Home Healthcare for Older Adults

Cannabis and the Rapid Growth of Canadian Home Healthcare

 

The rise of Canadian home healthcare has big implications for cannabis. 

 

As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele. 

 

Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe. 

 

Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor. 

 

But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians. 

 

That is both good and bad news for medical cannabis. 

 

While federal laws say nurses can authorize medical cannabis use, many nursing regulatory institutions have been reluctant to allow it. 

 

And seniors increasingly want to try cannabis. As Canadian home healthcare continues to increase in appeal with the population’s age, more nurses will be the primary point of information and patient advice when it comes to helping patients obtain and consume medical weed. 

 

What is Canadian Home Healthcare? 

Broadly, home healthcare refers to medical services received in a residence as opposed to doctor’s office, hospital, or outpatient facility. This can anywhere from a few visits to long-term care, but does not include nursing home facilities. Also called community care because it happens in the community as opposed to medical offices, home healthcare is still regulated by Canadian government agencies — although not in the same way that regular medical care is.

 

Home healthcare is meant to assist those who have trouble getting to a healthcare facility or to and assist in-home caregivers with their duties. 

 

It covers a wide range of medical services, including nursing care (such as changing dressings, and preparing and administering medication), speech therapy, nutrition counseling, and covering the cost of medical equipment or supplies (such as ventilators, oxygen equipment, and wheelchairs). 

 

One of the most appealing parts of Canadian home healthcare is diversity of services offered. It can be on a short-term basis, in order to help patients recover from a surgery or a major illness in comfort; as a rehabilitation service for the temporarily disabled; for end-of-life care in a hospice manner; or as long-term car in the comfort of the home. 

 

Not only is home healthcare convenient, it has proven patient benefits. 

 

Research has shown that formal home care (the kind involving nurses or other professionals – not simply family members) was associated with decreased mortality, improved quality of life, reduced hospitalization and lower healthcare costs. 

 

Hospitals, it turns out, can be depressing and full of other chances for patients to get sick. Staying at home is more conducive to a healthy spirit — and often easier to visit for family members and friends who sometimes dread the burden of making visits at hospitals.

 

So, home healthcare cheaper and more effective than traditional medicinal care — does that sound like anything else that’s gaining popularity in the Canadian medical space? 

 

Barriers to Canadian Home Healthcare

The popularity of home healthcare has led to an increase demand for its service — and increasing headaches over its cost. 

 

Almost two-thirds of all Canadian residents have insurance, either bought privately or through their workplaces, that cover the costs of home healthcare. 

 

While millions of Canadians benefitted from home care in 2018, approximately 1.2 million needed such care, but were unable to receive it. 

 

For many, the biggest factor preventing the acquisition of home healthcare was simply the availability of the service. Several places in Canada have more need for home healthcare than availability, forcing people to either go without care altogether (if a hospital or doctors visit is too hard) or to seek more traditional care. 

In those cases, patients are typically getting worse overall care. 

 

But a lack of nurses and supplies isn’t the only limiting factor. Personal characteristics, cost, and ineligibility are the next most-common barriers to home healthcare access. 

 

Some people who desire home care are deemed inappropriate receivers for government-paid home healthcare by their primary care physicians, others cannot afford it, and still others have trouble convincing someone to care for them at home, either due to personality issues, the state of their residence, or other factors. 

 

While seniors are using home healthcare services at the highest rates, the demographic most likely to want home care but not receive it are those ages thirty-five to forty-nine. Why them? Many in that group lack long-term care insurance, which could help ease the financial burden of the service. That group also has a high number of single people, who cannot split the cost of care with a spouse, and are aging into poorer health. 

 

When people who want Canadian home healthcare cannot access it, they experience worse outcomes. Poorer health is only consequence of unmet home care needs. People who lack home healthcare and need it show an increased use of other services, which can put an undue burden on the healthcare system; show an increased admission into nursing home, losing out on independence; and have less emotional wellbeing, which brings with it a range of consequences in quantity and quality of life. 

 

When Home Healthcare Isn’t Available

According to the Canadian Institute for Health Information, more than ninety percent of the hospital patients can access home care — but not many take advantage. 

 

One out of every twelve hospital patient eligible for home care have to spend extra time in the hospital until home care support becomes available. That’s enough to fill up three four-hundred-bed hospitals every day. 

 

Those extended hospital stays usually take less than seven days, but ten percent spend two months or more waiting for home healthcare. Those most affected by the wait are seniors over age 82, and three out of five are women. 

 

The most common reasons for being granted home healthcare services following a hospital visit are dementia (twenty-three percent), diabetes (twenty percent), cancer (nine percent), chronic obstructive pulmonary disease (eleven percent), and congestive heart failure (thirteen percent).

 

Amazingly, cannabis treats many of those problems. That’s why seniors are increasingly interested in cannabis. Cannabis can treat the symptoms of dementia, such as anxiety, depression, and psychosis; it can help reduce the negatives associated with cancer; it shows promise for treating COPD; and may help reduce blood pressure and clear arterial plaque.

 

Is it any wonder seniors are interested? 

 

How Government Agreements Govern Home Healthcare

Health Canada does not insure home healthcare in the same way it does hospital and doctors. Instead, most Canadian home healthcare is served by the governments of provinces, territories, and municipalities. 

 

Other sources of home healthcare are delivered federally, but those go only toward specific populations, such as veterans, indigenous peoples, and the Royal Canadian Mounted Police. 

 

In 2017, Canada saw the writing on the wall and decided to make home healthcare more available. It created a ten-year federal, provincial, and territorial agreement to invest $11 billion of federal money toward improving home healthcare and mental health services.  In exchange, the provinces and territories have agreed to fulfill a common set of objectives to improved home healthcare and mental health services. 

Each province or territory will use their allotted money differently, but the end goals will be the same. Those goals include doing better evaluations of the home healthcare and mental health services provided, setting specific goals, and publicly reporting on them. 

 

Pertaining specifically to home healthcare, the government has vowed to increase home healthcare access in a way that is more integrated with traditional health practices; to create better avenues of access for palliative and end-of-life care; to increase support for caregivers; and to make the entire infrastructure of home healthcare more accessible. 

 

Each province and territory will decide how to prioritize these goals because each have different needs. The more northern and remote areas of Canada have different needs than more urban centers, for example. While this can lead to inconsistent home healthcare services, the advantage it gives to tailor province-specific policies to their needs is encouraging. 

 

The Cost of Home Healthcare

Canadian home healthcare is used by every demographic in the country, but not all at the same rate. People 65 years old and above make up forty-four percent of users, while those under thirty-five account for nineteen percent. 

 

But how are all these people paying for their care?

 

Just over fifty-one percent of households taking advantage of Canadian home healthcare have costs that are paid solely by the government, and slightly more than twenty-five percent pay for the services entirely out of pocket. 

 

For people with supplemental insurance, only seven percent have home healthcare entirely covered by their policies. 

 

In other words, about half of Canadians who receive home healthcare pay something for it, be it through insurance or from their own bank accounts. 

 

But this isn’t the only cost associated with home healthcare. Often, people who need home healthcare need other in-home services, too. Those can range from help with getting food (think Meals on Wheels) to cleaning aids, babysitting, meal preparation, and transportation.

 

Even those lucky enough to be fully covered by insurance or government providence often still find themselves shelling out money for assistance in other realms. 

 

Nearly every sickness has a ripple effect, causing a loss of time or money to the affected party or their family members and friends. The total cost to the economy, based on the latest Economic Burden of Illness in Canada report was $130.7 billion — that includes both direct and indirect costs of the sickness. 

 

Nursing, Home Healthcare, and Cannabis

One of the reasons that home healthcare is more economically advantageous than traditional care is its reliance on nurses instead of physicians. 

 

But nurses have their own troubles, thanks in no small part to their governing bodies, which have had a difficult time adjusting to the introduction of medical and recreational cannabis in the country. 

 

According to research published in BMC Nursing (2019) only seven of the twelve nursing regulatory bodies in Canada have stated, formalized cannabis policies in place — and those often aren’t helpful. That means many nurses in Canada are working in jurisdictions without any guidance on how and when to prescribe cannabis or the best practices for doing so. 

 

That’s worrisome. Not only because some seniors may lack professional medical advice that could be helpful in choosing to begin cannabis treatments, it also means that home healthcare clients who opt to self-medicate will also not benefit from professional advice. 

 

This is not how it was supposed to go. The inclusion of nurse practitioners as professional who could authorize medical cannabis consumption was done specifically to offset these sorts of issues. For many patients without primary care doctors, nurses are the best chance to access professional medical knowledge and advice. 

 

Yet, many nurses are still unable to prescribe cannabis treatments, thanks to their governing bodies. 

 

The same laws that legalized cannabis (the Access to Cannabis for Medical Purposes Regulations or ACMPR) allows both registered nurses and licensed practical nurses to possess, distribute, and directly and indirectly assist in the administration of medicinal cannabis. 

 

But the government and nursing organizations had different ideas. 

 

After the law’s passage, the Canadian Nurses Protective Society issued a statement that directly addressed the issue: “In light of the explicit authorization given to physicians and [nurse practitioners] to administer the substance, the corresponding lack of legislative authorization given to [registered nurses] to do so and the use of the phrase ‘providing assistance in the administration’ of cannabis, it is recommended that [registered nurses] do not directly administer cannabis to patients at this time, even when they are provided with a valid medical document issued by [a nurse practitioner] or a physician.”

 

Canada’s twelve regulatory agencies represent eleven provinces and three territories, and yet very few of them have regulations that allow nurse practitioners to authorize medicinal cannabis consumption. The result is that nurses are flying blind when it comes to cannabis policy — unsure if they will be backed up by their governing bodies for helping patients attain and consume cannabis, and even less clear what the industry best practices are. 

 

For example, take Medical Cannabis Guidelines for Manitoba Nurses, published by the province’s colleges of Licensed Practical,  Registered, Psychiatric Nurses. It notes that all nurses are authorized to help administer cannabis in a community setting (which covers home healthcare) as long as the cannabis has been medically prescribed. It The documents advises nurses to go by the dosage and administration methods listed on the prescription, but has no specific guidelines or rules of thumb about general cannabis guidelines — and when it may be a good idea to avoid a dose. 

 

When nurses aren’t sure of the best dosage guidelines, how can they advise patients new to cannabis or calm their fears about taking too much? 

 

Individual hospitals or healthcare facilities can get around the lack of nursing regulations by posting their own cannabis guidelines in regard to how, when, and why to use it as treatment. And while that can be helpful, it doesn’t do much for home healthcare patients. 

 

Further, how can nurses know when cannabis may interfere with medications their patients are legally consuming? Nurses should be able to counsel patients on the methods for cannabis administration to fit their medical needs as well as the best way to prevent unwanted side effects. 

 

The idea that there’s “not enough research” is just not a legitimate excuse anymore. Cannabis healthcare has a rapidly growing trove of evidence-backed data to help guide medical practice. 

 

What Do Home Healthcare Nurses Know About Cannabis?

A survey of Canadian nurses, published in Cannabis and Cannabinoid Research (2018), found that serious gaps in education and understanding were evident in cannabis education.

The majority of nurses said the need for further education on cannabis for therapeutic purposes was strong, and nearly fifty percent said they felt uncomfortable authorizing a patient to consume medical cannabis through the ACMPR. 

 

This is troubling. Nurses play a vital role in advancing the safe and effective consumption of cannabis, especially for medicinal purposes. When dealing with an elderly population of home healthcare recipients, who may be less experienced with cannabis and have greater health risks overall, the pivotal role that nurses play is even more important. 

 

Research published in the American Journal of Public Health (2017) for that most adverse health outcomes from cannabis can be significantly reduced by informed behavioral choices among consumers. 

 

And while cannabis is the most widely used “illicit” substance in the world, its consumption rates in Canada are some of the highest recorded anywhere, according to a global epidemiology study published in PLoS One (2013). 

 

The scope of practice for nurses of all stripes needs to include comprehensive cannabis education. 

 

Why Cannabis Matters to Canadian Home Healthcare

Right now, Canadians over sixty-five make up seventeen percent of the national population. Those over seventy-five years of age account for an additional 2.6 million citizens, and that segment is expected to double within twenty years. By 2023, elderly Canadians (those above sixty-five) will be twenty percent of the nation’s populous, and by 2063 they will account for twenty-eight percent. 

 

The same rising demographic is also a rapidly growing customer base for medicinal cannabis. Seniors are increasingly turning to medicinal cannabis to cut down on their prescriptions and enjoy a natural alternative to pharmaceuticals. 

 

The results have been astounding. Now that physicians can recommend and prescribe a full spectrum of cannabis products, instead of merely THC, seniors have lower-risk options that can treat a wide variety of common ailments, such as sleeplessness, nausea, chronic pain, and skin issues. 

 

The over-sixty-five demographic showed the most growth in consumption after Canada legalized cannabis, and continues to consume at a rapid clip. The trend coming after legalization also shows that seniors want direction and help with cannabis. That’s where home healthcare providers, as the primary medical point of contact for an increasingly large percentage of elderly Canadians, can make a big difference. 

 

The Future of Home Healthcare and Cannabis

The Canadian Home Healthcare system needs some work, but the pace of change of promising. The governmental data on effectiveness could shine a brighter light on the need for cannabis education among home healthcare workers. And there is reason to hope it will. 

 

Compared to the United States, Canada spends less on healthcare per person — and does better. Rates for life expectancy, obesity, infant mortality and avoidable deaths are all much lower in Canada than those of its southern neighbor. 

 

But that doesn’t mean it’s perfect. The home healthcare system is great for the millions of Canadians who can access it, but there are still other barriers to health and wellness. 

 

Nursing education on cannabis is one of the best ways to ensure a broader system of home healthcare support for Canadians, especially the elderly who are increasingly interested in trying cannabis. 

 

But nursing education isn’t enough. The rapid rise of Canadian home healthcare has led demand for nurses to outpace availability. In some provinces and territories, personal support workers or PSWs or filling in the gaps. While some personal support workers are regulated and work directly under nurse practitioners, several in home healthcare are completely unregulated. 

 

Though they’re filling an important need and are often certified, personal care workers have less experience and knowledge of medicine — especially cannabis — than nurses. This can lead to even more confusion of how to integrate cannabis medicine into a treatment or the best ways to administer it to patients. 

 

Seniors want cannabis medicine. They also want home healthcare. The two are inherently intertwined and need to grow together. The rise of cannabis nurses groups provides hope that many are planning adequately for the future, but it may not be enough. 

 

Beyond nurse education, doctors and personal support workers also need education in cannabis — and not just once. The research about cannabis is growing at an astounding rate, and continuing education is required to keep up with all the news. 

 

The best way to ensure the long-term viability of Canadian home healthcare is to make sure it meets patients’ needs. That includes evidence-based cannabis education. 

 

Citations

 

Balneaves, Lynda G. et al. (2018.) A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes.  Cannabis and Cannabinoid Research. Dec 2018. 66-73. http://doi.org/10.1089/can.2018.0002

 

Rahme E, Kahn S, Dasgupta K. et al. (2010). Short-term mortality associated with failure to receive home care after hemiarthroplasty. Canadian Medical Association Journal. 182(13): 1421–1426. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942914/

 

 

Fisher, Benedikt et al. (2017). Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. American Journal of Public Health. 107, e1_e12. https://doi.org/10.2105/AJPH.2017.303818

 

Degenhardt L, Ferrari AJ, Calabria B, et al. (2016) The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 Study. PLoS One. https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0076635 

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.

The rise of Canadian home healthcare has big implications for cannabis.
As Canada’s population ages, the healthcare industry is shifting away from institutionalized care in hospitals and doctors’ offices and toward a model that accommodates an older and less-mobile clientele.
Industry analysts predict the home healthcare industry to grow at an annual rate of three percent per year between now through 2023, as Canada’s senior population increases at a rate of three and a half percent during the same timeframe.
Senior Canadians typically have more money to spend and are increasingly shelling out for the convenience of home healthcare over the hassle of going to the doctor.
But they’re not the only ones taking advantage of the option. Many disabled people, those in rehab, and people who are briefly disabled due to a surgery or illness are increasingly relying on care provided at home, and mainly done by nurses instead of physicians.