Aging at Home

Here in New Brunswick and across the country, citizens want to live and age at home. To do so, they need access to reliable home care services. This is particularly important in New Brunswick, where 23% of the population is 65 years of age or older¹. Of those aged 65 and over, almost 90% reported being diagnosed with or treated for one or more chronic health conditions. Furthermore, more than one-third reported having three or more chronic health conditions². When we project the numbers into the future, by 2030, the percentage of the New Brunswick population aged 65 or older is expected to increase to nearly 28%³, which might create more demand for home care services. To meet this growing need, home care options will need to be accessible and efficient. 

There are two types of publicly funded home care services in New Brunswick: The Extra-Mural Program (EMP) Home Health Services under Extra-Mural/Ambulance New Brunswick (EM/ANB) Inc. which is managed by Medavie Health Services NB, and the home support services (HSS) under the Department of Social Development. They offer different types of home care services to clients and are managed differently.

For both types of services, referrals from hospitals tend to get priority over other types of referrals.

Wait times for publicly funded home care services differ depending on where someone lives and the type of service(s) they need.

When we think about access to home care, wait time plays a big part.

For Extra-Mural Program (EMP) services, wait time is defined as the time it takes for someone to start receiving home care services after a referral is submitted. This wait time is reported as a median.

In 2023-2024, median wait times for EMP services were as follows:

• Wait times were longest for rehabilitation services. They varied across the seven health zones, ranging from 9 days in Zone 1 (Moncton and South-East) to 22 days in Zone 4 (Madawaska and North-West).
• Wait times were shortest for nursing services, at 2 days across all zones.
• For other types of services, such as speech language pathology, respiratory therapy, registered dietician services, or social worker services, the median wait time ranged from 4 days in both Zone 3 (Fredericton and River Valley) and Zone 4 (Madawaska and North-West), to 7 days in Zone 7 (Miramichi).

Some citizens receiving EMP services face much longer wait times, resulting in impacts to their health:

“Fell in May. [Doctor] referral in June. Did not see [Extra Mural Program] until [November]. 5-month wait with continued falls and mobility issues” 

 

2024 Home Care Survey – EMP questionnaire respondent)

For services under the Long-Term Care Program, which include home support services, there is information on:

• Wait time from referral to assessment complete for all services under this program, including home support. 
• Wait time from referral to receiving services, specifically for home support services.

In 2023-2024, the average wait times for the Long-Term Care assessment, (including, but not limited to those requiring home support services (HSS)) ranged from an average of 30 days in Zone 7 (Miramichi) to 106 days in Zone 2 (Fundy Shore and Saint John).

Wait time from referral to receiving services for HSS specifically ranged from an average of 45 days in Zone 5 (Restigouche) to 107 days in Zone 2 (Fundy Shore and Saint John).

Some HSS clients see these wait times as problematic:

“The wait to hear back from [a] social worker with [Social Development] is too long. Having difficulty getting in touch; someone [should] increase [their] service hours. We now need to add my father to the program, but the wait is long” 

 

(2024 Home Care Survey- HSS questionnaire respondent)

Long wait times may lead to negative impacts on quality of life, deterioration of health, and hospitalizations. Citizens seeking these services may also decide to use other private home care services that might cost them out-of-pocket, or to visit the hospital emergency department. Furthermore, without the support of professional services, there is an increased burden on informal caregivers.

If patients are waiting for home care services or other continuing care services in an acute hospital bed and their discharge is delayed because of long wait times, they are considered Alternative Level of Care (ALC) patients. Waiting for home care services could contribute to an increase in the percentage of patients in hospitals who are classified as ALC. However, some pilot projects, such as the introduction of social workers in hospitals and more recently, having hospital staff complete Long-Term Care Program assessments, have since been established to provide quicker assessment and help discharge patients from the hospital to home care more quickly.

According to the results of the New Brunswick Health Council’s 2024 Home Care Survey, once citizens receive services, they have a really good experience (giving a favorable rating of 8, 9 or 10 out of 10). They reported good communication, sharing of information and coordination of care. 

• For Extra-Mural Program (EMP) services:
  • 97% of citizens receiving EMP services gave a favorable rating for the care they received.  This is an improvement from 2021 (96%).
  • In some zones, this percentage is even higher: 98% of EMP clients living in Zone 6 (Bathurst and Acadian Peninsula) gave a favorable rating. 

• For home support services (HSS): 
  • 89% of citizens receiving HSS gave a favorable rating for the care they received.
  • In some zones, this percentage is even higher: 92% of HSS clients living in Zone 6 (Bathurst and Acadian Peninsula) and 95% of clients living in Zone 7 (Miramichi) gave a favorable rating.

Here are some of the things survey respondents had to say about the services they received:

“Excellent service. New Brunswick should be very proud of this program!”

 

(2024 Home Care Survey – EMP questionnaire respondent)

“My workers are amazing, they treat me so great. I would be lost without them. They treat me like family.”

 

(2024 Home Care Survey – HSS questionnaire respondent)

Communication

• More than 9 in 10 citizens who received services from the EMP reported good communication from staff (an improvement from 2021).
• Around 8 in 10 citizens receiving HSS reported good communication from staff.

Sharing of Information

• More than 90% of EMP clients reported that the staff gave them the information they needed to take care of themselves and kept them informed about their progress.
• 8 in 10 EMP clients reported that the staff discussed with them what could be shared with their informal caregivers.
• 9 in 10 citizens receiving services from the EMP and HSS reported that their informal caregivers received the information they wanted when they needed it.

Coordination of Care

• 79% of EMP clients and 59% of HSS clients reported that the staff always seemed informed and up-to-date about all the care and treatment they received.

In addition to reporting a good experience with their home care services, 97% of EMP clients and 99% of HSS clients reported that the services received helped them stay at home.

Although the services provided helped them stay at home, a small percentage of citizens receiving such services reported that more could still be done.

• 6% of EMP clients and 15% of HSS clients reported that more could have been done to help them stay at home.

According to survey respondents, more could have been done in terms of the types of services provided and how long they were provided for. 7% of EMP clients and 20% of HSS clients reported that there were limits in the types and duration of services.

“Yes, would like equipment up to date, [for example a] hospital bed and electric lifter to lift him”

 

 (2024 Home Care Survey - EMP questionnaire respondent)

Other services that are not within the mandate of the Extra-Mural Program or home health services that were also mentioned as needs by citizens include things such as snow removal, delivering blood work to the hospital, social visitors, and housework, among others.

In addition, both EMP clients and HSS clients expected more hours from the programs especially during the night, on weekends and on holidays.

“More hours of support would be valuable, specifically at night” 

 

(2024 Home Care Survey - HSS questionnaire respondent)

There is still a strong reliance on informal caregivers

Despite receiving home care services, survey results indicated that clients also relied on informal caregivers to help them out. 7 in 10 citizens receiving EMP services and 6 in 10 citizens receiving HSS reported that they received help from informal caregivers. In terms of how often they received that help, 9 in 10 EMP clients and 8 in 10 HSS clients reported needing help from their informal caregivers at least once a week.

These results suggest that there is still a need for support for informal caregivers in the province.

Aging at home and the accessibility of home care services remain priorities for both the provincial and national health care systems. In New Brunswick, where the aging population is rapidly increasing, the demand for these services is expected to rise. While publicly funded home care services such as the Extra-Mural Program (EMP) and home support services (HSS) play a vital role in allowing seniors to remain in their homes, challenges such as long wait times persist. Once received, however, these services are generally well-regarded, with many recipients reporting positive experiences and improved quality of life.

Despite the overall success of these programs, many clients continue to rely on family and friends for additional care. Moving forward, as the aging population grows, it will be essential to address these challenges to ensure that all citizens can continue to age with dignity and independence in their own homes.