Presented at IRPP Montreal, PQ April 3, 2009. Family/friend Caregivers: Often invisible and...
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Transcript of Presented at IRPP Montreal, PQ April 3, 2009. Family/friend Caregivers: Often invisible and...
Presented at IRPP Montreal, PQApril 3, 2009
Family/friend Caregivers: Often invisible and unrecognized but critical ingredients in the
maintenance and growth of the aging population
Dilemma: Caregivers need to be recognize as individuals with rights to their own services and supports. At the same time public policy will need
to be targeted to caregivers who provide a certain amount of care (not help).
1st Reality Check: ◦ The majority of care provided to older people in the
community is by family and friends – assumptions of their continued availability is problematic.
2nd Reality Check:◦ System of supports for family/friend caregivers is limited
and inconsistent; their role as caregiver, ambiguous. 3rd Reality Check
◦ An increasing proportion of the Canadian labour force are caregivers to older persons –resulting in short and long term consequences.
4th Reality Check◦ Reduced availability of family and changing values in
purchasing care will increase demand for publically and privately-funded home care programs and services – Can this demand be met?
• Income Security – Many caregivers incurred extra expenses, other countries have financial support policies (beyond tax credits).
• Health/Home care services – Caregiver needs are rarely assessed – their needs are diverse. Respite, education and support are needed.
• Labour policy – Employed caregivers face short and long term consequences on income, career advancement, and productivity.
• Human Resource Policy – Increased demand for paid workers to provide support and personal care
Availability of Family/Friend Caregivers
Issue: ◦ Family/friends caregivers are the reason why home care is
cost-effective yet supply and demand changing.
Issue: ◦ Limited access to supports for these caregivers
Income security limited eg financial support, CPP, taxation policies (Reality #1)
Issue: Diversity of family caregivers – there is no one solution but a range of responses that are needed
Solutions: Review international policies on financial support
for caregivers:
15%
17%
19%
21%
23%
25%
27%
29%
31%
33%
2001 2011 2021 2031 2041 2051
65+ 85+
Proportion of females 65+ with no surviving children, among those living in the community, by age group,
2001-2051.
Supply: Availability of surviving children
65+
85+
Source: Carrière, Y.; Keefe, J.; Légaré, J.; Lin, X.; Rowe, G. (2007).
• In long term - decreased number of children.
• Narrowing mortality gap means older spouses caring.
• In short term more adult children affected by:
• Women’s participation in the paid labour force• Mobility Patterns
In rural areas – Out-migration of youth• In urban areas - Increased cultural diversity• In rural areas access to supportive services• Length of care and Sustainability
9
0
100000
200000
300000
400000
500000
2006 2011 2016 2021 2026 2031
Eld
erl
y p
op
ula
tio
n a
ge
d 6
5+
re
ce
ivin
g a
ss
ista
nc
e
Men - Formal Women - Formal Men - Informal
Women - Informal Men - Mixed Women - Mixed
+ 79 %
+104%
+101 %
+ 90
+142%
+111%
Variation 2006-2031(%)
Women continue to be greatest number of receivers of informal and formal support but their rate of increase is less than men
Source: Keefe, J. & Légaré, J. (unpublished data)
Limited Supports for Family/Friend Caregivers
Diversity in support:◦ Public home care programs vary in supportive
services for family/friend caregivers ◦ Most can only be accessed through the client
Shift to Community CareReduced hospital staysIncreased complexity of care and expectations/ burden on
family/friend caregivers.Caregiver needs not assessed
System Challenges/opportunities`◦ Continuing care policies are under P/T jurisdiction◦ Public continuing care programs becoming increasing used
for acute care substitution ◦ Formal support for chronic care privatized and not regulated
Federal
• Compassionate Care Benefit
•Tax relief
Private
• Home support services
• Respite
Community
• Voluntary organizations
• Advocacy and support groups
Provincial• Home care, respite
• Tax relief
• Education, information, support
Federal - Issues• CCB limited scope
• Tax Credits are non-refundable
Provincial - Issues• Varies by province and region
• Eligibility, entitlement• ↑ Acute HC
Private - Issues• Limited to those who can
afford these services• Location
Community - Issues• Do not exist in all regions
• Rural/urban
Federal : Taxation and EI Reviewed financial support policies in
10 countries (direct, indirect & labour)◦ Review policies for compensating caregivers
and assess their applicability to Canada◦ Understand strengths and limitations of other
countries approaches◦ Assess how they might be implemented in
Canada
Direct Services Enhanced Respite/Home Care Education/Information/Support
Direct Financial Support◦ Allowances paid to caregiver (less extent wages)◦ Allowances paid to care receiver to pay caregiver◦ Reimbursement of expenses
In Direct Financial Support◦ Taxation (benefits, exemptions )◦ Pension (Credits, exemptions)◦ Social security (workers comp, vacation, sick days)
Keefe, Glendinning & Fancey (2008). In A. Martin Matthews & J. Philips (Eds) Blurring the Boundaries
Caregiving is a global issue Countries have “carer” strategies or comprehensive
programs* New Zealand Strategy for Careers (Jan. 2008) United Kingdom - National Strategy for Carers (Renewed June 2008) Australia - Home and Community Care Program HCAA (1992) -
National Respite for Carers Program (1996) US Amendment to Older Americans Act (2000) established the National Family
Caregiver Support Program Some recognize caregivers as clients
Australia’s HCAA recognized caregiver’s as clients in their own right United Kingdom’s Carers (Recognition and Services) Act (1995) gave
caregivers the right to an assessment of their needs. England & Wales – 2004 The Caring Equal Opportunities Act gave caregivers
more choice and opportunity.
*See http://www.msvu.ca/mdcaging/policyprofiles.asp for more information on international caregiver financial compensation policies.
• ~$90 CAD every two weeks to caregiver (+$600 annual bonus)
• Available to all caregivers who meet care requirements for child or adult (including elderly)
• Not taxable
• “Recognition” rather than income replacement
• CG may be eligible for Carer Payment and direct services
GermanyLTC insurance Home Care/
Domiciliary Care Benefit
• Eligible clients choose money or services or combination
• 3 payment levels based on CR needs
• $318 to $1033 per month
• Paid to CR to pay CG – but no evidence of how it is used
• Additional payment available for 1 month Stand-In Care
•Pension and accident insurances premiums covered
All 10 Policy Profiles are available at: www.msvu.ca/mdcaging/policyprofiles.asp
1. Introducing Money into the care relationship
2. Supportive or negatively affecting women 3. Consumer Choice and empowerment4. Woodwork effect – costs
Employed caregivers
In 2002, more than 1.4 million Canadians age 45 and older combined paid employment and care to older adults, and most caregivers worked full-time (Walker & Fast, 2005)
◦ Issues: Economic Costs - Short and long term consequences, lost productivity;
◦ Non economic Costs: Health
◦ Policy Review: International review of public policies in labour similar to Canada’s EI Compassionate Care
◦ Solutions: Proposed labour policies to support employed
caregivers
Percentage of caregivers 45 years and over who experienced employment consequences, 2002
Consequences to employed caregivers
CanadaCanada SwedenSweden JapanJapan CalifornCaliforniaia
PolicyPolicy Compassionate Compassionate Care BenefitCare Benefit
Care Leave Care Leave ActAct
Family Care LeaveFamily Care Leave Paid Family Paid Family Care Leave Care Leave BenefitBenefit
NatureNature Gravely ill Gravely ill TerminalTerminal Dependent careDependent care All reasonsAll reasons
LengthLength
Average Average useuse
6 wks + 2wks 6 wks + 2wks waitingwaiting
4.3 weeks4.3 weeks
60 days60 days
10 days10 days93 days93 days
N/AN/A42 days42 days
33.6 days33.6 days
Benefit Benefit Rate*Rate*
Average $Average $
# # BeneficiarBeneficiariesies
55%55%
$1,425$1,425
17551755
80%80%
$1001$1001
95509550
40%40%
$2,532$2,532
49864986
55-60%55-60%
$2549 $2549
16,500 (12%)16,500 (12%)
EligibilityEligibility Parent, spouse, Parent, spouse, or child or child (expanded in (expanded in 06 to most 06 to most family)family)
Employee must Employee must have have accumulated accumulated 600 insured 600 insured hours in past hours in past 52 weeks52 weeks
Family, Family, friends, or friends, or neighboursneighbours
Employee Employee must be must be contributing contributing to sickness to sickness benefitsbenefits
Extended family who Extended family who co-reside** with the co-reside** with the employeeemployee
Employee must have Employee must have worked more than worked more than 11 days in a month 11 days in a month for more than 12 for more than 12 monthsmonths
Parent, Parent, spouse, or spouse, or childchild
Employee Employee must be must be contributing contributing to State to State Disability Disability Insurance Insurance benefitsbenefits
Employees
Caregivers
Caregivers
Employees
Recognize that any policy occurs in a particular context:
Home and continuing care servicesOther income security and labour standards important
National policiesall caregivers
National policiesemployed caregivers
Workplacepolicies
Percentage of
Caregivers Who areeligible
Direct Services Enhanced Respite/Home Care Education/Information/Support
Direct Financial Support◦ Allowances paid to caregiver (less extent wages)◦ Allowances paid to care receiver to pay caregiver◦ Reimbursement of expenses
In Direct Financial Support◦ Taxation (benefits, exemptions )◦ Pension (Credits, exemptions)◦ Social security (workers comp, vacation, sick days)
Keefe, Glendinning & Fancey (2008).
Labour Unpaid Leaves Paid Leaves for familyPaid Leaves for compassionate/chronic care
Challenges in accessing formal services
Reality Check: Reduced availability of family and changing values in purchasing care will increase demand◦Issue: Recruitment and retention of human
resources result in competition for resources within continuing care.
◦ Issue: Working conditions, compensation education and training diverse across Canada
Human resources to meet growing demands ◦ Less attention given to continuing care/care
workers
Retrieved from Women on Home Care
Published by the Canadian Women’s Health Network
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
Informal Formal Mixed
2006 2011 2016 2021 2026 2031
+87 %
+124 %
+100 %
Compensation◦ Low wages, wage parity, limited benefits, travel
Education and training◦ Standardized training, entry requirements, skills
upgrading, meeting current demands/needs Quality assurance
◦ Standards for home care programs, employees and continuity of care
Working conditions◦ Work loads, stress, safety, job insecurity, “value”
Income Security Direct Financial Support:
Caregiver Payment/Allowance
Pension Schemes reduced penalty for dropout State pays pension credits
Taxation System Inclusion of care expenses Expansion of Tax Credits
Social Security State pays
employment/sickness insurance
Health/Continuing care Respite care/Home Care Recognize caregivers as a clientAssess caergiver needs
Employment/Labour Leave policy – employment insurance Labour Standards policy
Health Human Resources ` Improve working conditionsTraining and Standards Focus on Recruitment and retention
POLICY DOMAINS
Workplace policy directed to employees National insurance for all employees Direct support policy to all caregivers
(including employees) Increase direct service policy to support
care in the community Intersect of policy domains
◦ both financial support in multiple domains as well as services need to be considered.
BUT WE CAN’T AFFORD IT…
IT COSTS TOO MUCH…….
0
2000
4000
6000
8000
10000
12000
2001 2011 2021 2031 2041 2051
Co
st
(mil
lio
ns)
Option 1:Option 1: Provision of allowance ($2400 per yr/person) Provision of allowance ($2400 per yr/person)
Option 2:Option 2: Provision of respite (4 hours/week additional respite - $5200/yr) Provision of respite (4 hours/week additional respite - $5200/yr)
Option 3:Option 3: Cost of average additional 3 months of an institution for CR $12000/yr) Cost of average additional 3 months of an institution for CR $12000/yr)
2. Services
1. Compensation
3. Institutional Cost 3 months
5.7 billion
10.9 billion
Keefe, J.; Légaré, J.; Carrière, Y. 2007. Developing new strategies to support future caregivers ... Projections of need and their policy implications. Canadian Public Policy, 33, 65-80
Need to consider the ECONOMIC, SOCIAL, and HEALTH CARE Costs of NOT supporting caregivers.
BUT WE CAN’T AFFORD IT… IT COSTS TOO MUCH…….