Abstract
Background
Unmet home care needs have been linked to poor health, increased use of other health services, admission to nursing homes and reduced emotional well-being.
Data and methods
Using data from the 2015/2016 Canadian Community Health Survey, this article describes home care use and unmet home care needs by type (i.e., home health care [HHC] and support services) in community-dwelling adults. Among the population with home care needs, the degree to which needs were met, partially met or unmet is presented, as well as information about the barriers to obtaining home care services and the places services were sought. Multivariate analysis was used to examine factors associated with unmet home care needs by type, while controlling for predisposing, enabling and needs-related factors.
Results
In 2015/2016, just over one-third (35.4%) of people with home care needs, an estimated 433,000 people, did not have those needs met. This was more prevalent among those with support needs than those with HHC needs. Availability of services was most often cited as a barrier to obtaining home care services, particularly for those with an unmet need for HHC services. Age group, household type, long-term care insurance and health status factors were associated with perceiving an unmet home care need, with few differences by type of unmet need.
Interpretation
The degree to which needs were met and the perceived barriers to obtaining home care services varied by type of unmet home care need. The results indicate proportionally higher unmet needs for home care services among adults aged 35 to 49. This suggests a possible service gap.
Keywords
cross-sectional study, health survey, socioeconomic status, home nursing
Findings
Home care encompasses a wide range of services delivered to individuals of all ages in their home rather than in a hospital or long-term care facility. Purposes of home care services include short-term care for recovery from surgery or acute illness, longer-term care for those who are disabled or experiencing limitations because of a chronic condition or aging, or care for those who are terminally ill. Unlike hospital and physician services, home care is not an insured service under the Canada Health Act. Therefore, the provinces and territories are not required to offer it to qualify for federal transfers for health care. However, all provinces and territories have home care programs that are an important component of the health care system. Variations in how expenditures are recorded and which services are included pose challenges to estimating overall costs. Two recent estimates of home care expenditures range from $3.7 billion to $5.9 billion. [Full Text]
Author
Heather Gilmour (heather.gilmour@canada.ca) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.
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What is already known on this subject?
- Unmet home care needs have been linked to negative health consequences and increased health care costs.
- Little is known about differences in factors associated with unmet home health care (HHC) service needs and unmet support service needs.
What does this study add?
- An estimated 1.2 million Canadians aged 18 or older living in the community had home care needs in the previous year. These needs were met for 65%, partially met for more than one-quarter (26%) and unmet for 1 in 10 (10%).
- Those with a need for support services were more likely to have those needs unmet or partially unmet than those with an HHC need
- Availability issues affected the ability to obtain home care services, more so for HHC services than support services (42% versus 25%). Most frequently, services were sought from government home care programs.
- Although HHC and support services differ in the nature of care provided, the multivariate analyses showed few differences in the correlates of having an unmet need for either type of home care.
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