Seniors' use of and unmet needs for home care, 2009

By Melanie Hoover and Michelle Rotermann

Population aging, increasing prevalence of chronic diseases, and changes to health care delivery contribute to the need for home care.1,3 Home care services for seniors can alleviate demands for hospitalization,4,5 and can reduce readmissions5 and the likelihood of institutionalization.6 Home care can also be more cost-efficient than residential care.5,7,8

This study uses data from the 2009 Canadian Community Health Survey–Healthy Aging (CCHS–HA) to provide a profile of community-dwelling seniors receiving home care and describe the types of care they receive from formal and informal sources. Seniors' unmet needs for professional home care are also examined (see The data).

One in four

In 2009, 25% of people aged 65 or older (just over 1 million) reported that they had received formal and/or informal home care in the past 12 months (Table 1). However, it is likely that the prevalence of the use of home care is actually greater. Some informal care, from a spouse, for instance, may not have been reported, since it may be perceived as part of usual support provided to family members.

Table 1 Number and percentage of seniors receiving home care, by selected characteristics, household population aged 65 or older, Canada, 2009Table 1 Number and percentage of seniors receiving home care, by selected characteristics, household population aged 65 or older, Canada, 2009

A larger percentage of senior women than men reported having received home care (30% versus 18%). For both sexes, the percentages reporting home care rose with age from 12% of men and 18% of women aged 65 to 74, to 44% of men and 59% of women aged 85 or older.

Seniors living alone were more likely than those living with others to have received home care. As well, a higher percentage of seniors who reported some form of social assistance as their main income source reported receiving home care, compared with those who reported another main source of income. These results are consistent with earlier findings showing that living alone9,10 and lower income are associated with higher rates of home care use.10,11

As expected, seniors with limited functioning were more likely than those in better health to receive home care. For example, half of severely disabled seniors reported receiving home care, compared with 12% of those who had no or mild disability. A relatively high percentage of individuals with physical limitations received assistance with personal care activities such as bathing or toileting, compared with people who did not have these limitations.

Provincial differences

The prevalence of home care use (formal and/or informal) varied across the country. Reported use of home care was lower in Newfoundland and Labrador (18%) and Quebec (22%), and higher in New Brunswick (29%), Ontario (27%), and Manitoba (29%), when each province was compared with the rest of Canada. Estimates for the remaining provinces were comparable to the national figure. These provincial differences remained when only formal home care was considered, except for Alberta, where the reported use of formal home care was less than the national estimate, and Quebec, where reported use was comparable to the national estimate (data not shown).

Provincial differences in the use of home care can be influenced by the age and health profiles of seniors residing in each province, and by variations in service availability, eligibility criteria, and the structure and delivery of care.16,19 The analyses in this study do not adjust for those factors.

Sources and types of care

More than half (53%) of seniors who reported receiving home care in the past year indicated that it had been provided exclusively by informal sources such as family, friends and neighbours (data not shown). Another 18% received only formal home care from paid employees and unpaid volunteers. The remaining 29% reported mixed sources of care, underscoring the complementary relationship between the informal and formal care networks.1,7

The sources of care differed somewhat by the type of care provided, and for nearly all types, the informal network generally predominated (Figure 1). The exception was medical care, with equal shares reported to be coming from formal and informal providers, and a smaller share from mixed sources.

Figure 1 Percentage of seniors receiving home care, by type and source, household population aged 65 or older, Canada, 2009Figure 1 Percentage of seniors receiving home care, by type and source, household population aged 65 or older, Canada, 2009

Understanding which services are provided most frequently by various types of caregivers is important, because hours of care tend to be higher when informal care is available.20 Seniors who reported receiving care only from formal sources were less likely to have tangible support (66%) than were those who received help from informal (81%) or mixed sources (76%) (data not shown). Lack of tangible support may also be predictive of a senior's future professional home care needs.

Among seniors who had received home care, housework (including home maintenance) was the most common type reported (18%), followed by transportation (15%) and meal preparation (10%) (Figure 1). This pattern was consistent across all provinces. Those who received medical or personal care, both of which are associated with greater dependency, were more likely to have received at least one other type of care (data not shown).

Unmet needs for professional home care

In 2009, close to 180,000 (4%) seniors reported that they had at least one unmet need for professional home care services (Table 2). Across the provinces, the percentage of seniors reporting unmet home care needs was generally comparable. Close to two-thirds (63%) of seniors with unmet needs for formal care attributed them to personal circumstances, such as inability to pay; 24% cited features of the health care system, including lack of service availability; and the remaining 13% mentioned a combination of both (data not shown). Research shows that unmet needs for assistance are associated with negative consequences including inability to prepare food for oneself,21 injuries,21 depression and reduced morale,22 higher hospitalization rates,23 and increased risks of falls,3 institutionalization, and premature death.21

Table 2 Number and percentage of seniors with unmet needs for professional home care, by selected characteristics, household population aged 65 or older, Canada, 2009Table 2 Number and percentage of seniors with unmet needs for professional home care, by selected characteristics, household population aged 65 or older, Canada, 2009

Women were more likely than men to have unmet needs—5% versus 3%. The percentage reporting unmet needs rose from about 3% at ages 65 to 74 to around 7% at age 85 or older, and was twice as high among those living alone as among those living with others. The prevalence of unmet needs was also associated with disability. For example, 10% severely disabled seniors reported an unmet need for professional home care, compared with 1% who had no disability. Among those who had severe personal care or mobility limitations, the prevalence of unmet needs was 20% and 29%, respectively; this compared with about 3% and 4% among seniors who did not have personal care or mobility limitations. Housework and personal care were the two most common tasks with which seniors needed, but did not receive, professional assistance. These associations between unmet need and sex, living arrangements and disability are consistent with other research.21-24

Conclusion

As the number of seniors increases, the need for home care is expected to rise. Home care can help to maintain seniors' health, independence and quality of life.1,3 Results from the CCHS-HA show that one in four Canadian seniors received home care, most commonly, housework and transportation. Informal care from family, friends and neighbours predominates across most care types. About 180,000 (4%) seniors reported an unmet need for professional home care.