A third of people caring for a frail senior at home are in distress, and yet some provincial supports such as adult day programs remain under-used, according to a new report from B.C.'s Seniors Advocate.

A survey of health assessments for 30,000 B.C. seniors found that the majority of those who report fatigue and other stresses from caring for a relative or friend aren't using provincial programs.

B.C. offers three kinds of respite services, adult day programs, respite beds in care facilities that offer care for up to 30 days at a time, and home support visits from care aides.

Seniors Advocate Isobel Mackenzie said availability of programs is better in urban areas than rural ones, but in general B.C. offers less respite care than Alberta and has more unpaid caregivers reporting distress.

Mackenzie says increasing availability for adult day programs could reduce emergency visits from complex home care patients by a third, and hospital admissions by half, detecting medication or other health problems before they produce a hospital visit.

One puzzling result from the survey is that while there are waiting lists for adult day programs in B.C., one out of four spaces is empty each day. Mackenzie said there may be logistical problems with home care patients, such as a need to attend medical appointments at the same time as the day program is offered.

Mackenzie isn't suggesting government-paid substitutes can replace volunteer caregivers, most of whom are spouses or other relatives, but says they should have more opportunities to take a break.

"Caregivers do it all," she said. "Sometimes it is is simple as driving mum to the doctor's office. Other times it is as complicated as insulin injections or changing catheter bags.

"Sometimes it is dropping in on mum and dad at the end of the work day and other times it is living with your wife of 65-plus years as she surrenders to the ravages of dementia, does not know who you are, cannot be left alone and must be fed and toileted."

Health Minister Terry Lake said the province has increased investments in home health services over the past 10 years, and is working with health authorities to shift from hospital to home-care as the population ages.

Mackenzie said the number of adult day program clients and days utilized has declined in the last three years, and the number of respite beds at care facilities also appears to be down.

The survey found that only half of the clients registered for home support reported receiving a home visit in the previous seven days.

The report and other services are available at the Seniors Advocate .