Lara Osis, B.A., freelance writer and Maureen Osis, retired nurse and family therapist
Compared to the younger population, seniors are more likely to use the health care system. When aging parents need home/community care, you will want to know:
- the differences between home and community care
- the services provided by home care programs
- the differences between public and private services
- who’s who on the home/community health care team
- who to contact
- when to consult a specialist
Differences between home and community care
Generally, home care refers to services provided in the client’s home or place of residence and community care refers to services provided in the community such as a wound care clinic or day program.
A range of services is offered through the Canadian publicly funded healthcare system. The main sectors include adult day care, geriatric assessment, home care, public health, respite, and facility based care. Each of these is summarized below:
Adult day care programs are often operated within a long-term care centre or other health or social facility. Some programs provide social activities while others include medical surveillance and some direct care. Most programs offer regular attendance that varies from two days to five days per week.
Geriatric assessment units admit people for a limited period of time to assess and determine care needs. These units may be found in an acute care or rehabilitation hospital. The team often includes nurses, physicians, physiotherapists, occupational therapists, dietitians, social workers, and other specialists. The team consults with the family about recommended services that are available after discharge.
Respite care is temporary support, given to provide relief to the family. If Mom is taking care of Dad at home and needs a break, you will want to find respite, or relief services. There are three different ways for this service to be provided:
- in-home care: In-home care will bring someone into the home of the senior to help with personal care.
- adult day programs: Adult daycare programs enable the senior to meet other people and enjoy activities away from home. The program may also offer therapeutic activities, meals, transportation to and from the program, and some personal care.
- and short-stay care. Short-stay respite allows a senior temporary access to the care at a long-term care facility.
Services provided by home/community care
In Canada, home and community care services are delivered by provincial, territorial and some municipal governments. Each of these jurisdictions determines what services will be offered, based on an assessment by a professional. Services can include:
- Personal care such as help with bathing, dressing, and feeding,
- Occupational therapy,
- Speech therapy,
- Social work,
- Dietitian services,
- Homemaking, and
- Respite services.
The goals of home and community care are to:
- Help people maintain or improve their health status and quality of life,
- Assist people in remaining as independent as possible,
- Support families in coping with a family member’s need for care,
- Help people stay at or return home and receive needed treatment, rehabilitation or palliative care, and
- Provide informal/family caregivers with the support they need.
Differences between private and public providers
Home and community care services are offered through both public and private providers. Public services are funded and managed by the local health authority or municipal government. Private services are offered by individuals or private corporations on a fee-for-service basis.
Public services are provided on the basis of assessed needs. Eligibility is based on a professional assessment of individual needs, existing supports, and community resources. Eligibility for these services varies between provinces and even within provinces (i.e., between rural and urban settings.)
Many private providers offer a variety of home care and support services. Some are non-profit organizations, while others are business corporations. These providers vary in types of services, staff qualifications, and costs. Seniors who want to stay in their homes can find a mix of different types of services, both public and private.
If you are choosing a private provider, you might find it helpful to use this checklist.
Evaluate Private Health Care Providers
What are ADLs and IADLs?
By about the age of 85, almost half of seniors need some assistance with their activities of daily living (ADLs). These activities include:
- mobility (walking/ambulation and ability to transfer oneself from bed to chair or wheelchair);
- feeding oneself food that is prepared;
- toileting, including getting to toilet and cleaning oneself);
- and dressing & grooming (selecting appropriate clothing and managing one’s personal appearance).
Instrumental activities of daily living (IADLS) include shopping, meal preparation, housework, laundry, using the phone, driving or using public transportation and managing finances. Sometimes these needs can be met by family and friends. If not, the senior and the family might have to seek private providers.
Who are the professionals and caregivers that provide home and community health care?
The following list identifies the most common health providers that you and your parents are likely to encounter in a home care or in a community setting. When you meet these providers, ask for their name and their role. This might help you to know who to contact when you have questions or concerns.
A case manager is a professional (often a registered nurse or social worker) who oversees the assessment and planning for care and services for an individual. Some Geriatric Case Managers can be hired privately on a fee-for-service basis.
A discharge planner is an individual who works in a hospital and assists patients to connect to healthcare services in the community following a hospital stay.
Home Care Coordinator or Community Care Coordinator
A home or community care coordinator is a health professional who assesses and oversees the home care services that are provided to a client at home or in a community program. The coordinator determines eligibility for the services and then assigns the patient’s care to the most appropriate member of the team.
Home Health Aide (Personal Care Aide)
A home health aide or personal care aide is an individual who provides personal care: bathing, dressing, grooming, and assistance with eating. The education of these workers is not standardized. In facility settings, this worker may be called a nursing attendant or assistant.
Licensed Practical Nurse (LPN) or Registered Practical Nurse (RPN)
A licensed or registered practical nurse is a graduate of an approved education program and registered with the provincial college that governs the profession. The LPN/RPN provides care as part of the health care team in hospitals, long-term care, and community programs. They administer medications and perform some nursing procedures.
Registered Nurse (RN) and Nurse Practitioner (NP)
A registered nurse is a professional who assesses a patient’s condition and makes decisions regarding appropriate nursing interventions. RNs can respond to complex situations involving patients with acute and chronic illnesses, deliver health education programs, and provide consultative nursing services to promote, maintain, and restore health of individuals and families.
Nurse practitioners are registered nurses with advanced training in health assessment, health promotion, and illness prevention. NPs diagnose and treat health problems, order and interpret diagnostic tests, and prescribe drugs.
A pharmacist is a professional trained in the art and science of pharmacy. In some provinces, under certain conditions, pharmacists can prescribe medications.
Who to contact?
If your parent is in hospital and you want to know more about discharge plans, talk to the “case manager” or the “discharge planner.” These professionals will help to make the connections with home or community services. Note: the title of this professional may vary between different health authorities.
Hint: Always get the name and contact information of anyone on the team. And make notes after a meeting. Then you can follow up when necessary.
If your parent needs home care, your will want to contact a “Home Care Coordinator”, also called a “Community Care Coordinator.” This individual is knowledgeable about the services that your parent needs and will qualify for. Then you can talk about the level of care required: that is, by an RN, LPN, or a personal care aide.
Hint: In addition to services provided by the health care system, you can also look into private care. There are many companies that provide care and support in the home.
Note that each province and territory has jurisdiction over home care services. Access to the services is through an assessment process, conducted by a professional. Each public home care program determines who is eligible for what type of care/services and for how long. To learn more about home care in your area, you will need to contact the local health authority.
When to consult a specialist
When older adults experience illness, they may need specialized care because of the complexities in diagnosis and treatment. Many health professionals have specialized education or experience in geriatrics or gerontology.
Geriatrics (jer’ē-a’triks) is the study, diagnosis and treatment of common diseases associated with aging.
Gerontology (jer’on’tol’o’jē) means “the study of elders” and includes the physical, mental, and social aspects of a senior’s life.
Ask for a geriatrician or a physician with special interest in caring for older adults. These physicians can sort out whether the problems are caused by the disease, by the treatment, or are related to the aging processes.
Ask for a Certified Gerontological Nurse or Nurse Practitioner. These nurses have written national certification exams to demonstrate their knowledge and skills. As part of the health care team, their focus includes avoiding the dangers of over-treating as well as under-treating chronic and acute health problems in older adults.
Evaluate Private Health Care Providers. Checklist available on Activities page of our website.
Home and Community Care
Government of Canada
Please Note. This article was written for general information. During the pandemic, home health care may be disrupted or you may be concerned about the safety of having a health care worker coming into your home. Suggestion: Read
Does Your Home Health Worker Present a Coronavirus Threat.? Published May 5, Next Avenue.