Canada’s aging population faces a harsh reality: growing numbers of older Canadians with chronic illnesses, disabilities and cognitive impairment are regularly discouraged by the efforts required to access and coordinate fragmented health and social care services. These challenges are often most profound for those who cannot rely on help from family members or friends, but they add greatly to caregivers’ burden as well.
In this study, Laura Funk argues that navigation problems are rooted in the structures and operations of existing care systems, as well as the downloading of administrative and coordination tasks to individual patients and their families. In her view, navigation work must be transformed from a private struggle into a public responsibility.
According to the author, navigation challenges and caregivers’ burden are compounded by health and social care systems that are difficult to access due to overly restrictive eligibility criteria, convoluted application processes and other gatekeeping mechanisms. The lack of transparency due to limited or conflicting information on how to access public services is particularly problematic. The work involved in overcoming these obstacles — the search for information about available services, the effort needed to access them, and the ongoing monitoring and advocacy required to ensure health and social needs are met — is far from negligible. It generates important economic and social costs, including time that caregivers might have spent on other care activities, in paid employment or in social activities.
Although there has been an expansion of navigation supports in recent years, existing programs, whether provided by nonprofit organizations or by government agencies, are often specific to particular care-setting transitions, such as from hospital to home, or to people with particular health conditions, such as cancer or dementia. Availability varies greatly across regions and locations of care. A dedicated, comprehensive policy strategy is needed to reduce the navigation burden for broader patient and caregiver populations.
The author proposes a three-pronged patient-centred approach to alleviate navigation problems. It consists of improving service information, expanding public navigation programs and better integrating care services for older adults. Removing the navigation hurdles faced by older persons and their caregivers is key not only for improving their health and well-being, but also for preventing exhaustion among caregivers and reducing inequities in service access. Doing so could also make it possible for older adults to remain at home longer if they wish to do so.
There is still much policy-makers need to learn about which specific elements of navigation programs — be they administrative, organizational or financial — provide the largest benefits in terms of improved health and well-being and reduced caregiver burden and service access inequities. Systematic and thorough evaluation of navigation programs and initiatives for older adults — involving researchers, providers, service users and caregivers — is essential if we are to tackle this problem effectively.