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"They can do it immediately," said Mackenzie at a news conference for the release of her report, titled "We Must Do Better."

"The world has not fallen apart in Alberta or Ontario, where they do not charge for this," Mackenzie said.

She said a senior in B.C. with an annual income of $29,000 is charged $9,000 a year for daily one-hour home support visits.

Mackenzie said the fees are not affordable for most B.C. seniors when other costs such as food, shelter, medication and health-care supplies are considered.

She said the home support cost barrier is one reason many seniors enter long-term care, where costs are subsidized.

"The evidence is fairly compelling we are seeing premature admissions to long-term care," Mackenzie said.

She said she wants support costs to be addressed by the government over the next year, "either eliminated or meaningfully reduced."

Health Minister Adrian Dix said coverage of home support fees in Ontario and Alberta is not universal, whereas in B.C. more than 65 per cent of seniors have their costs covered.

"In B.C., about two-thirds of clients have no charge," he said. "Those are obviously the lowest-income clients. We spend not far from $1 billion on home and community care and about $30 million of that comes back in fees."

Dix said it's "absolutely legitimate" for Mackenzie to advocate for fee elimination.

He said he agreed with Mackenzie's concerns that some seniors are entering long-term care too early when they could still be at home.

Home-care improvements for seniors were a major part of B.C.'s recent talks with the federal government about an improved health-care funding agreement, said Dix.

The advocate's report said 61 per cent of B.C. seniors admitted to long-term care received no home-care services 90 days before admission.

B.C.'s rate of recently admitted long-term care residents with low-care needs is twice as high as Alberta and Ontario, Mackenzie said.

Home support ranges from bathing and daily personal care, to more complex tasks that include catheter care, oxygen therapy and management of medications.

"We need a fundamental restructuring of our home support program if we are to meet the needs of a growing seniors population," Mackenzie said. "This review has examined tens of thousands of clinical records and includes the feedback from over 6,000 current home support clients and their family members."

The report also found a decline in satisfaction with home support services over the past five years among seniors and their loved ones.

The number of people who previously rated their home support as excellent has declined by 30 per cent in the past five years, Mackenzie said.

The report also said more than 33 per cent of home support clients need extra services, including housekeeping, bathing and meal preparation.

Mackenzie said the report also said family members are less likely to feel home support for loved ones is meeting their needs compared to five years ago.

The report — the second by the advocate's office on home support — recommended increasing respite care, setting targets for service delivery, modernizing care plans, and measuring and reporting on performance.

This report by ºÃÉ«tvwas first published Feb. 23, 2023.