Providing care in non-traditional settings, such as home care services (HSS), is indispensable to ensuring the viability of the health care system and to supporting older citizens to age independently at home and in their communities for as long as possible. This is particularly important in the context of the aging population in New Brunswick, which brings greater health care needs. In general, older adults face less difficulties when it comes to accessing the health care services they need, however, there are still unmet needs in home care services, notably for home support services. More can be done to help older adults stay at home: some patients experience limitations in their services, and the COVID-19 pandemic had an impact on the types and duration of services they received. The specific needs vary by Zone. It is essential to adequately understand the needs at a local level for services to be more citizen-centered and to achieve the Provincial Health Plan target of “supporting seniors to age in place”.
In this article, we will explore the role of home care services in New Brunswick on older citizens’ ability to age in place. In Part 1, we will provide a health profile of citizens aged 65 and over in New Brunswick, outlining key elements of their unique health care needs. In Part 2, we will discuss current trends in access to health care services for older persons. Finally, in Part 3, we will review key results from the 2021 edition of the Home Care Survey, with a focus on unmet needs of older persons in New Brunswick.
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The data presented throughout this article was collected primarily through two sources: the New Brunswick Health Council (NBHC) Primary Health Survey and the NBHC Home Care Survey. Both surveys are distributed only to individuals who live in private residences. In New Brunswick, 94.1% of older persons (65+) live in a private residence5 and 5.9% (approx. 10,500 people) live in a collective dwelling6, such as a nursing home, long-term care facility, etc. Accordingly, the analysis in this Report is not inclusive of the experiences of older persons living in collective dwellings in New Brunswick.
In New Brunswick, 21.9% of the population is aged 65 and over1. This represents 171,262 people and ranks New Brunswick among the top jurisdictions for the highest proportion of older citizens in the country. Aging can be associated with greater complexities in health status and care needs; in New Brunswick, older adults are more likely to live with chronic health conditions, to have a disability, and to take multiple different prescription medications. Aging is also associated with great wisdom and experience, as well as important long-term contributions to our families, communities, and province as a whole. Accordingly, greater emphasis must be placed on supports and services that help older citizens in New Brunswick age safely and independently in the place of their choosing.
Canada’s provincial and territorial governments have expressed a commitment to working together “to ensure health care systems continue to respond to the needs of Canadians”2 and “New Brunswick is ready to reset priorities for all future policy developments around healthy aging”3. In this context, healthy aging refers to providing support and services to those who need them to manage their chronic health conditions, health behaviours or social factors, in order to better enable older adults to age independently at home while actively contributing to their community3. Furthermore, the recently released Provincial Health Plan – Stabilizing Health Care: An Urgent Call to Action4 identifies 5 key action areas that require immediate attention, one of which is “Support Seniors to Age in Place”. It emphasizes that although “seniors in New Brunswick value their independence, […] in recent years, more seniors are admitted to hospital beds, away from their homes and loved ones”4. The Plan acknowledges that nearly 1 in 3 hospital beds in the province are occupied by an older person who could be “experiencing a better quality of life and receiving services tailored for their stage of life and specific needs”4 elsewhere.
Access to services outside of traditional health care settings (clinics, hospitals, etc.) can help older people live safely and independently in their communities for longer2. Home care, provided through the Extra-Mural Program and Home Support Services in New Brunswick, is vital to ensuring safety and quality of life for older adults, and in turn, the sustainability of the health care system. In fact, supporting older adults to stay at home through home care services can delay or prevent their admission to a long-term care home, consequently fulfilling the desire of many seniors to age in place and supporting timely access to facility-based care for citizens with more complex needs.
What is Home Care?
Home care is a range of health and support services received at home that help citizens achieve and maintain optimal health, well-being and functional ability. In New Brunswick, there are two types of publicly funded home care services.
- The Extra-Mural Program (EMP) are home health care services like physiotherapy or nursing care. EMP services are funded by the Government of New Brunswick and are managed by Medavie Health Services New Brunswick.
- Home support services (HSS) are personal care services, such as housekeeping or meal preparation, provided by home support workers. These services are funded, entirely or partially, by the Department of Social Development.
In order to generate a deeper understanding of the quality of home care services in the province, the New Brunswick Health Council (NBHC) conducts the Home Care Survey every three years. This survey evaluates home care services whose costs are being entirely or partially covered by public funds. Over 7,000 service recipients responded to the Survey in 2021, answering questions about their experiences with several key dimensions of health care quality such as accessibility, safety, provider/client communication, client and family-centered care, and overall satisfaction with services.
In New Brunswick, 21.9% of citizens are aged 65 and over1. This number is expected to rise to 28% of the population in the next 10 years4. However, the distribution of older adults varies across health zones, hereinafter referred to as Zones, in the province (for a complete list of Zones, click here). In fact, 27.9% of the population in Zone 5 (Restigouche Area) is currently aged 65 and over, compared to only 19.5% of the population in Zone 3 (Fredericton and River Valley Area). Moreover, not all older adults are alike – the needs of one individual, or group of individuals, can be completely different from those of another. For example, while 26.8% of NB citizens aged 65 and over rate their health as very good or excellent, this number varies from 22.2% in Zone 4 (Madawaska and North-West Area) to 28.5% in Zone 3 (Fredericton and River Valley Area).
Older adults are more likely to be diagnosed with chronic health conditions
Older adults in New Brunswick are more likely to report having a chronic health condition than citizens under the age of 65. In the Primary Health Survey, chronic health conditions include: arthritis, asthma, chronic pain, emphysema or chronic obstructive pulmonary disease (COPD), cancer, diabetes, depression, a mood disorder other than depression, heart disease, stroke, high blood pressure or hypertension or gastric reflux diseases (GERD). In the 2020 edition of the Survey, 85.9% of older adults (65+) reported having been diagnosed or treated for one or more chronic health conditions, compared to 56.4% of those aged 18 to 64. Moreover, 41.4% of older adults reported having been diagnosed or treated for three or more chronic health conditions, compared to only 16.3% of citizens aged 18 to 64.
The percentage of older adults who reported 3 or more chronic conditions also ranged between Zones: from 35.3% of seniors in Zone 6 (Bathurst and Acadian Peninsula Area) to 45.9% in Zone 5 (Restigouche Area).
The top reported chronic health condition among older adults in New Brunswick was hypertension (54.1%), followed by high cholesterol (41.7%) and arthritis (35.8%). Despite the high prevalence of chronic conditions among older adults, only 43.9% of older persons with at least one chronic health condition reported being very confident in managing their health condition and only 30.6% strongly agree that they know how to try to prevent further problems with their health condition. Furthermore, 26.6% of older adults reported that they have a chronic condition and take 6 or more prescription medications on a regular basis. However, only 40.3% of those strongly agreed that they know what their prescribed medications do.
Older adults are more likely to report living with a disability
35.6% of older adults reported a disability, compared to 25.1% of New Brunswickers as a whole. This prevalence is as high as 41.9% of older adults in Zone 7 (Miramichi Area) and as low as 28% in Zone 6 (Bathurst and Acadian Peninsula Area). Chronic health conditions were the highest reported type of disability among older adults (76.1%), followed by pain-related disabilities (69.6%) and mobility disabilities (65.4%), which ranked second and third.
Older adults have perceived unmet mental health needs
Older adults reported a lower level of perceived unmet need for mental health services. Only 7.3% said that they felt the need to see or talk to a health professional in the last 12 months about their mental or emotional health, or their use of alcohol or drugs compared to 18.2% of New Brunswickers in general.
However, just like the general population, 30.1% of the older adults who reported a mental health need, did not consult a health professional in this regard. This varied across Zones in the province (see table below) for several reasons. The most reported reasons were that seniors did not know how or where to get help, they were too busy, or the services were not available at a time that was convenient for them. Perceived unmet mental health needs among older adults can aggravate existing physical conditions, and consequently further complexify their needs7.
95.3% of citizens aged 65+ in New Brunswick have a primary care provider (family doctor or nurse practitioner), which is higher than the provincial average of 89.9%. Older adults tend to rely on their family doctors for their care: they visit their family doctors more (an average of 3.4 visits in the last 12 months for seniors compared to 3.1 visits on average for the general population), are more likely to go to their family doctor when they need care (73.8% and 57.0%, respectively), and are less likely to go to an after-hours or walk-in clinic (9.8% of older adults vs. 20.5% of New Brunswickers) or to a hospital emergency department (7.1% of older adults vs. 10.4% of New Brunswickers) as their regular place of care.
Older persons seem to have timelier access to their family doctor as well: 57.9% can get an appointment within 5 days versus 50.8% for the general population. They are also more likely to give a favourable rating of health care services received from their family doctor than the general population. In 2020, 86.4% of older adults gave their family doctor a favourable rating of 8, 9 or 10 out 10, compared to 81.5% of New Brunswickers.
Older adults generally face less difficulties accessing health care services, but proximity of services remains a challenge. When comparing difficulties faced by New Brunswick citizens to accessing the health care services they need, older adults seemed to be facing less difficulties when it came to:
• Financial barriers
• Communication with health care professionals
• Physical access to health care setting
• Access to medical or rehabilitative equipment
• Services not available in area
• Navigation of the health system
On the other hand, data from the 2020 edition of the NBHC’s Primary Health Survey shows that older adults are at a disadvantage when it comes to proximity of health services: 19.6% of older adults reported that they had to travel over 100 kilometers to access health care services, in comparison to 17.6% of New Brunswickers. This fact is particularly prevalent in Zone 5 (Restigouche Area), where the highest percentage of older adults reported that they had to travel over 100 kilometers to access health care services (33.5%). Thus, older adults in Zone 5 have the highest prevalence of chronic health conditions, and they also face the greatest disadvantage when it comes to accessing care in their communities.
In the 2020 edition of the Primary Health Survey, the NBHC asked citizens whether they had unmet home care needs. In general, 3.0% of NB citizens aged 18+ reported that, in the last 12 months, they felt they personally needed home care services, but did not receive them. Among those 65 and older, this number was higher: 4.4%, or approximately 7,500 older adults, reported feeling that they personally needed home care services, but did not receive the services they felt they needed. In fact, New Brunswick has a higher than average percentage of newly admitted long-term care residents who could have been cared for at home if the appropriate formal supports were in place (e.g. help with bathing, dressing, eating)8. Citizens in New Brunswick also spend a higher than average number of days in hospital awaiting access to home care services9, highlighting the considerable impacts of unmet home care needs.
Conversely, older adults who do receive home care services report that these supports help them age in place. In New Brunswick, 91.7% of households receiving public or private home care services reported that the services they received helped them stay at home compared to 82.9% in Canada on average10. With respect to publicly funded home care services in particular, 97.0% of citizens receiving services from the Extra-Mural Program and 97.6% of those receiving home support services reported that these services helped them stay at home in the 2021 edition of the Home Care Survey.
Even though most older patients of home care services report that the services they received helped them stay at home, some of them also reported that more could have been done to achieve this goal:
• Extra-Mural Program – In the two months preceding the Survey, 6.4% of older patients receiving services from the EMP reported that more could have been done to help them stay at home. For example. although they were receiving home care services from EMP, 2.1% of older patients reported that they went to the hospital emergency department in the last 12 months for a condition that they felt could have been prevented with better services from this program. This number is as high as 4.4% of older patients in Zone 5.
• Home Support Services – For HSS, 13.5% of older patients reported that more could have been done to help them stay at home in the previous two months.
Furthermore, although most older adults receiving home care services report that they are very satisfied with the number of times they receive services (68.7% of older patients for home support services and 77.0% for the Extra-Mural Program), some reported experiencing limitations or reductions in the types or duration (number of hours available) of services available to them:
• Extra-Mural Program – Some older patients of the EMP report experiencing limitations to the services such as reductions in the duration of services (3.8%), or the type of services (4.7%) they receive, with Zone 4 demonstrating the highest percentage.
• Home Support Services – For HSS, a considerably higher proportion of older patients report limits or reductions to their services. Overall, 20.2% of older patients report limitations to the duration of services they receive, and 18.1% report limitations to the type of services they receive with a greater variability between the Zones. Zone 7 reported the lowest proportion and Zone 1 reported the highest.
Emergency situations, such as the COVID-19 pandemic, can further impact the ability to provide necessary services to support aging in place. In the 2021 edition of the Home Care Survey, the NBHC asked clients of both programs questions about how the pandemic affected the services they received.
Clients of both the Extra-Mural Program and home support services were asked about limitations or reductions in services as a result of the COVID-19 pandemic. In the two months preceding the survey, 6.9% of EMP clients and 13.0% of HSS clients reported that they needed home care services but there were limits, reductions or cancelled visits due to the COVID-19 pandemic. The percentage of clients who experienced limits, reductions, or cancellations in visits varied from 8.1% (Zone 6-Bathurst and Acadian Peninsula Area) to 23.0% (Zone 4-Madawaska and North-West Area) across Zones for HSS and from 4.4% (Zone 2-Fundy Shore and Saint John Area) to 20.9% (Zone 4) for EMP services.
Survey respondents were also asked how often their care provider wore a mask, kept 2 meters of distance (where possible), and washed their hands before providing person-to-person care. Overall, 97.2% of EMP patients and 90.1% of HSS clients felt that staff from each program took their health and safety seriously during the COVID-19 pandemic, thereby supporting them to continue receiving the services they need to remain safely at home and in their communities.
1. Statistics Canada. (2020). Population estimates: Customized data. Retrieved from: Statistics Canada Centre for Demographics.
2. Government of Canada. (2017). A Common Statement of Principles on Shared Health Priorities. Retrieved from principles-shared-health-priorities.pdf (canada.ca).
3. Government of New Brunswick. (2015). Home First. Retrieved from HOME FIRST (gnb.ca).
4. Government of New Brunswick. (2021). Stabilizing Health Care: An Urgent Call to Action. Retrieved from Stabilizing-health-care.pdf (gnb.ca).
5. Statistics Canada. (2021). Table 98-10-0045-01. Type of collective dwelling, age and gender for the population in collective dwellings: Canada, provinces and territories. Retrieved from: Department of Social Development, Government of New Brunswick.
6. Statistics Canada. (2021). Table 98-10-0042-01. Structural type of dwelling, age and gender: Canada, provinces and territories, census metropolitan areas and census agglomerations with parts. Retrieved from Department of Social Development, Government of New Brunswick.
7. Dockett, L. (2018). Increasing Access to Mental Health Care for Seniors. Psychotherapy Networker. Retrieved from Increasing Access to Mental Health Care for Seniors (psychotherapynetworker.org).
8. Canadian Institute for Health Information. (2019). New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home: Indicator results. Retrieved from: New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home | CIHI.
9. Canadian Institute for Health Information. (2019). Hospital Stay Extended Until Home Care Services or Supports Ready: Indicator results. Retrieved from: Hospital Stay Extended Until Home Care Services or Supports Ready | CIHI.
10. Canadian Institute for Health Information. (2022). Home Care Services Helped the Recipient Stay at Home: Indicator results. Retrieved from: Home Care Services Helped the Recipient Stay at Home: Indicator Results (cihi.ca).