Funding home care and long-term care is fast becoming the main challenge of our outdated medicare system -- a system developed in the mid-twentieth century for a young population that mostly required acute care from hospitals and physicians. But that need is changing rapidly with our aging population.
The Canada Health Act states that all "medically necessary" services should be covered by public funding. The chronic diseases of today's aging population render the existing definition of medicare coverage obsolete. Our health system routinely fails to address the complex needs of seniors.
Let's face it: Canadian baby boomers are getting older and many will soon require home care and long-term care. We need important reforms now to fund the health care system that they will need in the all-too-near future.
In the current funding paradigm, which prioritizes hospital and acute care, it is unrealistic to expect that home care will be prioritized.
The perverse effects of our current system of health funding result in the use of costly resources from hospitals and other institutions to respond to disabilities and chronic conditions instead of using more cost-effective home care services. In the current funding paradigm, which prioritizes hospital and acute care, it is unrealistic to expect that home care will be prioritized.
It is equally unrealistic to believe the elderly will have the fundamental freedom to choose their living environment or care providers without basic reforms in how the health system is financed.
As it stands now, many older Canadians in most provinces have to endure the tyranny of public institutions which decide the level of home care services provided, the limits of any home care provided, and even the time a senior should leave their home for long-term care and where they should move to. This is unacceptable.
After a long career of research in health services for older people, I became minister of health and social services in 2012 in the minority government of Pauline Marois. In a recently published article in HealthCarePapers, I outline how one of my top priorities was to implement an Autonomy Insurance (AI) plan. It was an attempt to introduce publicly funded long-term care insurance, which includes home care coverage, in the health care system.
Similar funding systems have been introduced with success in many European and Asian countries, such as Germany, France, Japan and South Korea. The design of the AI plan was based on the assessed needs of the elderly and those with disabilities, using a disability scale.
Under the proposed plan, the benefit would fund public institutions or purchase services from private providers. Case managers, already in place in Québec as part of the integrated service delivery system, would be responsible for performing assessments and helping users and their families plan services and decide how to best use the AI benefit.
The funding of the AI plan was based on general tax revenues without any capitalized funding ("pay-as-you-go"), under a separate and protected budget program. Cost projections were made; although requiring additional budget increase, the AI would be affordable and less expensive than the status quo. All the legal, administrative, funding, training and contractual issues were dealt with in anticipation of the plan's implementation in April 2015.
Bill 67, creating the AI plan, was introduced in the National Assembly of Québec in December 2013. Unfortunately, the minority government of the day was defeated in April 2014 and the bill died on the legislative agenda.
Bill 67 demonstrated that a long-term care insurance plan is feasible within our universal tax-funded health care system. While Bill 67 was stillborn due to political circumstances, its underlying concept still has merit today.
Clearly, our hospital- and physician-centered health care funding model is not appropriate for our aging population. A different approach must be taken to ensure that home care and long-term care is funded appropriately.
An insurance plan like the one conceived by Québec should be implemented by the provinces.
Should it be a federal program?
It is technically feasible for the Government of Canada to put forward a long-term care program and partially fund it, as was done in the 1960s for the health insurance system at that time. This would be a major step to improving health care in this country and a judicious use of federal health transfer payments in the coming years.
Politically, however, is the federal government ready to negotiate with the provinces on an issue that has historically been a political minefield? To improve an antiquated health care system, ensure its long-term sustainability and responsiveness to the needs of older Canadians, it is worth trying to get a consensus around this issue.
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About 70 percent of Americans over 65 will need some kind of help with the activities of daily living for months or years as they age. It may be due to an illness, chronic disease, or disability. But often, the care is required because of the natural decline due to aging of one’s eyesight, hearing, strength, balance, or mobility.
Many people confuse “long-term care planning” with “long-term care insurance plans,” but they are not the same. Insurance is just one of many options people consider for covering the costs of long-term care. Long-term care planning means developing your personal strategy and making decisions now for how you want a range of things to be handled later when you or a loved one is in need of long-term care services.
A number of public programs, including Medicare and Medicaid, may help pay for some long-term care services under certain circumstances. However, each program has specific rules about what services are covered, how long you can receive benefits, whether or not you qualify for benefits, and how much you have to pay in out-of-pocket costs. It is best not to assume that a government program will pay for long-term care services until you have fully researched the program rules and limitations in your area.
The best time to create your long-term care strategy is before you actually need long-term care. If you’re over 50, there’s no time like now to begin. But, even if you are in the midst of receiving services for yourself or a loved one, it’s still helpful to go through the planning steps. That way, you can be better informed, prepared, and in control of decisions ahead.
Long-term care is more expensive than most people think, and you will likely be responsible for paying out of your own pocket for the care you need. Because there are many kinds of long-term care services and supports, there is a wide range of costs depending on the type of care, where it is given, and by whom.
Unpaid family members are the most common source of long-term care help. But, they may not be able to provide all the care you need, or be there every hour of the day. As part of your long-term care strategy, look into caregiving services in your area, including in-home care providers and elder daycare centers. Find out about elder shuttles, meals on wheels, and other low-cost services offered in your community here.
Did you know that one in three older Americans falls every year? Falls are the leading cause of both fatal and nonfatal injuries for people aged 65+, and can result in hip fractures, broken bones, head injuries, and significant loss of independence. The good news about falls is that most of them can be prevented.
While there is no cure for Alzheimer’s, you can plan ahead to make a difficult situation better for everyone. In general, planning for long-term care is like planning for dementias like Alzheimer’s disease. While many of the same planning steps apply, certain steps take on added importance. The loss of executive function associated with dementia can create hardships for caregivers in arranging or paying for care.
Long-term care is a lot more than nursing homes, and getting care where you want may require thinking ahead. In thinking about long-term care, it is important to consider where you will live as you age and whether your place of residence can accommodate your needs should you become unable to fully care for yourself.
Long-term care can be very expensive and represents a huge financial risk to retirement savings. While some people may qualify for a public program to help pay for these expenses, most people use a variety of options, including long-term care insurance, personal income and savings, life insurance, annuities and reverse mortgages to ensure they can pay for the care they require.