Fact:

-one in three adults over age 85 will develop dementia

-260,000 Ontarians currently live with dementia

– most people living with dementia ( like all of us) prefer to remain in their community and out of long term care homes

-Supporting aging in place (for all Canadians) will reduce  shortages in LTC and hospitals

– “In 2020, the province estimated that the cost to provide home and community care was $103 per day.  This was in comparison to $201 per day for providing services in long-term care, with the number surging to $730 per day for alternate level of care (ALC) in hospitals.”

– People living with dementia are more likely to require care and services from the healthcare system (visits to doctors, hospital admissions and publicly funded home care.

The report ‘Roadmap Towards a Renewed Ontario Dementia Strategy’ [Alzheimer Society April 2022- expert panel analysis] recommends the following:

• “Implement a renewed Ontario Dementia Strategy under the authority of a dedicated Secretariat with the authority to oversee dementia care and make recommendations across the spectrum of government services, including health and long term care.
• Establish integrated community based care, encompassing community support services, day programs, respite care, homecare, memory clinics, occupational therapy, and medical interventions to retain the quality of life of people living with dementia.
• Complement the current plan of expanding long-term care homes and building of new long-term care beds by ensuring that the sector has sufficient health human resource capacity and well-trained staff to provide adequate care for older Ontarians, particularly dementia care and behavioural support.”

Systemic issues:

• Ontario’s physicians receive very limited training for neurology and less for dementia diagnosis and care.
• Most front line workers, including PSW receive very limited education and training in working with those living with dementia.
• Very fragmented journey from diagnosis onwards with inadequate culturally specific resources.

Recommendations:

• “Develop a standardized pathway for individuals living with dementia, with specific, time-indexed steps with a focus on obtaining a clinical assessment, consideration of diagnostic options, review of potential pharmaceutical interventions, and a plan for accessing home and community supports.
• Adopt Health Quality Ontario standards for dementia, to ensure equitable access to clinical and non-clinical services for people living with dementia and their care partners, while respecting their human rights and dignity.
• Develop dementia-specific tools within advanced care planning (ACP) such as providing information about substitute decision – making and powers of attorney.
• Encourage research with dementia diagnosis through blood biomarkers, cerebrospinal fluid biomarkers and retinal scans
• Improve infrastructure by providing community used diagnostic tools such as MRI, and PET scans and ensure that OHIP covers these expenses.
• Absolute shortage of geriatricians.  A 2019 study found that in Canada there were 376 geriatricians and 354 care for the elderly (COE) physicians.  Ontario reported 168 geriatricians.  Establish funding models to expand geriatric services and ensure geriatric clinics have access to OT’s and PT, RSW and nurses for consistency of care within the interprofessional teams.
• Expand the availability of integrated community – based care, day programs, respite care, home care. Increase memory clinics to limit emergency room visits and hospitalizations and referrals to LTC.
•  Introduce fully refundable tax rebates and /or access to direct funding programs and increase Seniors’ Home Safety Tax Credit
• Create a dedicated funding stream for dementia-specific respite services.
• Develop a province-wide dementia awareness campaign and expand community supports to maintain quality of life.

We have a long way to go. In addition to designing dementia specific communities, as a former Vocational Rehabilitation Counsellor  I would also like to see  work/placement programs that supports those with dementia to contribute and have purposeful activity.