I/ More of the Same
System Complexity Seniors in the Shadow Increased Public Investment in Community Support Focus on Facility-Based Care
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.
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.
Housing: Where do older adults live and how is it paid for?
Status quo options continues:
Most older adults with care needs live in assisted living facilities or long term care homes that look and feel a lot like today’s models. These homes are built through additional government funding and may be operated by municipalities, non-profit or for-profit entities.
Growing wait lists:
Wait lists for spaces in these types of elder care facilities have grown even larger and there are not enough beds for those that need them.
A two-tier system expands:
Those that can afford it hire full time care, effectively replicating a nursing home in their own home, or choose to relocate to private pay settings built and operated by the incumbent well-established seniors living players. Many of these residents never move into government-funded long term care but prefer to remain in their private retirement home, creating a two-tier system in the final years of life with those that can afford to paying for a higher quality of care and a higher quality of life.
Migration:
There are paltry private pay seniors living options in urban areas where land costs and the cost of living are high. Most older adults end up moving to smaller communities with more affordable housing and care options.
Home by default, not by choice:
Many older adults find they have no choice but to remain in their own homes, even homes that may not be suitable for healthy aging, but there are not many alternatives available that meet their needs if they are unable to pay for expensive private settings.
Care: Who delivers care and how is it paid for?
Trying to do more with less:
Government continues to pay for the care of residents living in long term care settings. There has been some increased investment since the 2020 pandemic so residents receive more hours of contact from their care providers, however; the system is still stretched given high demand, increasing acuity of residents and high staff turnover rate.
Home care demand and supply imbalance:
There has also been an increase in public investment in home
care for older adults seeking to remain in their home, however, to receive adequate care most individuals still need to supplement publicly funded care with private care and/or unpaid caregiving from friends and family. Care is highly reactive and often only available to those with very high needs with caps on the amount of care that care be received.
Families feel stuck:
It is difficult to meet the needs of more complex individuals in the community and their families are desperate for a spot in a long term care home or a seniors community as it is the only way all care needs are sufficiently met.
Aging adults’ experiences: How are older adults doing and how different are their experiences across the country?
Healthspan and lifespan mismatch:
Generally, older adults experience moderate to poor quality of life while life expectancy remains consistent with other OECD countries.
Upstream drivers of health ignored:
Healthcare investments have focused on doing more of the same (more buildings, more beds, more acute care services, more reaction to immediate needs) and there has been little to no new investment in prevention, health maintenance or the social and environmental determinants of health that enable healthy aging.
New actors step up:
There are, however, several wonderful innovations across the
country — small municipalities that are encouraging age-friendly developments, non-profits and other mission-driven
organizations offering community-based support programs and innovative housing models and some fledgling startups that are trying to better meet the needs and desires of older adults. These programs and housing options are grassroots, local, and always oversubscribed.
Sub-scale impact:
Despite the evidence of their success, new housing models
have been difficult to scale due to inconsistent policies, complex funding environments and difficult approvals processes across geographies.
Identity of aging: How are older adults valued or perceived?
Ageism persists:
The default paradigm continues to be that seniors need to be “cared for” in predefined ways and in “facilities”. Despite the major exposure of ageism during the 2020 pandemic, there has been little to no change in the inequities this population experiences and older adults are not generally recognized as autonomous or bringing value to society .
Lots of talk, little action:
After the height of the pandemic, there was a lot of talk about better supporting care of the elderly in Canada. Federal home care standards were enacted and provincial governments doubled their investments in building new long-term care beds, however, those efforts didn’t go far enough to meaningfully change the status quo. After those early announcements, little further work was done to encourage a broader range of housing and care options to better meet
the desires and needs of older adults.
Leaderless:
Growing old continues to happen in the shadows with no sector having accountability nor taking a leadership role in driving systemic change.
Policy: How does government work?
Stability trumps modernization:
Government is trying to cope with multiple financial/social safety net crises, one of which continues to be the availability and quality of care in long term care homes. Their focus has been on stabilizing the sector, not modernizing care of the elderly. Overall, incremental improvements have taken place rather than a systemic shift.
No common agenda:
There is no real federal or provincial vision on transforming the way seniors are cared for and therefore no real attempt to activate all levels of government or all departments or sectors to better meet the needs of this demographic in a more coordinated way.
A Day in the Life
I continue to struggle with accepting the choice we had to make. After dad passed, we moved mom to a nursing home when her dementia and physical frailty became impossible to manage. She had another fall in the two story suburban house that she raised us in, 400km away from any of her three children, and broke her wrist this time.
Visiting mom at her long-term care home is something I try to do every couple of weeks but it’s far from home and I can’t always manage the drive. I love and appreciate the staff. They always make a point of greeting me and filling me in on how she’s doing. “Hello Ms. Patel,” they say with a big smile. Their kindness is infectious, but they seem tired most of the time, bordering on burnt out. My mother would never complain, she seems happy enough. Yet when my sisters and I share stories about our visits, we worry.
There was that time her medications seem to have been skipped for a day or two. Another time, her sheets didn’t look like they had been changed recently. And sometimes she seems really dehydrated and unsteady on her feet. When I chat with the staff, they say that management is aware of how stretched the staff are and the need for some changes, but change comes slow. From what I can tell, things have been this way for a while.
I researched different options for my mother, thinking that maybe other homes might have more to offer her, but all the places we looked at seemed to provide the same service. They all looked the same, they even had the same (or worse) online reviews. I feel guilty that I can’t care for her at her home, or in my home; but when I tried it was too complicated to organize all of the support she needed and I found I was having to miss work or pay for private care to fill the gaps and we can’t afford that. Once mom started wandering at night we got really worried and felt there was no option but to move. Staff tell me there is now a two year waiting list to get a bed in their building, and by the time most people get a spot their health has been declining for some time. Waiting for a space to open was the most stressful time for our family.
My sisters and I took turns living with mom to ensure she was safe which meant we were away from our own families for every one in three weeks for over a year. It was exhausting.
We found a great small community about an hour away operated by a nonprofit charity on land that had once belonged to the local Catholic hospital. The community catered to the growing East Indian population nearby with a fun, fresh vibe and cuisine, decor and music that mom would have preferred. I think she would have loved it there but it filled up within the first hour registration opened, and the waitlist is now several years long.
It seems crazy that in a world where so much has changed, and where so many problems are really being solved — an electrified transportation system, CO2 reduction, regrowth of our rainforests — that liveable, desirable, affordable and safe homes for our elders in Canada haven’t kept pace. While other countries seem to have found a way to provide older adults with housing and health options on their terms, Canada seems to have been unable to deliver on that promise.
