is shouldered primarily by Canadian women. Consider:

  • 80% of paid and unpaid caregivers are women

  • Caregivers often end up in poor health themselves

  • Caring for others often blocks women from the paid workforce or has other negative life consequences and long-term costs for Canada

  • Although women make many of the daily decisions related to health care, they are only a minority of the policy and management decision makers

  • Women receiving or giving care are subject to violence and other physical risks

Instead of acting on the evidence, decisions taken by governments have made the situation for caregivers and patients worse, not better.

Patients are now ejected from the health system quicker and sicker, conscripting women into delivering ever more complex medical and nursing care at home, even when research shows that these providers have a profound need for training and support.

Homecare and myriad other health care issues are being studied again by new commissions of inquiry launched by Ottawa. Senator Michael Kirby leads one while former Saskatchewan Premier Roy Romanow heads up a second.

Canadians can hope that these separate but similar exercises aren’t covering the same ground. But we should be worried that while these two Honourable gentlemen criss–cross the country, Premiers like Alberta’s Ralph Klein and B.C.’s Gordon Campbell are working to shift more of the burden of health care on to individuals through user fees and privatization of health services.

Dozens of Canada’s leading homecare experts brought together in Charlottetown by the Centres of Excellence for Women’s Health recently reviewed the body of homecare research. Their conclusion: enough evidence exists to design and implement a homecare system that will work and work for women. It’s time to transform the research into government policy and action, while continuing to fill the research gaps that remain.

The experts were able to bridge gaps arising from the diverse interests and experience they each brought to the table. In an example of consensus building the Premiers could well learn from, the experts signed on to a "Declaration on the Right to Care."

The Declaration represents a fresh vision for Canada’s health care system that recognizes the role played by unpaid caregivers, and the interests of patients. It’s a renewed statement of our collective responsibility to each other as Canadian citizens and an articulation of principles that would renew our health care system.

The Declaration states, in part:

"Canadian society has a collective responsibility to ensure universal entitlement to public care throughout life without discrimination as to gender, ability, age, physical location, sexual orientation, socioeconomic and family status or ethnocultural origin. The right to care is a fundamental human right.

"The right to care requires: access to a continuum of appropriate, culturally sensitive services and supports; appropriate conditions; the choice to receive or not to receive, or to provide or not provide unpaid care; access to reasonable alternatives and sufficient information and there is no assumption of unpaid care.

The prescription for a modern health care system that serves the needs of all Canadians is well documented and supported. Action to deliver the homecare services all Canadians desperately need is long past due.

We’re waiting for political will. We cannot afford not to care.

Pat Armstrong, Ph.D. is Chair of the Centres of Excellence for Women’s Health National Coordinating Group on Health Care Reform and Women.

This editorial was originally submitted to major newspapers across Canada. In this issue of the newsletter, the impact of health reform and restructuring is discussed. The CWHN is very interested in hearing from the women’s community. We are maintaining a list of contacts and groups working on health reform issues for women.

An expanded version of the Charlottetown Declaration on the Right to Care with background notes is available at no charge from the CWHN or can be downloaded from the Centres of Excellence web site