Rationing home care resources: how discharged seniors cope.

Rationing home care services has become a common strategy used by state/provincial governments to control escalating health care costs, particularly at a time when very little new funding has been re-directed to the home care sector. Across British Columbia, Regional Health Authorities had implemented service reforms that call for the discharge of higher functioning clients from home support service. This paper describes the coping strategies of 137 senior clients who were discharged from home support services and from the Continuing Care Program in the Simon Fraser Health Region located in British Columbia, Canada. Personal interviews were conducted by experienced case managers to gain an understanding of how seniors were coping 19 to 21 months after their discharge. Of the 137 clients, 34.3% are characterized as being "home alone and suffering in silence," 29.2% reported receiving assistance from informal sources or reported paying out-of-pocket for private care, and 28.4% reported that they can do the work better themselves. The remaining 8.0% of participants reported mixed feelings about the impact of their discharge from home support service. The effectiveness of discharge targeted to a senior population is discussed and it is suggested that functional status together with age are important criteria when rationing home care services.