The Canadian Medical Association (CMA) is proposing the creation of an innovation fund to expand home care services as the best way to invest the $3 billion that the federal government has already pledged for urgently needed improvements in this area.

Ottawa plans to disperse the $3 billion on the basis of $400 million in 2016, $650 million in 2017, $900 million in 2018 and $1 billion in 2019.

Proposals

The CMA is proposing either new or significantly expanded programming in the following areas:

• Palliative care programs offered in the home and in hospices.
• Telehomecare programs such as home monitoring for therapies, exercise programs, vital statistics, critical responses, crisis support, etc.
• Programs to identify persons at risk of becoming “high users” of health care and to implement mitigation strategies (e.g., team-based complex care plans, expanded paramedic services).
• Community-based programs to provide respite for family caregivers (e.g., day programs and overnight stays).
• System navigator programs that operate 24/7 and provide care coordination, including support for family members.
• Community-based programs that increase access to mental health and addiction services (e.g., harm reduction programs, emergency response support and support programs for families).
• Innovative funding approaches such as personal health care budgets so that patients and family members can manage their own care, if desired.

Allocating funds

The federal government currently allocates health care transfers to the provinces and territories based on an equal per capita basis. However, given the concentration of home care expenditures in the seniors population, the CMA is recommending that the federal government transfer additional funding based on the number of seniors in each province and territory.

Accountability

An effective accountability mechanism for the next health accord is essential. To this end, CMA proposes that:

• each level of government (federal, provincial, territorial) sign statements indicating their commitment to undertake the activities specified in the pan-Canadian health accord;
• bilateral agreements be signed (in addition to an overall pan-Canadian agreement) to address provincial and territorial needs while enhancing accountability between the federal government and each jurisdiction; and

• an independent, third-party organization report on the achievements and lessons learned from the initiatives and objectives specified in the accord. This organization could also be involved with disseminating successful innovations across the country that emanate from the accord.

Accountability, however, has been a sore point with previous health accords in Canada. The CMA believes that each level of government should track how their funds are being invested, how their health care system is functioning and how healthy their population is, using an agreed-upon set of indicators.

A national action plan

In the meantime, three health advocacy organizations have teamed up to build a national action plan for better home care in Canada.

The Canadian Home Care Association, the Canadian Nurses Association and the College of Family Physicians of Canada aim to enhance the delivery of home care services to meet the changing health needs of Canadians and to respond to advances in health technology.

The three organizations are consulting with home care providers, administrators and clinicians, as well as patients across the country, on how Ottawa can ensure that the home is one of the best places to recover from an illness or injury as well as to manage long-term conditions.

The resulting Better Home Care Action Plan will be shared with governments, policy makers and stakeholders across the country.

For more information on our recommendations, check out our issue sheet on expanding home care services.