Dr. Peter Zhang is a hospital pharmacist who writes about health care strategy and innovation. Dr. Anser Daud is a resident physician in orthopedic surgery who writes about health advocacy and human rights issues.
While senior citizens currently represent one-fifth of the Canadian population, they consume more than half of Canada’s health care dollars. By 2031, nearly one in four Canadians will be over the age of 65 and the cost of health care will undoubtedly increase.
A recent analysis by The Conference Board found that aging alone is expected to add $93-billion in health care costs in the next 10 years. To put this into perspective, the sum total of all public health care costs in 2020, including the surges in spending related to COVID-19, was $305-billion dollars.
Therefore, to meet the needs of an aging population in the future, investments to care for seniors are critically important. In February, 2023, the federal and provincial governments jointly pledged $6-billion over five years for home and community care. Although this is welcome news, commitments to innovate in the home care space also need to be a priority.
Home care currently refers to support services such as bathing and transportation. It can also refer to home health services, including nursing support, physiotherapy, or end-of-life care. Many patients depend on these services to continue their care when discharged from a hospital visit.
Let’s take the example of an elderly patient being admitted to the hospital with a hip fracture. Hip fractures usually occur in elderly patients who have co-existing medical conditions. In fact, they have been described as a hallmark of fragility and functional decline in elderly patients and require multidisciplinary care involving orthopedic surgeons, medical and geriatric specialists, physiotherapists, and pharmacists, both in hospital and after discharge. Oftentimes, these patients leave the hospital with a permanent decline in their functional level. For example, those who walk independently may now require a cane. Those who used a cane may now require a walker.
Such admissions are associated with significant long-term costs to the health care system. Analyses have shown that one in four Canadian women and one in five Canadian men aged 65 years or older living in the community at the time of experiencing a hip fracture entered a long-term care home within one year owing to their increased demands for functional support with activities of daily living. But our system may be too quick to shuffle patients out of their homes and into a long-term care facility.
Every patient and every person is unique. Many patients with declining function can in fact still carry out activities of daily living such as dressing, toileting or eating. Increasing the depth and breadth of home care services would therefore allow us to keep more elderly patients out of hospitals and long-term care homes. If we can build up personal support and health services at home, this would allow patients to maintain their independence and increase capacity in health care facilities for acutely ill and very low-functioning individuals.
The cost of an optimized home environment is significantly cheaper than that of a long-term care bed. In the case of hip fractures, direct costs to the health care system are significantly lower for patients who return to the community – $21,000 per patient – versus those who were transferred to long-term care living, which can be upward of $47,000.
To remedy this, policy-makers and health care innovators need to investigate solutions that would keep patients at home, whether it is additional clinical services or new technologies that augment care. Part of the solution to make this effort sustainable is fostering innovations to make home services more cost-effective.
Advancements in technology that support remote patient monitoring and virtual clinician visits may keep more patients out of hospitals and long-term care homes. All this still requires significant funding and change management in the existing health care system. But building a framework that expands the breadth of clinical services at home will not only allow seniors to obtain the care they need, but also allow them to maintain their independence longer.
To provide the best care for the increasing proportion of Canadian seniors, there needs to be a clear commitment to fund and foster innovation in the home care space. This includes improved delivery and expansion of existing services, but also the incorporation of novel technologies, which ultimately will contribute to health care sustainability and increased capacity for care.