Continuing Care

Sex and Gender-based Analysis of this topic

Definition
Continuing care services for seniors includes a range of medical and social services for individuals aged 65 and older who are experiencing challenges in self-care and require assistance in daily living activities. These services may begin in the home, known as home care, but can include more intensive levels of care such as institutional care as needs increase [1]. Continuing care is referred to by other terms in different provinces, such as: residential care, nursing home care, community care, personal care and long-term care. Women constitute the majority of continuing care recipients; in 2004/2005, 70% of senior continuing care recipients were women [2].

Sex Issues
In Canada, women have a longer life expectancy than men [3], which results in a higher proportion of elderly women compared to elderly men. The likelihood of living in a continuing care facility for seniors increases with age [2], which explains the higher proportion of senior women in continuing care services. Despite living longer, senior women have a higher prevalence of hospitalization, chronic disease and overall disability [4]. Continuing care is especially critical during the years of sub-optimal health.

Gender Issues

Women have longer life expectancies, which leads to many married women outliving their husbands, thus losing the protective effects of marriage such as care-giving from the partner as well as social and financial support [2]. The majority of continuing care recipients are unattached (single, widowed or divorced) elderly women [3].

Unattached senior women have the highest poverty rate of any family type in Canada of 46%, compared to unattached men who have a poverty rate of 33% [5]. Costs of continuing care act as a barrier for senior women of all income levels [6]. Costs of public services can be subsidized or reduced in some cases, however a lack of resources and facilities often leave Canadians who need continuing care without adequate services [7]. Even women who can afford to pay for private services may find it financially straining [8].

The majority of continuing care providers, both paid and unpaid are women [9]. In 2007, more than one in five unpaid caregivers provided care for seniors [10]. Although many women regard care-giving as personally rewarding, it can also be physically, emotionally and financially demanding. Caregivers often exhaust their own care-giving capacities before considering continuing care services as an alternative.

Diversity

Continuing care is considered an extended health service in Canada, which means that these services are uninsured resulting in varying levels of cost, eligibility requirements, availability, access to publicly funded and access to private services across the country [11, 12]. Access to continuing care is low among urban Aboriginal communities, ethnic, racial and linguistic minority communities due to a lack of culturally sensitive services [11].

Low income-groups are more likely to receive public continuing care services and live in a publicly-funded continuing care institutions [7, 13]. This difference is likely explained by income-based eligibility for public services and a preference for home-based continuing care among seniors who can afford these services [13].

Critique
Given that the Canadian population is ageing, information to support accountability, planning and quality in continuing care is important. Standardized collection across the provinces and territories about continuing care has only recently been collected, making comparisons between provinces and over time difficult [14]. Existing data does not cover unpaid care-giving, thereby underestimating the continuing care population. Data regarding utilization by minorities is needed to improve use of continuing care services by these groups.

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