Seniors in need, caregivers in distress:

14 Health Council of Canada
such as challenging behaviour or physical disability
combined with cognitive impairment. Their family caregivers
have the highest risk of burnout, and the seniors have a
high risk of placement in long-term care facilities if they and
their families do not receive the support services they need.
Our analyses show that increasing levels of need are not
necessarily matched by increasing levels of home care
services. High-needs seniors receive, at most, a few more
hours of care per week than those with moderate needs.
In some regions, the hours of care do not increase at all.
Due to limited funding, some provinces and territories
cap the number of hours or spending on home care clients
to the equivalent cost of a bed in a long-term care facility. 5
As we will discuss in the next section of the report, this
is causing significant stress for many of their caregivers.
Pain, depression, and falls are common problems
The RAI-HC analyses also showed that:
• More than half of all clients in each region experience pain,
with about 15% suffering from severe pain.
• At least 30% of clients in each region require a care plan
for depression. Many seniors are taking antidepressants
(17 – 30%) and 8 – 19% are taking sleeping pills (hypnotics),
which can increase the risk of falls.
• Approximately 16 – 19% of clients had experienced one fall
in the 90 days prior to their assessment, and 9 – 24% had
suffered two or more falls.
• In the 90 days prior to their assessment, 10 – 20% of home
care clients had visited a hospital emergency department,
and at least one-quarter or more of clients in all five regions
had been hospitalized.
Challenges with daily living
Analyses of RAI-HC assessments show that 95– 98% of
home care clients have some level of difficulty with
activities such as cleaning, cooking, grocery shopping, and
home maintenance (called instrumental activities of daily
living, or IADLs). A considerable number (23 – 41%) need
help with fundamental activities such as bathing, eating,
and toileting (called activities of daily living, or ADLs).
What home care provides—and doesn’t
When someone is referred to home care, a case manager
typically meets with the client and often the family caregiver
to conduct an assessment. Once someone is assessed
as needing home care, the case manager coordinates care
and authorizes all other home care services a client may
need. The case manager continues to monitor levels of
need and may make changes in the care plan as required.
All provinces and territories can provide a personal support
worker and /or nurse, depending upon need. A personal
support worker helps with basic daily living needs (such as
bathing and toileting), and may help with a limited number
of broader activities (such as the client’s laundry). A nurse
may provide clinical care such as changing the dressing
on a wound or monitoring the client’s condition. Depending
on the jurisdiction and client needs, home care teams
can also include occupational therapists, physiotherapists,
pharmacists, nurse practitioners, social workers, dietitians
and physicians. 5
A considerable number
(23-41%) of home care clients need help with
activities such as bathing, eating, and toileting