Aging + Housing + Healthcare: Impact of COVID-19
Building with Mission supports Canadian healthcare delivery organizations, and other mission-driven non-profit organizations, to build affordable housing that supports good health and care for older Canadians. This blog is part of a series to share our learnings and insights as they are developed. We will share new knowledge and ideas about trends and drivers related to (affordable) housing, health and aging. We will also highlight innovative approaches, roles and opportunities incumbent healthcare delivery organizations can play to expand the range and supply of housing options for older adults.
Building with Mission is a CMHC National Housing Strategy Solutions Lab designed to tackle complex national housing challenges. The Steering Committee is comprised of sponsors and experts from the following organizations.
“In Canada, the pandemic has, among other things, exposed the fault lines in our institutions - political, public, health, judicial and more. But no sector has been more brutally unmasked than eldercare, the hodgepodge of long-term-care homes, home care and affordable housing for seniors that lurks on the margins of health and welfare systems. We have long deluded ourselves into thinking our elders were well cared for. Now the norm has been shown to be horribly inadequate.”
Prior to the onset of the pandemic, Canada’s aging demographic foretold a scenario that was bound to cause us to revisit how to address the health and housing needs of older adults. Many have written reports, studies and books about how this demographic shift would have far-reaching ramifications on how older Canadians age and live, as well as the financial implications on the healthcare system and broader economy. A key pre-pandemic strategy in some places like Ontario was continued investments in building long-term care facilities, and a broad recognition that more affordable housing was particularly important for this segment of the population.
As COVID-19 began to take its toll on aging Canadians, the gaps in how we support the health and wellbeing of older Canadians were amplified, policy and structural gaps were exposed, and new gaps were illuminated. One of the most significant domains now in the spotlight is the setting in which older adults age, live and heal: their home.
In early 2021, the Building with Mission team canvassed over 100 Canadian healthcare delivery organizations (hospitals, long-term care operators, home care agencies, etc.) to better understand the trends they are contemplating at the convergence of aging, healthcare, and housing. Our questions focused on how COVID-19 has impacted the confluence of these three sectors.
Through a survey, we asked respondent how the pandemic is impacting three key dimensions of aging, living and healing:
The way that seniors think about where they want to live in the future
The way in which seniors housing is designed
The way we care for seniors
Two major insights emerged from our scan: where older adults age and the design and the features of those spaces are primed for a major rethink in the post-pandemic era.
Insight #1
There will be significantly more demand for home-based alternatives to restrictive congregate living models
The desire for older adults to age in the place of their choice, and to live as independently as possible for as long as possible was already high before COVID. Studies before the pandemic had shown that nearly 90% of older Canadians prefer to remain in their homes as they age. This desire is even more pronounced since the pandemic, as reflected in these quotes from the survey:
“Long term care is less desirable, and tools to stay in [one’s] own home is more desirable”
“[Older adults] will want to stay home now more than ever.”
Further, there was a consensus from survey respondents that “increased attention to the quality of the built environment in congregate settings” was also vital.
These views align with what citizens across Canada have also expressed. In a national survey conducted by Ipsos in late 2020 midst of the first wave of COVID-19 crisis, nearly 100% of Canadians 65 years of age and older said that they plan on supporting themselves to live safely and independently in their own home for as long as possible. This widespread consensus amongst older adults comes as no surprise as the proportion of deaths in long-term care homes represented 69 per cent of all COVID-19 deaths in Canada, which is significantly higher than the international average of 41 per cent.
There is now an ever-widening chasm between the desires of older adults to age in their place of choice, and the housing options available to them. Further, there is a mismatch between the desire for homes that support autonomous healthy aging with agency and the current default pathway of institutional predefined “senior living” models.
This creates both a need and an opportunity for healthcare delivery organizations to leverage the emerging work of the Building with Mission project and to get involved in creating more desirable and attainable housing options for older adults. The rationale is two-fold. First, mission-driven organizations can continue to deliver on their commitment to helping the vulnerable, including older adults in their communities, by contributing to the creation of a wider range and supply of affordable housing that helps older adults to optimize their health while meeting their needs and preferences to age, live and heal in the place of their choice rather than in institutional settings. Second, shifting focus and investment upstream to provide appropriate housing may quell demand for more costly healthcare resources leaving money for reinvestment elsewhere.
As people age, they are more likely to develop conditions that impinge upon their ability to live as they wish – frailty, chronic conditions, cognitive decline, or reduced mobility. There are strategies to lower the prevalence and acuity of these limitations, but they require a major shift in the approach to delivering care to this population. For example, between one in nine and one in five older Canadians in long-term care facilities could live in their own homes with appropriate home-based care supports. That is a living arrangement that would suit them better, would produce better outcomes and would be less expensive. These benefits have been magnified during the pandemic, as the rampant outbreaks and severe restrictions that have taken place in congregate settings resulting in a desert of boredom and isolation might have mostly been avoided.
Insight #2
Design matters to older adults and can be a major determinant of health and independence
In addition to thinking about where people live and how care is experienced, the design of the physical spaces that older adults live in is increasingly a critical determinant of health. Many respondents to our survey emphasized that having fewer shared rooms, and instead offering all residents a private room in institutional settings, with the addition of in-suite amenities such as a kitchenette, would be best suited to optimize health and well-being in a post-COVID world. One respondent elaborated that “if older adults have the ability to cook, they will want to cook in their own suites”, or at least have that option. Many responses echoed the idea that “we need to consider design in a way that can ‘segregate’ different areas of the building in the event of an outbreak.” Part of the rationale for these design changes is to enable enhanced infection prevention and control protocols but that is likely just the tip of the iceberg. Outside of congregate seniors settings, we have all seen the impact of technological advances and their ability to support us when we cannot venture far from home. From food and grocery delivery to virtual visiting, technology can help to support independence and maintain social connections. It may be possible to make congregate settings more desirable to older adults by reimaging how they look and operate in ways that go well beyond improvements for infection control. Based on our survey results, many believe the future requires a reimagining of living accommodations to smaller household groupings that support relationships and foster stronger connections while also supporting enhanced infection control.
It’s important to remember that Canadian adults aged 65 years and older are not a monolithic segment. This population includes Canadians that may be born multiple decades apart, come from a wide range sociocultural backgrounds and experience their health and well-being very differently. Services and experiences that serve this demographic need to be intelligently designed and highly tailored. Respondents emphasized that some citizens will need “navigators to ensure required care is accessible.” A citizen-centred approach to designing new care and housing models that promote dignity and respect for this diverse population group will be critical.
Looking ahead: Housing + Health + Aging in Canada
Acting on these two insights about housing, health and older Canadians will require a very different approach than the current default pathways of building more preordained senior living models. Even a year after the pandemic, there is a level of rigidity present with some 2021 provincial budgets that notably seem to reinforce institutional models. Now is the time to galvanize a wider group of organizations across sectors to think about the various ways that they can better serve the needs of older adults, especially those that are most vulnerable. We hope the Building with Mission project will provide the support and resources necessary for healthcare delivery organizations that have previously viewed housing as outside of their mandate to join others in filling significant gaps in their communities. As long as there is a collective intention to enhance the physical, mental and social health of older Canadians, new opportunities await.