III/ Private Models Win
System Complexity Seniors in the Shadow New Incentives & Business Models Rethinking Housing & Care Options
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 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.
Housing: Where do older adults live and how is it paid for?
Market solutions emerge:
The private sector has stepped in and filled many of the gaps in housing for some segments of the population, e.g. new housing + care bundles for middle-income Canadians, an increase in co-housing models especially in urban centres, adaptable and technology enabled laneway / garden suites.
Alternative sources of capital:
New market solutions have been motivated by a surge in housing demand as older adults look to cash in on the equity in their homes and by new funding available from the private and the philanthropic sectors who are enthusiastic about investing in new real estate opportunities.
New players and partnerships:
Unusual partnerships come together on projects to deliver a wider range and supply of housing — religious organizations have become a major player in the seniors housing sector as have grocery chains and strip mall operators who have used their substantial real estate footprints to incorporate seniors housing in any site redevelopment and offer housing services coupled with things like grocery delivery and pharmacy services.
Care: Who delivers care and how is it paid for?
New, distributed care options:
Innovative private sector players are helping to fill many of the support gaps that older adults need (e.g. private long term care at home models, new applications for digital solutions to support extended independence at home, new service delivery models to bring support to the home).
Incentives to age in place:
In some cases, the cost of home modifications and care are offset by tax credits and a new personal budget has been introduced to every Canadian over 75 to enable them to age at home for longer. Companies like Home Depot, IKEA, Best Buy and Canadian Tire have established entire divisions for aged solutions in home modification, their fastest growing segments and the source of many new jobs in the new longevity economy in Canada.
Aging experiences: How are older adults doing, and how different are their experiences across the country?
Home equity finances care:
Higher and middle income older adults have a significantly higher quality of life, especially if they own a home. The continued rise in real estate prices across the country has driven a care economy built on spending the equity released through the sale of a family home to pay for private care and support services. Rather than passing that equity on to their children, most older adults rely on their home equity to pay for their rent and care as they age. Banks and new fintech companies that decided to target this segment have created entirely new financial products to serve the banking, investment and insurance needs of older adults.
Home ownership as a determinant of health:
For lower-income and/or higher-need older Canadians, who might never have owned a home that appreciated in value, there remain significant challenges as they cannot afford their monthly rent and care expenses on modest fixed incomes. The life expectancy differential by income has grown more and more stark across the country.
Navigation nightmare:
Health care services are inconsistent from province to province and even from region to region and there are endless complaints about how difficult it is to navigate the system to get even the most minimal amount of care organized at home. Hiring a private care navigator is an increasingly popular option, but not everyone can afford this.
Identity of aging: How are older adults valued or perceived?
Family advocates still vital:
With no consistent framework or standards for meeting the needs of older adults across the country, families have to advocate for their needs and coordinate their own care — sometimes it works out well (for those who are in the know, and have the agency to advocate and demand more) … and other times it doesn’t, especially for the growing segment of elderly Canadians who were not born in this country or who do not have English or French as their first language.
Employers step up:
Some companies have put in place phenomenal caregiver insurance packages for their employees — they have virtually no turnover of their more experienced staff who make sure to stay put while they have parents who need support. Of course, Canadians in the gig economy, who do freelance work or own small businesses are not able to access these same perks further exacerbating inequities.
Policy: How does government work?
An ad hoc approach:
Unlike most OECD peers, Canada continues to lack a cohesive seniors strategy that aligns all levels of government — older adults have never really got on the agenda in a meaningful way.
Federal incentives:
The federal government has however made some important policy changes since the 2020 pandemic. Although they were never really able to influence provincial health policy the way they had hoped, they have incentivized new business models by introducing national tax credits for home renovations for aging in place, and a federal seniors care program similar to Australia’s Aged Care federal program from the early 2000’s. In this program there are personal budgets for older adults that qualify (e.g. over 75 & meanstested). This budget can be spent on anything that helps that individual to remain healthy and independent for longer or can be used to pay for care and services to age in place or to subsidize the cost of appropriate housing.
Inertia provincially:
Meanwhile, at the provincial level, there has been a lack of substantial action on a seniors housing strategy or modern seniors care model. While studied to death, there does not appear to be a clear vision for how to care for older adults and budget allocations have not changed dramatically. Canada remains a major outlier in how we care for (or don’t care for!) older adults in the community.
Cities step up:
After the pandemic, driven by the net migration out of cities, some municipalities were determined to take a leadership role in making their communities the best place in the country for older adults to live. They have instituted a wide range of new planning policies to encourage more age-friendly development and have made it much easier and more attractive for new private and nonprofit players to build more accessible and affordable homes for older adults. A handful of cities around the country have become meccas for older adults looking for a place to downsize while aging on their own terms.
A Day in the Life
Options for Aging - a national nonprofit joint venture between SE Health and Covenant Health just received approval for another new build. That’s three this quarter. What a wonderful way to start the week. We’ve been so busy these past few years and there doesn’t seem to be signs of it stopping, which is good if you're in the business of providing holistic living experiences to seniors. We’ve been called the “WeWork for affordable seniors housing” (before WeWork fell into scandal, that is). My boss says that momentum wasn’t always this strong, but I have no idea what he’s talking about — the last few years all we’ve done is grow. Our rented apartment offering with home healthcare bundled into the lease price is wildly popular.
Options for Aging builds garden suites that people can put in their yard for their aging parents as well as small seniors-only rental properties. The price point is still out of range for most fixed income Canadians, but demand is huge, and the product is still 50% cheaper than what the for-profit seniors living operators offer. On top of building housing, we’ve also partnered to offer residents a range of non-clinical service options like meals and cleaning services. We focus on offering “housing-as-a-service” and a personalized living experience for everyone.
We believe people should live in our homes because they want to, not because they have to. We’ve been sure to align the services available to those that are covered by the federal Older Persons Personal Budget so that those residents that qualify can make use of that benefit, and we ensure it is seamless, no bureaucracy. It works well for a lot of people, but sometimes older adults need more than we can provide — especially if they have significant health needs.
Navigating the healthcare system has become an industry in and of itself — it’s so complicated and really hard to get enough care at home unless you can afford a top of the line provider. The role of “care navigator” is an entire professional industry, outnumbering nurses! So much for less administration in the system.
In a few cities, we work hand in hand with municipal planning teams to bring affordable rentals to market for older adults. We usually build on city owned land or land provided by a local church or community group, but we only do this kind of thing in places that have made the process easy. It’s just too time intensive to try to bring this kind of project to market when lack of funding support, red tape and impossible planning approvals make things harder rather than easier. We're proud of what we do and just wish we could offer this kind of housing to everyone.
