With the reputation of Long Term Care Homes hitting a new low, it comes as no surprise that seniors want to grow older in their own homes. However our hospitals and our emergency departments have become a temporary holding spot for many seniors, who cannot return home. The August 25, 2022 Globe and Mail article reported: ‘lying in a bed in a noisy, unfamiliar environment designed for short-term stays causes these patients to lose 5 per cent of their capacity a day, say medical experts. And there’s an impact on the health care system too: Beds occupied by ALC patients deplete resources for the critically ill, and are one of the root causes of emergency ward backlogs in many hospitals across Canada.’ As a recent result, at the end of June 2022, 10 hospitals in Ontario temporary closed their emergency departments.
A few facts: The number of seniors increased by 4.2 million over the past 38 years. Over the next 22 years Canada will need to accommodate the needs of another 4.2 million, of whom 82 percent will be 75 years of age and older. If nothing else changes, Long Term Care (LTC) beds would need to double between now and 2041.
The School of Policy Studies at Queens University in November 2020 published Ageing Well which highlighted between one in five and one in nine seniors living in LTC could manage in their own homes with adequate home care rather than living in LTC.
The study showed that “1.3 % of GDP is spent on LTC and by 2041 this will increase to 4.2% which will be unaffordable to the government and taxpayers. Canada spends 0.2% of its GDP on home care, which is the lowest allocation in the 37 OECD member countries”. Practically speaking for every $1.00 spent on home care, $6.00 is spent on institutional care. The study also reported that only 6 percent of Canadians receive publicly funded home care services which continues to push frail seniors on a wait list for LTC.
Looking at dollar costs alone, Alternate Level of Care (ALC) beds in hospitals cost about $1,000 daily while LTC is $142/day and formal homecare is $45/day. ALC is the term used to describe patients who have to remain in hospital but don’t require hospital level care but have nowhere else to go. For more information on ALC, please read my earlier blog.
In 2014 the C.D. Howe Institute published Paying for the Boomers: Long –Term Care and Intergenerational Equity which documented that the average cost of institutional care was $ 60,200 per person while formal home care had a price tag of $18,000 per person.
The Ageing Well study documented “over the next 22 years, the fastest-growing cohort is projected to be 85 to 94-year-olds, growing at an average of 6.4 percent annually, with the 95+ cohort close behind at 5.9 percent. The increase in seniors, particularly those aged 75 and older, will put unprecedented pressure on long-term and healthcare services in Ontario. The need for alternative, expanded, and more cost-effective approaches to continuing care of the elderly is obvious.”
Many of these residences get a failing grade; major renovations are needed. Actually I would add that many need complete remodeling as well as a major shift in why they exist in the first place. Canada has 58 care beds per 1000 seniors which is one of the highest number of LTC beds proportional to population. Different countries operate with a different philosophy on how they treat and support their older citizens; Denmark and Japan embrace a culture that supports their older citizens to age at home. If this pandemic showed us anything, is that we are not prepared and we need to think differently.
Just a reminder, there are alternatives to both aging alone and needing to rely on long term care and these are worth highlighting. They include:
3. Home Share
 Ageing Well, Queens University, accessed April 18, 2021