In order to understand the tapestry of care in the home, we need to realize that in addition to regulated staff providing care, home support workers, volunteers and family and friend caregivers provide essential support to the frail, disabled and chronically ill. In their article "Employers, Home Support Workers and Elderly Clients Reveal Key Issues in Delivery and Receipt of Home Support," Anne Martin-Matthews and Joanie Sims-Gould touch on a number of key issues related to the delivery and receipt of home support services. This topic is especially important and timely given the significant role home supports play in the lives of Canadians, in particular those with ongoing care needs, such as seniors. Home supports also play a vital role in reducing pressures on other parts of the healthcare system. As the authors point out, home support workers address the majority of home care clients' needs, providing between 70 and 80% of care. (For the purposes of this article, the term home support worker will be used to reflect a number of roles including personal support workers, community health workers, community healthcare aides, home helpers and homemakers.) However, it is important to note that this figure only takes into account the work covered by paid healthcare staff and does not reflect the unpaid care many Canadians require to stay healthy and independent in their homes.

Home Supports: Good for Canadians and Good for the System

Providing home supports such as transportation and housekeeping benefits clients, their caregivers and the overall healthcare system in a number of ways. For example, providing long-term home supports helps Canadians age in their homes - exactly where the vast majority want to be - and improves their quality of life. For family and friend caregivers, home supports are a form of respite, allowing them to share some of the care responsibilities with others, thereby protecting their own health. Providing ongoing home and community supports and services can reduce demand on more costly sectors of the healthcare system, most notably hospitals and long-term care (Teplitsky et al. 2006), and help address pressing challenges such as the misuse of alternative-level-of-care beds and emergency rooms.

Creating a "Support Net" for Seniors

Home support workers, volunteers and family and friend caregivers complement the efforts of regulated professionals such as nurses and physiotherapists by providing essential ongoing support and care. In short, they provide a "support net" for seniors, helping them to remain healthy, safe and independent in their homes.

Home support workers perform various tasks, including washing floors, bathing clients and being companions. Over time, they often develop close relationships with clients and their caregivers, as both groups come to rely on them to provide ongoing care and support. Home support workers help clients remain independent in their homes - especially those who may not have access to help from friends and family. For caregivers, home support workers represent an essential resource, allowing them to share the responsibility of care and giving them "peace of mind" (Victorian Order of Nurses [VON] Canada 2004).

Although home support workers contribute immensely to people's care in the home, their working conditions are often less than ideal. They frequently make close to minimum wage, with little or no group benefits, especially for non-unionized employees. Not surprisingly, recruiting and retaining home support workers remains a significant challenge.

Volunteers provide invaluable support to home care staff, clients and their caregivers. They deliver a number of services and supports to people in their homes and strengthen the capacity of the home and community care sector. Programs such as Meals on Wheels and companionship programs are often only available because of a dedicated volunteer base. VON, a national not-for-profit home and community care organization, can attest to the value of volunteers. In 2006, a total of 8,857 VON volunteers provided over 407,000 hours of service across Canada.

However, Canada's volunteer force is changing, with fewer people providing the majority of service (Hall et al. 2006). This is not a sustainable model as many of these dedicated volunteers are seniors. Recruiting and retaining volunteers is becoming increasingly complex, with more people interested in "episodic" volunteering rather than commitments to long-term positions (Robertson n.d.). This creates a number of challenges for organizations as more and more resources are devoted to attracting volunteers from an increasing smaller volunteer pool. Unless corrective measures are implemented, Canada's shrinking volunteer pool will have significant implications for the healthcare system.

Caregivers are people who provide care and assistance for their family members and friends who are in need of support because of physical, cognitive or mental health conditions (Canadian Caregiving Coalition 2001). There are an estimated 2.85 million Canadians who report caring for a family member with long-term health problems (Cranswick 1997). Caregivers provide wide-ranging care and support, including the organization of resources and community supports, transportation and medicine administration. In addition to the impact they make on the quality of life of the care recipients, caregivers provide more than two billion hours of caregiving each year (Fast et al. 2002). Without the unpaid labour provided by family caregivers, the Canadian healthcare system would be unable to cope with the increasing demands for care.

Despite the valuable contributions being made by caregivers, there are too few services in place to help them maintain their own health and balance. Although some supports and resources for caregivers are available across Canada, they tend to be limited and are often provided through voluntary organizations (Keefe et al. 2007). While caregivers acknowledge the rewards of caregiving, they often provide care at the expense of their own physical, emotional and financial well-being.

Conclusion

The balance of care is shifting from institutions to homes and communities. Driven by a host of factors, such as hospital bed reductions, an aging population and increased consumer demand, home care has become the fastest-growing sector in healthcare. It is expected that reliance on the sector will continue to grow. Home supports play a major role in this scenario. If governments intend to keep their promise and help Canadians "age at home," concerted efforts must be made to ensure that we have sufficient numbers of well-trained people available to provide the necessary care. Home support workers, volunteers and caregivers are essential components of the care team. Like other team members, they deserve comprehensive supports to help them carry out their duties and maximize their contributions.

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