Health Care Coverage for Older People Canada

Family and friends provide a substantial portion of the care received by older people, whether they live in institutions or in their own homes. Informal care is based on normative or voluntary interpersonal association, while formal care arises from a client-agency relationship and is provided by specially trained persons. The major group of formal caregivers is employees of direct service organizations. In a 1998 study conducted within several continuing care environments, Keating, Douzeich, Fast, Dousman, and Eales observed that family members provided approximately forty hours per month of direct services to residents. It is to be expected that the amount of informal care provided in the home would significantly exceed this. Provision of informal care in Canada has followed what Keating et al. (1998) term as a substitution model (as opposed to a complementary model), in which informal care is seen to be a cost-effective means for substituting for formal care, which often takes place in an institution and is hence more costly to society.

During the 1990s, as the health system was restructured in Canada, opportunities for formal care of older people were limited, thus shifting much of the burden of care to informal caregivers. Such a shift in responsibility from facilitybased to home-based care carries with it the need to provide support for informal caregivers. Increases in respite services and home care services, including options for weekend and night services, are slow in coming as various health service sectors, including acute care, compete for scarce health care funds. Direct remuneration or tax exemptions for informal caregivers have yet to be seriously considered as policy options in the Canadian context.