by Sylvain Comeau
|Is the future of health care in the home?
When we get sick, will our loved ones be our nurses,
caring but probably untrained?
To speakers on a panel sponsored by the School of Community and Public Affairs (SCPA) on March 1, that scenario is a grim one, and a leap backwards for public health care.
David Woodsworth, professor emeritus of social work at McGill, is concerned about the shift toward ambulatory care, with its emphasis on discharging people as soon as possible.
"There is pressure on hospitals to cut by half the number of acute-care beds, on the premise that technology will have advanced by then to the point that they can treat people fast and send them home much sooner than before. That's a dangerous assumption."
Nancy Guberman, a professor of social work at UQAM, charged that families are under increasing and unreasonable pressure to take up the slack from an inadequate health care system.
"What's happening today is that despite CLSCs, 75 per cent of home care is administered by families. According to some studies, people being treated at home are just as sick as those in institutions. And you have to be very sick to get into institutions these days."
Worse, the care is often provided by only one family member, usually a woman. "Families are the cornerstone of health care policy. Are families equipped to be the cornerstone and provide 24-hour care? You can only provide care according to your resources. Often there is inequality in the family unit, and the primary caregiver is only one woman."
Guberman said that she has seen many cases of lay people being responsible for monitoring medical equipment, giving intravenous injections, bandaging and other things mainly done in hospital, without the benefit of years of medical training. In addition, as a result of juggling these duties with work and other responsibilities, "we see caregivers who suffer from exhaustion, frustration, very high levels of depression and guilt. Some of them are old people who have their own chronic health problems."
Hazel Harrington, president of the Victorian Order of Nurses (VON), said that patients, particularly terminal ones, often prefer to be at home.
"Patients want to be in the more familiar surroundings of home if they can, but of course that can be stressful for families, so we offer to send a nurse into the home to help take some of the load off the families. [For terminal patients,] this means they can die at home instead of a hospital, and with a nurse who's been with them for a long time." The VON charges for its services, "but we have never turned down a patient because they have no money."
Metu Belatchew, homecare community organizer at CLSC NDG, said that caregivers are given some training in the services they are asked to provide, and that allowing patients to stay at home is a form of empowerment.
"Calling it empowerment is a misnomer, in many cases," Guberman countered. "It can be more of a burden."
She said that more and more families are refusing to shoulder that load. "They'll probably keep transferring more and more responsibilities to the families, until the families start saying no. They are starting to get organized to do just that. Caregiver support groups are evolving into activist groups, and developing a political voice."
Woodsworth added that the situation is creating an increasing health risk. "This becomes literally a do-or-die situation for families. The question is, how many dead people can the government stand?"
School of Community
and Public Affairs
Monday, March 20, at 6 p.m.
Le Nouvel Hotel,
1740 René-Levesque Blvd. W.
chief editorialist of La Presse
author of No Logo: Taking Aim
at the Brand Bullies
feminist and author
of Imagine Democracy
Institute for Research
on Public Policy
Hon. David MacDonald
For more information,
please call 848-2575.
Copyright 2000 Concordia's Thursday Report.