Room for growth in health care


Oct 29, 2007

Doris Morley leans back in her favourite chair and reflects on what she likes most about her live-in caregiver, Joan.

Surrounded by pictures of family in the living room of her suburban Toronto home, it looks like the former dietician momentarily forgets the question as she enjoys the late-afternoon sun. Suddenly she clasps her hands together and almost shouts, "Her cheer."

Ms. Morley is a client of Home Instead, a franchise run by Sharon Galway that employs Joan as one of 60 "caregivers." She lives with the widowed Ms. Morley, who is in her early eighties, and helps with things like bathing and dressing, but also provides companionship, and peace of mind for Ms. Morley's grown children.

Home Instead is one of a growing number of small businesses across the country that are serving an ageing population that has money to spend on personalized, in-home care.

"Deep down we all knew ? people would want to stay in their communities as close to their homes as possible," says Ms. Galway, a 30-year veteran of the health-care industry.

According to Statistics Canada, 13% of Canadians are classified as seniors, and that number is expected to double within 25 years. The 85-plus age group is the fastest growing portion of the population.

Ms. Galway's previous job as an elderly abuse counsellor for the Ontario government made her realize the public health-care system is woefully ill-equipped to handle a rapidly ageing population.

She saw young parents buckling under the pressure of caring for elderly relatives, while they were raising children, and both usually going to work.

Former investment banker John DeHart knows this experience firsthand. He and Ken Sim started Nurse Next Door in Vancouver in 2001 after encountering difficulty finding care for sick relatives. But unlike many other home care providers, Nurse Next Door also provides full medical care to its clientele.

"We found an industry that lacked professionalism, it lacked standards, it lacked customer service, and it really lacked a brand," says Mr. DeHart. "But at the same time it was such a valuable and needed service."

When Mr. Sim's wife was confined to bed rest during her pregnancy, the first caregiver he hired had no criminal record check or medical screening, while the second had not met in person with company that hired him.

Their goal is to build the first national home-care brand in Canada that offers the same level of care found in a hospital or nursing home. NND has four franchises in B.C., and plans to expand in Ottawa and Toronto.

As with Home Instead, which has 20 franchises operating across Canada, their goal is to keep seniors in their homes as long as possible at the most affordable price. It is possible to get their service for as low as $50 a week, for simple tasks like getting groceries, says Mr. DeHart.

In Canada the price of nursing home care ranges from$4,000 to $12,000 a month, he says. Full-time care 24 hours a day, seven days a week with Nurse Next Door costs between $5,000 to $7,000 a month. Ms. Galway says the average cost of Home Instead service is about $1,000 a week; she charges $18 an hour, with the minimum level of care being three hours per visit.

One of the biggest issues facing this nascent industry is a lack of regulation. Ms. Galway says her caregivers undergo a rigorous screening process, and her franchise is a member of the Ontario Homecare Association, which acts as an advocacy group for the industry.

The Canadian Council on Health Services Accreditation, which sets standards for hospitals and nursing homes across the country, began offering similar accreditation to homecare providers in 1996. Whether or not private homecare providers pay for accredidation is up to them, says CCHSA spokeswomen Liane Craig, although she says it would make a business more attractive to potential clients.

Since there is no regulatory body overseeing the industry, NND simply imposes standards on itself. The company uses multiple interviews, reference checks and medical testing, as well as requiring basic first-aid and CPR licences for its caregivers. It also employs nurses, certified care aids and certified companions for more involved medical care.

Another coast-to-coast ho-Those in the industry say the biggest initial challenge is sheer exhaustion. Mr. DeHart says he slept with his phone for the first year he was in business. NND has since designed a central dispatch unit that schedules appointments for franchises. In fact, Mr. De-Hart says the company is now shifting to training and development organization.

He says the best caregivers are in 50-plus age range, usually women whose children have left home and want to work in the community.

Those working in the industry talk openly about how they feel their work also provides a service to the community. They say that while there is money to be made, those looking solely to turn a quick buck are likely better served by other ventures.

Ms. Galway says one of the most rewarding things about her job is the people. Some of her oldest clients, the ones she calls her "nifty nineties" include a woman who marched with Martin Luther King, the architect who designed Toronto's first subway stations and a retired judge.

What surprises her most is how people still expect the government will take care of them in their old age. She said she is pushing the envelope to convince people that in the future, they will have to pay for quality homecare, and suggests society should start thinking seriously about services like senior daycare.

"It's really frightening that people who built this country think that, after all their hard work the resources will be there," Ms. Galway says.