According to Mullaly (2007), "neo-conservatives have called for a return to the economic values of the private marketplace" (p. 72). This includes a strong trend to the privatization of functions normally considered a state responsibility. One of these areas is home care.
A recent report by the Canadian Healthcare Association indicates that private spending on home care now outstrips public spending. There is an increasing trend to shifting the responsibility for home care to the the private sector. One of the many impacts is that for older people who can't afford to pay for care, informal caregivers (mostly women) have to carry much more of the care.
Having worked in a Quebec CLSC specializing in the development and provision of services to older people, I observed the superiority of public home care services over most for-profit services. Our workers, who had to fulfill certain educational requirements to be hired, were paid a fair wage, unionized, received benefits, and were properly trained. Private sector workers are paid much less (for example, an Ontario study shows they are paid $6 per hour less in that province).
In my Quebec CLSC, our home care workers were part of the multidisciplinary health care team. They are the professionals who see the older person on a day-to-day basis. Often it was the home care worker who drew our attention to serious problems such as elder abuse and they were often an important part of the solution. When home care services are privatized, they no longer have this connection with the larger health care team and it is the older person who often suffers.
I suspect this trend to privatizing home care and health care will continue under a Conservative government, even though there is some evidence that privatizing home care does not save money in the long run (Shapiro, 2006) and a Winnipeg experiment to do so was deemed a failure (Shapiro, 2000). The Romanow Commission called for a National Strategy on home care and we are still waiting for it -- a strategy that will ensure that every older person has equal access to the services they need.
Silvia,
ReplyDeleteFirst off, thank you sharing your experience with home care in Quebec. As an individual who has recently been working quite closely with the Manitoban home care program, I believe you’ve raised an interesting dilemma that not too many people are aware of. My experience with this system has mainly been from a case management perspective within an inter-disciplinary health care setting in Winnipeg (which I will leave nameless in this post). Within this newly developed program we have the ability to meet with individuals on a weekly basis, the chance to connect with client’s family and other supports, provide respite services, have access to a number of health care professionals on site, and we also have connections to a variety of other resources. The main goal of this program is to keep individuals in the community as long as possible, however it does come at a cost. The participants are charged on a monthly basis which is determined based on their income, and they also must cover the cost of their prescriptions, dental work, eye care etc (which combined can be quite expensive). Although I would argue that this program has been very successful in providing a high level of care to elderly individuals and their families, I believe that it is subtly linked to the trend of privatization which you discussed in your post as a number of imperative services are not covered by our health care program.
I would argue this issue is linked to a general trend in our nation; the general population is very unaware of the care giving issues of elderly people in Canada and the logistical problems related to it. Although the increasing numbers of those who are aging is becoming more evident, little preparation for public services at a government level is being done. As a social work student hoping to work with the elderly population, I wonder what our system will look like in 10, 15, 20 years and if it is something that I will want to be a part of.
-Alison
Good points, Alison. The whole debate about the two-tier medical system is one that leads to more and more privatization of services. There is a logic to user fees that appeals to many people, but it's important to think about where that takes our up-until-recently universal health care system. I'm glad to see you are making these links. But by being alert and talking about these issues with other social workers, you can have a voice in what kind of system we will end up with.
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