Business Edge

February 9, 2007

Home-care crisis looms nationwide

Staff shortages hit companies providing service

by LAURA SEVERS, Business Edge

A silver tsunami is about to hit Canada's homecare network.

Already faced with labour shortages in parts of the country, the home-care system, which provides community supports to enable people to stay in their homes, is expected to be rapidly engulfed by an aging demographic that could put even more stress on health-care providers.

But while home-care companies and organizations prepare for the future, they're already dealing with a more immediate concern: A lack of staff.

"In many ways we tried to avoid the 'c' word but it is a crisis. There are many people throughout the province (of Alberta) whose care is not being fully serviced as a result," says Wes Campbell, president of the Alberta Home Care and Support Association (AHSA), which represents 65 member not-for-profit, private and public organizations servicing 50,000 clients annually.

While labour shortages are no longer news in that province, other regions across Canada are having problems in finding and retaining home-care workers.

Mississauga-based Bayshore Home Health, which describes itself as the largest home-care provider in Canada, says it is running into difficulties in various parts of the country.

From Bayshore's perspective, the shortage is most acute in the following cities, in order: Calgary, Edmonton, Vancouver, Winnipeg and Halifax, says Janet Daglish, director of community partnerships for Bayshore.

It's also not ideal in Ontario. The Ontario Home Care Association (OHCA) represents home health-care organizations that provide home-care services to an estimated 250,000 clients annually.

"Ontario is experiencing the same challenges in recruiting all types of home-care workers - nurses, therapists and personal support workers," says OHCA executive director Sue VanderBent. However, home care is the next wave of the future for health-care provision, says VanderBent. "If Canada goes the same way as Europe, we will expand and enhance our home-care delivery so people will be able to stay at home," she says. "That's where people really want to be.

"People want to live in their own homes and stay there and age there as long as they can."

Home care encompasses a wide range of services from assistance with daily living to at-home nursing care after a hospital stay. Further, many treatments that were once carried out in a hospital setting are now able to be done at home. Services can range from dealing with advanced stages of various diseases, using mechanical lifts to get in or out of bed, assisting people with bathing, to dealing with premature babies when they come home.

All concede that demand created by an aging population is one of the key factors, especially with the arrival of Baby Boomers into retirement age - a wave that could well result in a greater need for assistance.

It's in B.C. where this silver tsunami is likely to hit hardest.

Currently home to some 588,000 seniors, 25 years from now that number will more than double to 1.3 million seniors. One in four British Columbians will be a senior by 2031, according to the BC Care Providers Association (BCCPA), a non-profit organization representing non-profit and private facilities and agencies and suppliers, including Home Support members, that provide services to more than 10,000 clients each year.

Overall, Canada's senior population will double from 3.5 million to an estimated 6.9 million by 2021, says the Public Health Agency of Canada.

But demographics are just part of the picture. A booming economy is another.

"We're challenged by several factors," says the ASHA's Campbell. "One is the economic engine that's driving Alberta - in and of itself, it creates pressure for labour and that's well documented."

Add in declining enrolments for schools that train personal- care attendants and an aging workforce where people are retiring faster than they can be replaced, and you have a more complete look at the challenges faced by this industry.

"I can go to school for four months and get my personal-care certificate to make $13 an hour, or I can go out this afternoon to several places in town and they would hire me immediately and pay me more than $13 an hour," says Campbell. "There's not an economic or a time commitment incentive."

The BCCPA's Kate Hildebrandt, the association's director of public relations, says they're dealing with some similar issues. "Some of our colleges are doing well in recruiting new students and others have stopped the program because of a lack of enrolment, such as in the Okanagan and northern B.C., with officials there attributing it to better opportunities in the oilpatch," says Hildebrandt. "And there's better opportunities at Tim Hortons. You can get a full-time job there in northern B.C. at $15 an hour, you don't have to work nights and it's easier and clean work."

Another issue, says Hildebrandt, is also salary related. "We're hearing different problems in different pockets of our province," she says, pointing to booming tourism development in B.C.'s Interior, particularly around Radium Hot Springs. "There's so much tourism development (there). Boomers are going into early retirement and building up retirement communities, they're moving here from Calgary and Europe - when you've got that kind of development going on, there are so many opportunities in the trades."

This results in a lot of young people choosing a lucrative trades job as opposed to building a career from the ground up. "We had close to 350 people resign last year for better pay and better hours," adds Hildebrandt.

Industry insiders say there is a light at the end of the tunnel, though it will take time.

"Unfortunately, there's no quick fixes," says Campbell. "This didn't happen overnight. It developed over several years.

"No. 1, we have to figure out better and more effective ways to attract people to health-care careers.

"No. 2, we have to increase our retention rates. No. 3, we have to be aggressive with the ESL (English as a second language) candidates. We need to be very, very creative in the way we provide compensation and benefits. We also need to be competitive in our wages and benefits programs," says Campbell.

Hildebrandt agrees, adding not enough people know about the industry, the career choices it offers and the possibilities for advancement in the field.

There's also a cultural shift to deal with, in a society where a younger generation cares more about themselves than they do for others.

Meanwhile, one private-sector home-care provider, Nurse Next Door, headquartered in Vancouver, believes it has found its own solution.

Created in 2001 as a result of their personal experiences of trying to find the right caregiver for their own family members, John DeHart and Ken Sim are now in expansion mode.

In March, Nurse Next Door will open offices in Burnaby, Kamloops and White Rock and plans are to have 10 franchises up and running in B.C. by the end of the year.

In 2008, Nurse Next Door will look at expanding into both Alberta and Ontario.

"The whole labour shortage is a big issue in our industry. It's our No. 1 initiative as we roll out our franchise program across Canada," says DeHart. "We're taking it into our own hands, we're creating our own internal programs so we can find workers who become great caregivers and teach them to become home-care workers.

"We call it our 'rehirement' versus retirement solution. There's a whole group of older mature individuals that have a passion for what we do but don't have the skills or the training to do it. We're piloting it now, creating an entire program around finding older mature individuals and teaching and training them to become caregivers."

Many of the company's best caregivers are individuals over the age of 65, DeHart adds.

Bayshore has also developed its own plan to deal with the labour concerns.

It offers programs to help recent nursing grads to enter the home-care sector including teaming senior nurses with young nurses entering the home-care field, so newer staff can get the support they need.

It's using late-career nurses in educator roles, increasing support for licensed practical nurses so they can play a bigger role, as well as boosting support levels for personal-care workers or home-care aides.

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