By: Nancy Pollak
VANCOUVER, B.C: Dwayne Gough, 36, died alone at Christmastime, a victim of the crushing stress on home support in Canada. Gough, a paraplegic, died in his Victoria apartment on December 18, a few weeks after his home support services were completely eliminated. His case is the nightmare that home support workers across Canada have been warning about.
An active member of the disability community, Gough died of dehydration, after being sick with the flu. Over the past three years, Gough's access to Home Support had been steadily cut: from weekly visits to bi-weekly visits to a total loss. "If Mr. Gough had not been cut off his Home Support, a worker would have visited his apartment on the Saturday of the weekend he died," says Margaret Birrell of the BC Coalition of People with Disabilities. "He would have obtained immediate medical treatment."
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Early hospital discharges and home support cuts have left seniors and families with grim choices |
Home support is intended to be a preventive service that allows vulnerable people to stay healthy at home. Home support workers deliver the basics: a clean bathroom, a hot meal, laundered sheets and shirts, a safe bath. They perform health care tasks such as changing dressings and urine bags. They provide other life-saving essentials, too: a conversation, a watchful eye, a reminder to eat, a touch.
The eyes and ears of the community
"We're the eyes and ears of the community," says Gregory MacCay, an experienced Home Support worker in Vancouver.
Most Home Support clients are usually frail seniors (mainly women) and people with disabilities. They are often low-income folks - very low-income - who can't afford to buy private homemaking services. Many cannot even afford their daily necessities.
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"We all know how much those Depends cost. So they let the time they wear them stretch out - 'They're only a little bit wet.' If they have to buy a lot of them, they won't be able to buy food." |
"I have a couple of clients who are incontinent and wear Depends," says MacCay "We all know how much those Depends cost. So they let the time they wear them stretch out - 'They're only a little bit wet.' Because if they have to buy a lot of them, they won't be able to buy food."
B.C. has generally resisted cuts to health care. The province's investment in home-based care increased last decade, yet the number of Home Support recipients drastically declined: from 55,980 clients to 45,529 between 1991 and 1999. Home Support is now virtually unavailable to people who need housekeeping and meal preparation only. Patients with complex or severe needs are receiving most of the care.
"They said, 'No more housework.' They would send someone to help me get in and out of the bathtub - that's what they offered," says 100-year old Connie Moor, who lives alone on Vancouver Island.
"But I don't need that. Imagine having a lady to come and do something I can do myself? It seemed like a waste of money, so I said no."
When Moor turned down the offer of a bath from her continuing care assessor, she didn't know she was about to lose all her services. Yet at age 100 and living alone, Connie joined the growing ranks of people dropped from B.C.'s Home Support rolls.
She had been receiving two hours of house cleaning every two weeks. Not bad for a centenarian. But evidently too much for health authorities in B.C., where across-the-board cutbacks in 1999-2000 made endangered species of housekeeping and meal services.
Most Canadians would be horrified to learn that a 100-year-old woman - an independent, determined woman who is almost totally blind - had her services cut. Yet most Canadians aren't aware of just how threadbare public home support is across the country, or how Medicare itself is endangered by the gaps.
System burdened by early hospital discharges
And therein lies the problem. "Patients are being discharged from hospital much more acutely ill than before," says a home care nurse in Penticton. "The expectations on Home Support workers has vastly increased." This is the "sicker and quicker" scenario: people with intensive care needs dropped into the under-funded community's lap. Home Support workers - and beleaguered relatives - are cracking under the weight of hospital downsizing. The lack of long term care facilities or supportive housing for our aging population is another huge pressure.
Although governments extol the merits of "preventive services" and "maintaining seniors in their homes," the real-life needs of many people are deemed no longer affordable by the pinched regional purse. Everyone knows it's a penny-wise, pound-foolish policy.
"Sometimes all an elderly person needs is two hours a week to reduce their stress and anxiety. And that's what we're seeing with the cuts. Not that they need 'cleaning' but that they're anxious," says the nurse in Penticton, B.C. Abandonment translates into declining health, depression, falls and malnutrition - all of which rebound on the acute-care sector.
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Like death and taxes, every Canadian can expect an encounter with home support at some point in life |
"Not providing housekeeping is like saying, 'We'll make sure your body is still working, but not the rest of your life,'" says Sally Kimpson, a disability rights activist in Victoria. "As though people are only their bodies, as though health is only a physical condition." Kimpson is with the Home Support Action Group, which is raising hell about the situation.
The threat to Medicare comes from the simple fact that more and more Canadians are receiving their health care at home - outside the shelter of publicly funded, publicly delivered services. Individuals are facing spiralling out-of-pocket expenses, and all of us are facing mounting privatization as corporations move to profit from gaps in public care.
Regional health authorities aren't really the villains here. They lack both the funds and the legislative infrastructure to deliver stable home-based services. To date, the Canada Health Act has been narrowly interpreted as covering hospital and physicians' costs only. And Ottawa and the provinces are actively ducking their commitment to create a national home care program - to weave community care into the fabric of Medicare.
Just like death and taxes, every Canadian can expect an encounter with Home Support at some point in their own, or a loved one's, life. Ensuring it is an integral part of Medicare is essential. As activist Sally Kimpson says, "Home Support is not a medical issue. It's a health issue in the deepest sense. It's a human rights issue."
Nancy Pollak is the author of Cutting Home Support: From 'Closer to Home' to 'All Alone'.
The study is part of "Without Foundation: How Medicare is undermined by gaps and privatization in Community and Continuing Care" (November 2000), a co-publication of the Canadian Centre for Policy Alternatives - BC Office; B.C. Government and Service Employees' Union; B.C. Nurses' Union; and Hospital Employees' Union.
The other studies in the report are "Unfulfilled Promise: How Health Care Reforms of the 1990s Are Failing Community and Continuing Care in B.C.," by Donna Vogel, and "The Hidden Costs of Privatization: An International Comparison of Community and Continuing Care," by Michael M. Rachlis MD MSc FRCPC.
"Without Foundation" is available on-line at www.policyalternatives.ca.
To contact the CCPA, email: info@bcpolicyalternatives.org.
The Home Support Action Group may be contacted at: skimpson@uvic.ca.
The BC Coalition for People with Disabilities has an ongoing Home Support campaign: feedback@bccpd.bc.ca.
Posted, January 22, 2001
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