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It is often said that once you get where you need to be in Canada's health-care system, the care is excellent. But aside from a select few surgical procedures, we do a poor job of measuring who does and doesn't get timely access to needed services.

A new study by Statistics Canada offers insight into one of the areas that deserves a lot of scrutiny: home care. The findings are troubling.

The data show that 2.2 million Canadians receive home care – 8 per cent of the population over the age of 15. Most care recipients are frail seniors with chronic health conditions, but there are also many people with physical, developmental and psychiatric disabilities.

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About one in seven people – 331,000 people – who got home care in 2012 did not receive all the care they needed; their needs were only partially met. Another 461,000 chronically ill Canadians needed help with daily activities but did not receive any home care at all.

Without a doubt, these numbers underestimate the real needs. Statscan surveys do not reach people living in nursing homes, long-term-care homes and hospitals – and many of them could be living at home with the proper support.

It's very difficult to figure out who is falling through the cracks. However, Statscan does provide some clues: Low-income Canadians and immigrants are far less likely to receive home care, and one of the most underserviced groups is informal caregivers, the millions who care for their loved ones at home and don't know where to go for help.

Between the lines, the message is that to get home care in Canada, you either need to be educated and connected enough to wring service out of the system, or you need to be wealthy enough to pay for it.

In Canada, we talk incessantly about the impact of our aging population – especially the financial impact – and about the need to shift health-care resources into the community, into programs like home care. The new data are a stark reminder that we're all talk.

Baby boomers cherish their independence. Most people want to live at home, in the community, as long as possible – not in institutions. But the reality is that the older you get, the more chronic conditions you have and the more care you need. By age 85, about half of people need home care to continue living in the community. If we don't provide adequate and affordable home care, a lot of people are going to end up in those institutions, at much greater financial and emotional cost.

As Canada's demographics change, the demand for home care is soaring. But in most provinces, public programs are not keeping pace. Only about 4 per cent of public health spending, $6-billion a year, is going into home care.

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Increasingly, the burden is being shifted to families, who have to either provide the care themselves or pay for it out of pocket.

There are 8.1 million caregivers providing care to loved ones in Canada. Most do so willingly and lovingly, but their abilities and contributions vary widely. We don't need a nurse in every home around the clock. But we need policies that allow for a better balance of work, life and caregiving.

That means some accessible care from health professionals, homemaking (cleaning, bathing, shopping), community day programs, flexible work hours and caregiver leave programs. If we want to encourage people to live in the community, we also have to build senior-friendly cities with better public transit, affordable housing, grocery stores that deliver, and so on.

The question is not whether or not we will provide care to our elders, but how. Will we foster independence, community living and family caregiving? Or will we opt for isolation and institutionalization? Currently, we are lauding the former but delivering the latter.

The fact that Canadians are living longer and healthier than ever should be cause for celebration. The notion that the "silver tsunami" will bankrupt medicare and other social programs is not a given. The predicted massive increases in health costs are problems of our own making, and we can fix them.

The starting point is creating a health system that prioritizes the needs of its principal clientele: seniors. If we want Canadian care to be truly excellent, then we need to bring the care where people need it. Increasingly, that's in the home.

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