Nova Scotia is aging quickly, according to a Statistics Canada report. The province faces a pressing challenge as it becomes clear the current system is ill-prepared to meet the rising demand for senior care. Home care, a vital health care service in elder care, must be urgently reformed to address gaps and inefficiencies.
Home care is designed to help seniors maintain independence by providing tailored support in the home. Studies show seniors prefer to stay in their own homes for as long as possible. However, the current system in Nova Scotia is falling short, leaving seniors and their families to navigate a fragmented and strained network of services.
Cracks in the current system
In an article from 2022, CBC news highlighted some of the most prominent issues in home care in Nova Scotia. Complaints from home care clients include long waitlists, high turnover of care workers, frequent cancellations and poor communication.
In Nova Scotia, home care is offered in two streams: nursing services, which includes medically necessary services such as wound care or medication management, and personal care support, such as help with dressing, bathing, cleaning, cooking or respite care. Essential medical services are fully funded by the province, but personal care services are only partially subsidized according to household income, rendering these valuable services harder to access.
Currently, Nova Scotia’s home care services are delivered by a mix of private and public providers. Provincial funding is allocated to contract private companies which then provide direct home care to clients. The entanglement of public and private entities can lead to a lack of unified standards, both for care provision and home care staff, and an added burden to clients who must navigate between multiple providers.
Cash transfers for caregivers are a band-aid solution
Nova Scotia’s strategy has increasingly favoured providing caregiving benefits in lieu of committing to improving formal care, demonstrating an offloading of the burden of senior care onto families and unpaid caregivers.
The Direct Funding Program, offered through Continuing Care Nova Scotia, provides money to eligible Nova Scotians to purchase personal support services through private home care agencies. Although this seems an effective strategy to obtain services in areas with long wait lists, the process is laborious. In hiring their own care worker through this program, Home Care clients become legally obligated to comply with certain standards as employers, including workplace safety, which makes home care clients liable for workplace injuries. This is an unreasonable offloading of responsibility onto already burdened seniors and caregivers.
Alternatively, Caregiver Benefit offers $400 per month for family members providing at least 20 hours of weekly care. The baseline requirement of 20 hours means caregiving must effectively function as a part-time job — one that pays only $5 an hour for their effort. These cash transfers offer limited benefit over the long-term and do not effectively compensate caregivers for their time, energy and financial losses.
Hypothesizing change: an interprovincial comparison
A 2023 study found key differences in home care in Nova Scotia and Winnipeg, reflecting inefficiencies in Nova Scotia’s system.
Nova Scotian clients often had higher needs at the point of assessment, suggesting delays in seeking care. The current system prioritizes the most severe cases, which leads to a cycle of inadequate support for those with less critical, but still significant needs.
In Winnipeg, home care services are exclusively provided by public employees, while in Nova Scotia, private companies dominate. This lack of standardization can lead to disparities in service quality. For example, among the 11 VON-run home care sites across Nova Scotia, visiting nursing is offered at all 11, whereas personal care support is only offered at six.
Furthermore, home care clients in Winnipeg are not income-tested to determine fees for personal care support. The opposite is true in Nova Scotia, which may also delay Nova Scotians from seeking home care services until it is urgently needed, leaving caregivers unsupported for longer.
Winnipeg’s system reveals an improved model of home care is possible in the Maritimes. The government must take immediate action to restructure home care by increasing capacity, improving standardization between public and private entities and removing income barriers, providing equal access to personal care support. Without these changes, the system will continue to crumble under the pressure of an aging population, leaving seniors and their families to shoulder an unsustainable burden.
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