By Tracy Fuller
When 93-year-old Kathryn MacMillan fell and hit her head four months ago, she didn’t realize she would fall though a bureaucratic loophole.
A widow of 12 years, MacMillan lives alone in her home. When she fell she was hospitalized with a head wound. While there, she developed an infection. The experience left her with impaired mobility. She is now unable to come and go.
“I now need assistance because I can’t stand up by myself or use my walker,” she said. MacMillan receives home care from the BC Coastal Health Authority, but she also employs two private home care providers.
At first MacMillan didn’t question the qualifications of her private providers. “We simply contacted a company and arranged to have someone come,” said MacMillan’s daughter Kim. Unfortunately, MacMillan received “rough treatment” from one private provider. She has since changed services and is now wary of the care she receives.
There are no licensing requirements regulating private home care providers in BC. Yet every year more than 10,000 BC residents rely on home support services, says the BC Care Providers Association.
Apart from a standard business license, which requires a visit to the Licensing office, photo identification, a business application form and a $175 fee, private “Home Care” businesses need no qualifications, confirmed Rosemary Hagiwara, Manager of Vancouver’s Business Licensing Office.
“We don’t regulate them,” Hagiwara said. The business services are provided in clients’ homes, so there are not commercial establishments for licensing officers to inspect. As a result, checks occur only when formal complaints are filed, Hagiwara said.
What is “Home Care”?
Labeling inconsistencies are part of the problem.
BC’s Ministry of Health distinguishes between two groups of care providers. “Home Care” providers include Registered Nurses and other regulated health professionals who are subject to the standards of their colleges and licensing bodies. In contrast, “Home Support” workers are “unregulated providers” for whom there are no care standards or regulatory bodies.
From the Ministry’s perspective Home Support workers don’t require regulation because they only assist daily living activities. They do laundry, cook and help seniors eat their meals, bathe, etc. Home Care workers assist with health concerns, like taking medication.
But when it comes to actual licensing, there is no distinction between regulated and unregulated workers. Any at-home nursing service is considered Home Care.
The private home support service industry is “really a buyer beware situation,” said Alison Orr, manager of At-Home Supports for Vancouver Coastal Health.
New companies “pop-up all the time,” she said, and “not many of them can meet the kind of requirements that we put in place to safeguard seniors’ care.”
BC Coastal Health’s home and community care programs provide at-home health services which are highly regulated and run according to the Ministry of Health’s strict standards.
Private home care companies set their own standards of care.
“Education is the Key”
By 2031, over 20 percent of Vancouver’s population will be over 65. Within the province there are areas, like the Kootenay Boundary and South Vancouver Island, where that number will be closer to 30 percent.
“People are sicker in their homes now and the care they need is much more complex and detailed,” said Pat Bawtinheimer, the Dean of the School of Health Sciences at Vancouver Community College.
Although they are unregulated, many Home Support workers end up helping clients with their daily medical needs. Their assistance significantly contributes to the overall health and well-being of the seniors they support.
“Education is the key to quality home support services,” Bawtinheimer said.
The Ministry of Health requires Home Support/Resident Care Attendant certification as a minimum qualification of their own Home Support workers. In the realm of public health service, they recognize the need for a minimum level of education.
They are not willing, however, to set the same standards for private Home Support providers.
“The provincial government has no regulatory body for [private] home care,” confirmed Alison Orr.
Many seniors want to purchase privately because they feel “they can get more for their dollar,” says Orr, “but what they’re getting, they really have to be wary of.”