Foresight + Strategic Implications
In this workshop with St. Joseph’s Continuing Care Centre, the Building With Mission working group introduced four scenarios of the future of housing, care and aging which the project Steering Committee had generated collectively. We used these scenarios to initiate a deep internal dialogue about what the future might hold.
Approximately 20 participants were involved in identifying a range of strategic implications associated with each scenario - specifically looking at the economic, political, and cultural implications of each. We then explored how can plan for each future scenario and what steps would need to be undertaken. The strategic implications generated of each foresight scenario are found below.
Strategic Implications of Scenario One: More of the Same
To prepare for these uncertain worlds, participants identified several key themes for healthcare delivery and other mission-driven organizations who might be thinking about developing housing projects for older adults in the future.
This scenario More of the Same imagines a future where system complexity makes it difficult to build new types of seniors housing and where seniors’ needs and preferences are not at the forefront of government or corporate decision making. It also imagines a future where existing funding silos remain intact and where there is additional funding for traditional “beds” but not for alternative care solutions.
Economic
Money might be more readily available— especially given the gaps that have been highlighted through the pandemic—but beds will continue to be more institutional in nature. Social determinants of health will be considered but perhaps not prioritized to their fullest extent
There will be considerable stress on human resources as staff shortages in many areas continue including home care. Creativity with manpower will need to be emphasized. The mantra will be “do more with less.”
Informal networks will continue to be stretched beyond their capacity.
Technological solutions such as digital health and virtual care will need to be prioritized
Seniors will be asking why they can’t stay in their home, and will be wondering about their choices and how their voices are represented. They will be looking for activities that keep them sound mentally such as games and recreational opportunities
Political
There will be more oversight by community-based organizations and local representatives may have a more significant role. There may be a push toward developing a standard of care across long-term care and the Federal government could oversee this
The momentum with the emphasis on co-design will continue with the Ontario Health Teams to include a diverse range of voices to gain new perspectives
Considerations for the social determinants of health will likely exacerbate ambiguity around where responsibility lies
Cultural
The “nothing about us without us” movement will be strengthened with more transparent communication through community boards and resident councils. Diversity, equity and inclusion will be central to the discussion, particularly as it relates to Indigenous populations in Canada
There will be a focus on interdisciplinary healthcare and being prepared to take on risk in order to provide person-centred care
How can we plan for this future?
Stay positive, contribute to the discussion, and don’t be afraid to ask questions
Introspect and discuss the future with our loved ones
Challenge the status quo, especially in light of what we have learned from the pandemic
Highlight all the good work that is happening out there in housing, aging, and care
Strategic Implications of Scenario Two: Lots and Lots of Beds
Participants considered the economic, political, and cultural implications of a future in which there are plenty of beds and seniors’ needs are prioritized by the government and private sector, but the current siloes remain intact with little or no funding provided for alternative care solutions. Common themes included a need to address the economic inequality that undermines senior care, viewing residents/patients through a humanist lens, and promoting/considering cultural diversity.
Economic
There needs to be a change in funding models as homecare, whether government or private sector, is costly.
Many seniors want to stay in their homes, which requires adequate income. A Basic Living Income could address this through providing seniors the economic means to stay in their homes.
Participants identified a need for more equality in regards to the allocation of resources. High and middle income seniors should not be prioritized over lower income seniors.
Residents and patients need to be given a voice in how care is provided to them. This includes policy procedure development. Policies and procedures are commonly developed by individuals who are not at an advanced age and cannot directly relate to seniors.
The wait-time between applying for and being approved for subsidy and when that subsidy is actually available needs to decrease. The subsidy should be available as soon as the patient/resident is admitted to care.
A greater amount of available beds necessitates an increase in staff. This may require additional resources dedicated to training new staff members.
An increase in available beds should ideally mean a proportionate increase in subsidized beds so lower income seniors also have access to care.
Political
Participants identified a need to “Go back to the basics” and focus on patient care.
Innovation needs to be achieved through putting ideas into practice rather than getting stuck in bureaucracy.
Senior housing entities need to look at patients/residents holistically. Institutions sometimes forget that each patient/resident is human rather than a number.
There needs to be an emphasis on public/government senior housing rather than privatized/for-profit senior housing. Rather than focusing on profit, there needs to be a “Humanization of Care”. This will help maintain affordability while still providing quality care.
A Bipartisan group should exist to advocate for seniors’ needs.
Cultural
Dependent seniors who need care should be prioritized over independent seniors. Currently, independent seniors take up more beds than dependent seniors, which needs to change.
There needs to be an increased awareness of different healthcare groups/providers and their needs. This will help address the silos.
Senior care providers need to be able to provide the right types of beds for all of their patients/residents. Seniors differ in their independence and care provides need to account for this.
Processes need to be changed and streamlined to accommodate larger numbers as Baby Boomers start to age.
A role needs to be created to ensure that patients/residents are placed in the right type of bed.
Care providers need to be better prepared to help seniors transition to different types of care as they age and their level of dependency changes.
There needs to be more interdisciplinary cooperation between groups.
Inclusivity needs to be at the forefront of senior care. Retirement homes need to consider the cultural needs of a diverse population.
Retirement homes need to be built for the people who need them, meaning that seniors should be able to participate in the planning and development process of new or renovated retirement homes.
Strategic Implications of Scenario Three: Private Models Win
Participants considered the economic, political, and cultural implications of a future in which new players have entered the seniors housing and care landscape and where there is public sector interest and support for a broader range of age-friendly offerings. This scenario imagines a future where system complexity makes it difficult to build new types of seniors housing and where seniors’ needs and preferences are not at the forefront of government or corporate decision making.
Economic
Reflect on how can technology help bridge the gap of expectations, and augment caregiving and other wraparound services
Need to identify new ways of resourcing, and determine how technology can play a role in shifting paradigms
Expect more changes in the future regarding scarcity of land, building costs, and how resources are generally shared
Over time, there will be a greater focus on the resident experience, and attempt to situate services across the continuum of care so that they are easily accessible in one place
Challenges arising of providing similar levels of care despite varying levels of wealth.
As private models will dominate, major strategic branding is imperative to differentiate private institutions (what makes you unique/different/the value of care for cost)
Will be important to articulate the differences between Long-term care homes and these privates models for clients
The low and moderate income clients will need to be brought along as there’s a significant possibility they will be left behind
Political
There will be a significant reduction in “Red tape” around what care providers can and can’t do
Important to establish a collaborative decision making framework and other innovative strategies that emphasizes the voices of current and future clients
Community engagement should be prioritized as this stakeholder has significant input in the development of housing and how it affects local communities
Organizations will have to take on the brunt of the work themselves and in collaboration with other organizations as opposed to seeking support from the government
Observe and learn best practices from other organizations taking on this work
This scenario will require more risk taking through strategic directions and financial investments
Cultural
The needs, preferences, and expectations of older adults and future clients will be at the forefront
Leadership should be diversified to fulfill a range of expertise in the area of health, care, and housing.
Important to reflect on previous shortcoming and faults when attempting to build affordable housing for vulnerable clients
Increased awareness and knowledge pertaining to social determinants of health, specifically associated with housing and care
Anticipate changing communities and demographics within the Cornwall area, due to larger older adult population and increased immigration
Important to rebrand current identity as a long-term care organization into one that provides a continuum of different services, including housing
How can we plan for this future?
More housing expertise needs to be brought on board to help SJCCC be a project leader (awareness around housing models, different models of care, etc.)
Continue to engage various stakeholders, including the clients and the community, about their needs and preferences to ensure we are optimizing their health and wellbeing
Conduct environmental and jurisdictional scans to identify successful strategies of developing affordable housing that is financially viable, and that is generating positive outcomes for clients and the community
Begin to explore new programming as an organization to build organizational capacity in providing wraparound services to determine your capability as an operator for housing
Strategic Implications of Scenario Four: Greater Range and Supply for Everyone
This scenario was described as ideal but utopian. On one hand, it gave the group hope for the future, but on the other hand most felt that this would be a significant change from the current state and therefore would be unlikely to unfold. It was hard to imagine how we would get there from where we are today as this future feels like a huge shift.
Economic
Goal is a system that allows people to receive all the services they need from home if that is their preference
Expect that more total $ would need to be available for this future - although removing layers upon layers of administration and having funds flow directly to seniors so they can spend them as they like on services and housing options that suit them best could achieve savings that can be reinvested
Current shortage of human resources will need to be addressed - more staff will be needed for caring for older adults
System navigation and a single accountable point of contact is key - need a single accountable person to help older adults navigate and coordinate the care, support and housing they require, who stays with them overtime and support smooth transitions as needs change
Within a campus of care model, residents should be able to move around more fluidly with staff moving with them to provide more continuity of care and deepen relationships - accountability should be on ensuring whole person well-being for any resident living on the campus
In a system with more choices and options, older adults will need the resources and support to make choices that are best for them and clear communication of what is available will be important
Political
Goal is to give older adults more autonomy and the ability to make choices and decisions for themselves because the system can accommodate a wider variety of options
A more flexible and adaptable system of control is required - need to move away from rigid task oriented model and reduce layers of administration
Need housing and care options developed through consultation and design with customers (older adults) rather than by policy makers and care providers
Need different metrics to reflect a different approach to aging e.g. quality of life metrics, metrics around choice and autonomy
Today’s application process needs to change - older adults should apply directly to the places they want to live rather than having placements decided by someone who is neither familiar with the person or the place they prefer to be placed in
Municipalities can play a stronger role - prioritize age-friendly and affordable development
This future requires a rebuilding our systems without today’s regulatory silos and require a change in advocacy priorities
Cultural
We need deeper knowledge about what older adults want - need to understand desires and needs by listening to the customer
Don’t reinvent the wheel - need to know what already exists and works well
Focus on people with a variety of backgrounds to design housing and care solutions that reflect their cultural and lifestyle preferences
How can we plan for this future?
Identify / be pioneers - either formally or informally, organizations with an interest in this space need to act as pioneers and lead a change that others can learn from and follow
Some orgs are already pioneering new models - St. Joseph's Continuing Care’s rehab program, for example, focuses on safely discharging patients to home through innovative care pathways and support models
Campuses of care models can expand to include homes for older adult with no/low care needs (e.g. broaden the continuum) and vice versa, communities with concentrations of older adults (e.g. NORCs) can incorporate higher models of care onsite so people are not required to move as their care needs increase
A shift in advocacy is needed to prioritize autonomy and choice for older adults as well as to ensure care is available in the home for those with that preference