The uncompassionate elements of the Compassionate Care Benefits Program: a critical analysis

Abstract

Palliative care is a heavy burden to many Canadians who have dying relatives or friends. The Canadian government implemented a sub-program under the Employment Insurance - Compassionate Care Benefits Program (CCBs) to financially assist informal end-of-life caregivers (1). Since the current Employment Insurance Program's regulations pose a number of barriers for non-standard employees, many informal caregivers are automatically excluded from its sub-program; the CCBs program. This is especially true for those who belong to disadvantaged social groups, and women. This article explores whether a program designed as part of Employment Insurance can provide comprehensive support to those informal end-of-life care-givers, and whether it is equally accessible to all Canadians. The authors argue that, in order to make the CCBs program effective, it needs to be made independent from Canada's Employment Insurance Program and hence become a true compassionate program that supports all the informal caregivers equally.

Canada's Compassionate Care Benefit: Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

“…Meanwhile, they were so focused on caregiving tasks that they did not know to reach out to inquire about supports such as the CCB, evident from the comments of the non-applicant group. Since the unveiling of the CCB in 2004, there has been a lower uptake of the program than expected; this has led to criticism around a general lack of awareness of the CCB [50,56]. Two ways to address this knowledge gap have been suggested: (1) informing the general public about the CCB through informational campaigns; and (2) informing front-line palliative care providers about the program so that they can, in turn, inform caregivers with whom they are in contact [53].…”

“…The findings shared above demonstrate a gap between the needs of family caregivers and the very nature of the CCB program, as it is a Benefit with narrow eligibility requirements and a very narrow period of support. Addressing the various calls to revise aspects of the CCB, as outlined in detail elsewhere [1,13,48-50,53-56], may move the program from the building phase to the achieving phase, thus truly serving as a public health response to specific aspects of caregiver burden. Improving the CCB, as one federal policy that addresses caregiver burden and thus has public health implications, may enable impetus for an improved and more comprehensive federal policy that promotes equitable support for informal caregivers across Canada.…”

“…A P/EOL caregiving policy must also be responsive to the distinct needs of informal caregivers living in rural and remote regions, or who need to travel long distances to provide care [54,70]. It is likely that new immigrant populations and different cultural groups will also have unique caregiver support needs or barriers to accessing support, although little research has been done to determine them [50,71]. For Canada to uphold a truly healthy public policy and a responsive PHP intervention regarding P/EOL caregiver burden, the CCB must be augmented, with complementary programs created so that support is available to all Canadians - whether, for instance, full-time or part-time workers, rural or urban, thus living up to the value of equity in public health [9,20,72].…”

“…Critiquing the program from a public health perspective, they note that its eligibility requirements exclude many Canadian P/EOL caregivers. This is because only 22% of informal caregivers are full-time employees, and many low-income caregivers are unlikely to meet the working hours required to receive the CCB, as they are often temporary, seasonal, part-time, or self-employed workers [50]. In a recent development, self-employed Canadian workers can choose to pay into the EI scheme starting in January, 2011 [51].…”

“…Women are also disproportionately excluded from eligibility for the CCB as they make up the majority of informal caregivers as well as the majority of self-employed and part-time workers [24]. There is also a significant disadvantage for ethnic minorities and new immigrants accessing the CCB, due to language barriers and the lack of translation services available [50]. Certainly, these exclusionary dimensions of the program must be addressed if the CCB is to play a more effective role in addressing caregiver burden.…”