Where does Home Care fit in the re-organized Canadian Health Care system now being studied by Roy Romanow for the federal government? Care Watch Toronto, and most of its affiliated member organizations, have presented oral and written submissions to the Romanow Commission, advocating that home care and pharamacare become part of the national system under the principles of the Canada Health Act. How this is to be done remains in the realm of public debate, as Romanow himself retires from the public co nsultation process to put his recommendations together for his November 1st deadline.

 

One approach to an answer to where Home Care fits has been put forward by Marcus Hollander, in a recently released report for Health Canada entitled “The Third Way: A Framework for Organizing Health Related Services for Individuals with Ongoing Care Needs and Their Families”. This report puts forward a thoughtful definition of what Hollander calls Continuing/Community Care.

 

He defines the population groups whose needs such care should meet. The groups are:

·          seniors,

·          adults with disabilities,

·          adults with mental health problems, and

·          children with special needs.

At the end of the report he suggests two other groups whose needs might be similar: adults with addiction problems and HIV/AIDS patients.

 

To differentiate Continuing Community Care from

other segments of health care, the report elaborates on the difference between care and cure. The curative model is a bio-medical model, the goal of which is to cure some disease or restore function to a limb or organ injured in an accident. Such needs are met by doctors, nurses and rehabilitation therapists, who focus on specific medical conditions. Their relation to the patient is professional, i.e. it focuses on the expertise of the care provider. Anyone may need such acute, specialized care at any time, but the need is acute and short-term.

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The care model is supportive, oriented toward psycho-social needs. Its goals are to provide services that reduce the rate of decline, support independence and provide the best possible quality of life. It assists people with long-term functional deficits to deal with their physical and social environment in as normal a way as possible. Such needs are met by nurses and other health professionals, social workers, and homemaking/ personal support workers, who focus on the whole person and his or her environment. Supportive care is holistic and client-centered; it respects the expertise of the client and family in regard to client needs.

 

 He proposes that supportive care should be one cluster of a health system that includes a hospital cluster, a physician cluster (that may include reformed models of primary care), a health promotion/public health cluster and a pharmaceutical cluster. The benefit of this definition of a complete health system is that continuing/community care has equal standing with doctors, hospitals and drugs, instead of its present position as a stepchild of our health care system.

 

Hollander’s mandate was not only to define and clarify the sectors of the national public health care system.  It was also to look at the interfaces between the sectors and to consider how these interfaces can function more effectively. He rejects outright the model of integrated health care put forward and championed several years ago by the hospital sector.  He sees that as an attempt by the hospitals to expand their role and to dominate the delivery of health care. He also casts doubt on the regionalization of health care, which is now the norm in all provinces except Ontario, pointing out the problem of patients transferring from one region to another and the disparities in service between one (totally independent) region and another.

 

He acknowledges the possible viability of primary health care reform models that include all health professionals, as well as family doctors, as part of

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