A critical analysis of continuing care systems, integrated care strategies, and policies: Assessing the success of Canada, Denmark, and Australia

In recent years there has been a call for the development of integrated continuing care systems in Canada. Such systems would provide older adults and informal caregivers with a comprehensive continuum of integrated supports, linking formal and informal health and social care to improve efficiencies. The purpose of this study was to examine how an integrated continuing care system can be developed in BC to address limitations and gaps in service. The study was informed by a critical public policy and a systems approach. A multi-pronged longitudinal methodological strategy was utilized and entailed: 1) Analysis of BC's home and community care system; 2) Document analysis; and 3) Comparative analysis of systems and reforms in other jurisdictions (Ontario, Québec, Nova Scotia, Australia, and Denmark). Data were collected through a) interviews in 2014/15 and 2019/20 with stakeholders in BC and a small number of key informants for each comparison jurisdiction; b) analysis of government policy documents; and c) review of literature and other information sources. Key deficits identified in BC included: lack of a clear vision for home and community care; gaps and fragmentation in the care continuum; lack of investment in home and community care; and lack of supports for informal caregivers. Similar deficits were experienced in many of the comparison jurisdictions, but there also were areas of policy divergence. One of the identified points of tension for integrated care approaches was the fine line between the substitution of services and downloading of responsibilities. A key recommendation for BC is that the lens through which policy is being developed needs to be adjusted and moved away from simply viewing home and community care as substitutes for acute and residential care. Furthermore, the ambiguous position of continuing care in Canada is contributing to the marginalization, medicalization, and underfunding of continuing care systems. It is concluded that a funding model for continuing care needs to be developed at the national level, which has become particularly apparent during the COVID-19 pandemic. Additional recommendations include improving supports for informal caregivers, providing a broader range of community-based supports, shifting care paradigms, and strengthening the integration of services.