Cottage Industry No More
Is homecare the medical career of the future?

Homecare is important work. The array of medical and support services homecare workers provide to incapacitated Canadians and their caregivers in their homes enable patients to remain at home with safety and dignity, rather than moving to a new and often costly venue, such as a hospital or long-term care facility.

Whether you refer to it as community-based care, ambulatory care or homecare, its primary clients are people of all ages living with debilitating conditions such as congestive heart disease, kidney disease, cancer, diabetes, respiratory disease or genetic or acquired disabilities. Other clients require care at home after being discharged from a nursing home or hospital, after same-day or out-patient surgery, or after giving birth.

Homecare services, along with the above community-based services, help support the more than 2.8 million family and volunteer caregivers who make up the majority of unofficial homecare workers in Canada. Increasing numbers of Canadians are taking advantage of public ambulatory care services which are available in every province and territory, and many more utilize private care.

Paid homecare workers, or Personal Support Workers (PSWs), run the gamut from nurses, social workers, nutritionists and dieticians to occupational, speech, respiratory and physiotherapists and workers who provide home support (homemaking, personal care, meal services, minor home repair and maintenance) or social contact services (friendly visiting, telephone reassurance).

By providing a daily check-up for home-bound patients, assisting them with daily hygiene and nutrition, and even performing light housekeeping duties, these specialists are a godsend to family caregivers, not to mention a boon for the patients themselves.

The need for community-based medical care is growing by leaps and bounds. Over the next twenty years, the senior population will boom, and this, coupled with the high life expectancy we enjoy in this country, means significant added stress on a healthcare system that many feel is already failing to meet our needs.

Provincial departments of health are making ends meet by reducing the length of patients' hospital stays, increasing outpatient surgery and early discharges, and reducing the number of long-term and acute-care beds. This means that patients are habitually sent home while still in need of the medical care that used to be provided in hospitals and this is where homecare services come in.

Luckily, there have been significant improvements in home-based medical technology, such as dialysis and CADD pumps, not to mention information management systems for community care, which make it easier to provide continuity of care from the institutional to the home setting.

The growing need for these complex home-based medical services has proven to be an overwhelming challenge for the publicly funded homecare system. Faced with increased and immediate demand, even the federal government's three-year provision of $50 million per year for pilot projects is inadequate, according to the Canadian Home Care Association (CHCA), a national organization representing publicly funded homecare programs, non-for profit and proprietary homecare provider agencies and interested individuals.

In fact, at $2.1 billion a year, community care expenditures represent just four percent of all public health spending. The CHCA believes that only by drastically increasing healthcare funding will the government ensure the development of homecare programs that function as an essential part of the country's health system.

Furthermore, argues the Canadian Nurses Association, a federation of Canada's 11 nurses organizations, the federal government needs to provide leadership in establishing a national homecare initiative which would provide consistency to the patchwork of local programs currently available across the country.

Until that day, however, private homecare services are picking up the slack. While publicly funded agencies employ community care workers in provincial and territorial departments of health and social services, as well as in community or regional health boards, private agencies also hire large numbers of medical and social work professionals to provide homecare services to clients and their families for a fee.

As a result, the ambulatory care job market is changing. Not only are more jobs becoming available through private agencies, but these jobs are being filled by more highly skilled staff who are trained in operating advanced homecare equipment and/or information systems for case management, assessment and referral. Where basic qualifications were adequate in the past, these positions now require applicants to have a relevant certificate, diploma, or degree – many of which are offered by community and career colleges across Canada through one year programs. Those that do become certified and enter this field in the near future will enjoy the benefits of early advancement and seniority as homecare becomes more popular and competitive.

This branch of medical care has its own rewards. Homecare workers are proud of conferring dignity to their patients. Patients appreciate the personalized care as well as the autonomy they retain by remaining at home. And, not surprisingly, families are ever-grateful for the skilled care homecare workers provide their ailing fathers and grandmothers.

What's more, homecare services are currently in transition. It may be a few years before the industry fully comes into its own. But make no mistake, in time, community-based care will emerge as a leading force in the modernization of Canada's healthcare system. And when it does, increased prestige will likely follow for its specialized therapists, technicians and associated homecare workers.