What to Do if You Don’t Qualify for Provincial Home and Community Care Services
Community Care Access Centres (CCACs) coordinate home care, community care and long term care across the province of Ontario. If you or a loved one need extra help at home or can no longer safely live alone then a call to your local CCAC is in order.
The costs of CCAC services are covered by the government and any resident of Ontario can contact a local CCAC to make a referral for themselves, a loved one, or a patient. If you have an Ontario health card then you are eligible for an assessment by a CCAC coordinator to determine the type of care and service you need.
But what happens when your assessment doesn’t result in the care you feel you (or a loved one) require?
Statistics Show Canadians’ Home Care Needs Not Adequately Met
In 2012, Statistics Canada released a stunning report on home care deficiencies across the country. According to their survey (which did not include Canadians living in long-term care homes or institutions), 1.8 million Canadians received home care and were satisfied that they were receiving all the care they needed.
However, 792, 000 Canadians 15 years of age and older had home care needs for a long-term illness, aging or disability condition which were only partially met, or not met at all. Of this group of Canadians:
- 461, 000 needed home care but did not receive any at all
- 331, 000 received home care but did not feel they were receiving all the care they needed.
Of those Canadians not receiving home care services:
- 24% were 65 years of age and older
- 59% reported they had at least one physical problem
Of those Canadians receiving inadequate home care services:
- 40% were 65 years of age and older
Immigrants and individuals with a household income of less than $20, 000 were more likely to report that they had unmet home care needs.
Also, Canadians receiving inadequate home care services:
- Were more likely to have partially met needs if they had certain medical conditions: For example 30% of Canadians with back problems did not receive all the help they needed, compared with 11% of Canadians receiving home care because they had cancer
- This also included seniors who were primarily helped by: Friends or neighbours (17%), their son (12%) their spouse (11%) their daughter (8%)
Be Your Own Advocate in the Care System
The aforementioned Statistics Canada study shows that although many Canadians are receiving the home care assistance they need, a large number have needs which are unmet or only partially met.
In a system which is underfunded and overused, it is easy to become lost. It’s important to become your own advocate to ensure that you (or a loved one) receives the care you need and deserve.
Becoming an advocate means educating yourself about the services and levels of care you are entitled to and then following up with care providers and community groups to ensure you receive that care.
What Type of Care Are You Entitled To?
Within Ontario, when you contact the CCAC you will speak to a care coordinator who will discuss your concerns, needs and the support that is available. Anyone with an Ontario Health Insurance Plan is eligible for local CCAC services.
Your local CCAC assesses needs using standardized tools. The assessment will look at:
- Individual needs
- Health concerns
- Decision-making abilities
- Non-financial resources
- Social support
Based on their assessment, the care coordinator works with you to develop a care plan that may include a combination of services provided by the CCAC like nursing care (which are free), or other services within the community that may require a co-payment or full payment by you. These community services might include transportation to doctor’s appointments, help with meals or assistance with house work.
If you or a loved one are no longer able to live at home then your care coordinator will help with the application for long-term care. They are responsible for the application process, eligibility and wait list management.
You should be aware of some limitations to CCAC support:
- People requiring a high level of nursing care can receive a max of 28 visits or 43 hours of care a week
- People requiring a high level of personal support services can receive a max of 80 hours of service in the first 30 days and 60 hours for the next 30 day period
- There are 14 CCAC locations across Ontario and each one offers different services and levels of community care
- There are wait times for some services
If you require high levels of care above and beyond what the CCAC can offer then you should consider an application for a long-term care home.
Wait Times for Long-Term Care a Huge Hurdle for Canadians
Across the country wait times vary for long-term care communities. For individuals and their families with an urgent need for 24-hour care, these waits are difficult. Seniors waiting for long-term care are cared for in hospitals in the meantime, which is a stressful and emotional experience for families as well as an expensive and heavy burden on the health care system.
Once your application for a long-term care community is complete it is difficult to know how long you will have to wait to receive your space. You’ll likely be surprised at the long wait.
For example as of October, 2015 wait times in Burlington, Ontario were as high as 1048 days for some communities (almost 3 years!
What to Do if Your Application for Help is Denied
If you haven’t received the help you need from your local CCAC or your application to stay in a long-term care community is denied and you feel you have met all the conditions required of you then you have a few options:
- Contact the long-term care action line and ask to speak to an independent complaints facilitator, who is a neutral mediator between you and the CCAC
- If your complaint remains unheard consider launching an appeal of the CCAC’s decision. To do this you’ll need to contact the Health Services Appeal Board of Ontario
If you can afford care for yourself and a loved one independent of the CCAC then you may find that private home care or a retirement community is a better option to ensure you or your loved one receives the care you require in a timely fashion.
Do you have any experience qualifying for provincial care services? Share your stories with us in the comments below.
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