II/ Lots and Lots of Beds
System Alignment Demanding Better for Seniors Increased Public Investment in Community Support Focus on Facility-Based Care
This scenario imagines a future where policy alignment makes it easier to develop new seniors housing and care models and where seniors’ needs and preferences are a priority for government and the private sector.
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?
Abundance of institutional beds:
The system has invested heavily in building a range of new care facilities — there are new long-term care beds, alternative level of care beds, step down beds and dementia-focused facilities all across the country, maybe even more than can be used as the Baby Boomer demographic has hit its peak. They were built so quickly in the 2020s at enormous cost but it’s unclear what will happen to all of these buildings when the beds are no longer needed.
Two classes of seniors:
Fewer and fewer older adults live in their lifelong homes or independently in the communities that they lived and worked in for many years. There seems to be a distinct line between independent adults and “seniors” who need to live in segregated congregate facilities leaving many stuck in a funny grey zone in between where they would like to extend their time at the home of their choice, but can only access care if they move to an institutional setting with predefined living and care models.
Limited options in community:
There is limited additional funding available for care outside of these institutional settings and if you live in a smaller town, you usually need to move to a larger centre to find a bed.
Retirement living moves upmarket:
Private senior living communities are now catering to a much younger and wealthier demographic than before as residents with higher care needs usually move into a publicly-funded home. They have seen a huge shift in their business model and now operate more like luxury hotels than like care facilities.
Care: Who delivers care and how is it paid for?
Great care if you can get in:
If an older adult qualifies for admission to any type of seniors living facility, their care is publicly financed and is of high quality thanks to significant efforts regulators to monitor and enhance the quality of care and the resident experience. The only catch is that you need to qualify. The criteria for entering a publicly funded facility is rigid.
Home care options remain minimal:
There is some publicly funded home care but it’s limited — if you need any more than a few hours a week, you really need to find a public bed in a home. With more variety available, fewer older adults say they want to stay in their own home than was the case a decade ago. But still, over half of older adults would prefer not to move to a segregated senior community.
Traditional home & community care unfunded:
With investment in community support continuing to lag behind its facility based counterparts, services are delivered by incumbent mission-driven organizations
with motivated staff. Barriers to entry are too high for new players to emerge, and margins are too low to allow for investment in modernization or better staff or client experience - they can only do the bare minimum with the capital available.
Aging experiences: How are older adults doing and how different are their experiences across the country?
High quality care
Older adults who live in one of the many newly created spots in a seniors facility continue to do well from a clinical perspective and rank their quality of life as relatively high.
Lose of independence
However, many older adults lament losing their independence once they move to a seniors home and many still resist this move for as long as possible as they prefer to remain in their communities rather than live in age-segregated buildings.
Identity of aging: How are older adults valued or perceived?
Wholistic care:
Those who work in the field have adopted higher standards
around quality of care for all older adults and funding is aligned with this standard ensuring that the focus is not only on ensuring quality clinical care but also high quality of life.
Aging apart from society:
However, old age is seen as separate and older adults are not actively part of every day life, civic society or our communities.
Policy: How does government work?
One size fits all:
Each province has defined several facility types and has heavily funded the expansion of those models ensuring there is space for everyone; however, there is little room for creativity as specific requirements must be met to receive funding. This means that some segments of the older adult population are poorly served.
Pockets of financing innovation:
Any model that differs from those funded by government needs to attract funding from elsewhere such as philanthropy, fundraising, or other novel financing approaches
Little room for private sector:
There is very limited private sector innovation given the dominance of government-mandated and financed models and options. By and large, the private sector has moved away from seniors care and seniors housing.
A Day in the Life
The fourth and final wing of the building opened today. I was just hired as a caregiver in one of the 100 new campus of care villages that were set up across Canada after the pandemic. Residents usually move in needing some assistance — often they had a fall and now can’t manage in their former home — and then move from wing to wing as their care needs change. We have a lot of beds and they are usually available within a few days.
My grandpa remembers the days when the waiting lists were months long for a bed in a government funded care facility — he feels lucky there will be a spot for him when he’s ready to move although he says he wants to stay home as long as possible and just hopes his health is good for many more years. Moving into a home is a major life transition. Grandpa says you officially become “old” when you decide to move and doesn’t like the idea of living amongst lots of other “old” people. But when you need it you need it and there isn’t really another option I suppose.
Since starting here at Seniors Village Homes, I’ve really enjoyed getting to know the residents. Everyone is so well cared for and we work closely with many passionate community organizations that bring in all kinds of programming and activities. It was really amazing to see how quickly facilities like this were built across the country in the 20s. It’s a bit like when all those public schools were built in the 1960s in Canada. I only wish there was money left over for other things — the local high school and community centre are crumbling — but it’s so important to make sure that we care for older adults who really need our help.
