Thank you very much. I'm certainly pleased to be here. Again, I give our apologies as well.
I want to talk a little bit about the broader context of care delivery for the elderly, and then we can talk about the veterans independence program and how that fits into some of the parameters.
How care delivery systems are organized and structured can have a significant impact on how efficient and cost-effective they are in practice. The importance of integrated models of care delivery are now generally recognized, and many people in the continuing care industry support the need for preventive home care and home support for people needing care over the longer term.
An extensive program of research on the cost-effectiveness of home care, the national evaluation of the cost-effectiveness of home care, presented a number of policy recommendations regarding how home care services could be structured. The synthesis report of the project notes that if home care is to make more readily the types of substitutions required to achieve greater effectiveness, it needs to be part of a broader, integrated system of home care and residential care, often referred to as continuing care.
By having administrative and fiscal control over such a large integrated system of care, senior executives and policy-makers can take steps to ensure that appropriate and cost-effective substitution of home care services for acute care and residential care can in fact take place. Simply enhancing expenditures on home care per se may have a limited effect unless steps are taken to ensure that appropriate substitutions can be made of home care services for acute and/or residential care,
The history of home care and continuing care services is one of amalgamation of professional and supportive services. However, in our current national policy, the focus seems to be on shorter-term professional home care. Nevertheless, a recognition of the importance of preventive and supportive care is reflected in recent recommendations in Ontario and British Columbia to enhance home support services to allow people to remain in their homes.
There is some evidence about the extent to which long-term preventive home support services can reduce admissions to hospitals and long-term care facilities. A British Columbia study indicated that long-term home care can prevent or reduce the rate of admissions to hospitals and long-term care facilities. People who only received housekeeping services and were cut from service in two health regions were compared with people who were not cut from services in two similar regions in the mid-1990s. In the year before the cuts, the average annual cost per client for those cut from the service was a little over $5,000 compared with about $4,500 for the comparison group. These costs included hospital services, physician services, and drugs, as well as long-term and home care services.
In the third year after the cuts, the comparative costs were $11,900 and $7,800, respectively, for a net difference of some $3,500. Thus, on average, the people who were cut from care cost the health care system some $3,500 more in the third year after the cuts than people who were not cut from the service. Total costs over the three-year period after the cuts were $28,000 and $20,500, respectively, for those cut from care compared with those not cut from care. Most of the differences in the costs were accounted for by increased costs for acute care and long-term care services.
With regard to home support services providing a community-based alternative to residential care, a study of the cost-effectiveness of long-term home care found that over time and for all levels of care needs, home care on average was significantly less costly to government than care in a long-term care facility. It was also found that the savings from substituting home care services for residential services were not theoretical, but that actual savings were achieved in British Columbia from the mid-1980s to the mid-1990s by holding down future bed construction of long-term care facilities and by making investments in home care. Over a 10-year period, due to a policy of substituting home care for residential care, some 21 persons per 1,000 people aged 65 and over were shifted from residential care to home care.
What does not seem to be fully appreciated in the current policy discussion is a seeming paradox of service provision. While elderly persons with functional limitations have health conditions and need medically necessary care, the appropriate responses to their health care needs are, in large part, supportive services. Taking the time to give a bath to a senior who needs care, preparing a meal and feeding that individual, and ensuring a safe and sanitary environment in the home does not have to be done by a nurse. For people who are too frail to shop, cook, or take baths on their own due to their medical condition, this type of personal support allows them to maintain their independence for as long as possible, and may actually save the health care system money by avoiding repeated hospital admissions and premature entry into long-term care facilities.
A major strength of the veterans independence program—which David will discuss—is that the preventive care and home support services have remained a key focus of the VIP program over time, to the benefit of veterans and their families.