For the past five years, it has been my pleasure to address a local service club on the topic of Smart Ageing and discuss other topics proposed by the members. The members are retired professionals and businessmen with an average age of 80. The forty men present in person this year, plus those online, wanted to discuss the costly mistakes that could occur if appropriate personal care plans were not in place. For example, a hot topic was how to cope with the hospital discharge of a family member or friend when they would require substantial care that couldn’t be provided at home.

The participants were intrigued about why they should actively plan for a 100-year lifespan. In our last two blog posts, Lifestyle Changes Bring Increased Risk to Older Clients – All About Estates and Lifestyle Changes Bring Increased Risk to Older Clients and Advisors – Part 2 – All About Estates, we discussed how a 100-year lifespan does not necessarily equal 100 years of good health. We know that in the last decade of a person’s life, there could be more focus on health issues, medical coordination, and personal care needs. That gap between lifespan and health span creates new risks for caregivers and families who may not know what type of care or support they need. It potentially creates an increased burden for their family members or attorneys for personal care and property.

These are the three costly mistakes we talked about avoiding when planning for a 100-year-long life.

Aging in place: the reality and cost of care

Even though the vast majority of participants want to stay in their own homes until end of life, several people acknowledged that their care needs could escalate rapidly and become quite complex, requiring more specialized caregivers. Depending on the resources available to pay for caregivers and whatever is provided by government services, the breakpoint for decision-making is often the ability to manage multiple service providers and the costs of escalating care. For most people, paying $20,000 to $30,000 monthly for private caregivers is unsustainable. It triggers a decision about living accommodations outside the home.

Accommodation choices outside the home

A continuum of accommodation options is available to older people who choose to move to accommodation with more support. However, many people are not clear about the range of options, what type of services would meet their care needs, and the actual costs as their situation progresses. This is a topic for another blog post, but suffice it to say that many families make the wrong choices for their loved ones and don’t base their decisions on the older person’s care needs. Instead, they are impressed by the amenities or the location. Each move is costly and disruptive to an older person, especially someone who has diminished capacity and requires extraordinary effort to transition safely into a new environment with different caregivers.

We have several cases where families moved an elderly person into an independent type retirement home where the family was led to believe that their parent could “age in place.” However, as the elderly person’s care needs increased and dementia-related symptoms became more advanced, families were then advised the costs would increase substantially for the care component. Not long after the care costs increased, they were then informed the parent could no longer remain there as they were an “independent living” facility and could not meet the needs related to advancing dementia care.

Hospital discharge policies related to long-term care admission

With an estimated 50,000 people waiting for long-term Care home placements in Ontario, families struggle to understand the maze of policies and interpretations.[1] Transitions for older people with complex care needs, such as a transfer to a hospital, are difficult. Once in the hospital, there appears to be a significant amount of confusion about hospital policies around discharge from hospital to long-term care. Different hospitals seem to have different policies with various interpretations of the Fixing Long-Term Care Act, 2022 (FLTCA). The following are only two of many concerns:

1. Patients who require admission and are eligible for long-term care might be told that they must be discharged from the hospital and wait “in the community.” It may be suggested that they be discharged home under the “Home First” policy with increased care from Ontario Health at Home. What they do not realize is that this “increased care” is for a defined period, and then the services are reduced. However, the ill person still requires that care and families resort to paying for more private services to replace the previously promised government services.
2. Another common occurrence is that families are told if the patient cannot be taken home then they must go to a retirement home to wait. If a person requires a level of care that meets eligibility for long-term care, then many retirement homes simply cannot deliver that level of care. Families are told that they can pay the retirement home for their regular room and services and then hire additional private caregivers to “top up” the care for their older parent. This can result in substantial monthly fees.

Many families do not realize that when a person has been approved for eligibility and requires admission to a Long-Term Care Home while in the hospital, they are immediately placed in the Crisis Category for placement. However, if families move the person out of the hospital back to their home or they move them to a retirement home, they are not necessarily kept in the Crisis Category for placement. Some of these “policies” are not founded in law, and families need to choose wisely. For a much more detailed look at these and related issues, the Advocacy Centre for the Elderly has an excellent article on their website, Discharge from Hospital to Long-Term Care in the Wake of Bill 7: Important Information You Need to Know. [2]

These topics, raised by the gentlemen at our speaking engagement, are complex and  require thoughtful planning well ahead of time.  Costly mistakes can be made without understanding the reality and cost of care at home, choosing an appropriate retirement home based on needs, and the limbo that can result from a hospital discharge.

We are already booked to return to speak to the club again in 2026. No doubt, there will be another list of hot topics on Smart Ageing to discuss as we age together.

[1] https://www.oltca.com/about-long-term-care/the-data/

[2] www.ACELAW.ca  https://www.acelaw.ca/wp-content/uploads/2023/10/Discharge-from-Hospital-to-Long-Term-Care-in-the-Wake-of-Bill-7-Important-Information-You-Need-to-Know.pdf