When we hear the words “long-term care,” most of us think of nursing homes. However, long-term care can be delivered in many locations, including home and community-based settings. The National Institute on Ageing defines long-term care as “a range of preventative and responsive care and supports, primarily for older adults, that may include assistance with activities of daily living […] in settings that are not location specific.”
That Canada chooses to spend more than six dollars on institutional care for every one dollar spent on home care isn’t inevitable; it is a policy failure.
In Denmark, the aim of seniors’ policy is to keep seniors in their own homes for as long as possible. More than 30 years ago, the country changed its policies to prioritize building supportive housing units and providing community-based care. Demand for care in nursing homes fell and spending on long-term care for seniors over 80 was reduced by 12% overall. In 2019, Denmark allocated 50% of its spending on long-term care to home and community-based care; Canada allocated 18% that same year.
By 2031, almost a quarter of Canada’s population will be over the age of 65 and demand for long-term care will grow further. In the intervening years, we must reform our system.
Care in nursing homes is much more expensive than other kinds of long-term care. For example, Ontario’s ministry of health estimated in 2020 that providing home care to a client with complex needs costs $103 per day, compared to $201 per day for a similar client in a nursing home.
Not only will it be unaffordable to care for so many of our seniors in nursing homes, to do so would defy the express wishes of most Canadians. A survey conducted by the National Institute on Ageing, the Canadian Medical Association, and Ipsos in late 2020 found that 85% of respondents — and 96% of those 65 and older — will do “everything they can” to avoid moving into a nursing home.
In the short term, it is certainly appropriate that we prioritize the improvement of conditions in our nursing homes. But in the longer term, we must reallocate our efforts, and our resources, to the programs and services that will allow our seniors to remain in their homes as they age.
Fortunately, advocates and experts across the country have been working hard to meet this challenge. In October 2020, I launched an inquiry to call the Senate’s attention to weaknesses within Canada’s long-term care system exposed by the COVID-19 pandemic. In the course of my research for the inquiry, I found examples of diverse projects from all across Canada that seek to support healthy aging in place — including the Hospitals Without Walls pilot program in Prince Edward Island, the Hôpital Saint-François d’Assise’s mobile clinic in Quebec and the Better at Home program in British Columbia. These projects support healthy aging in place through the integration of age-friendly housing, accessible transportation, community support and innovative health care delivery, as well as through the coaching on, and adoption of, new technologies.
In addition, researchers at organizations like the National Institute on Ageing provide policy-makers with thoroughly researched reports that show the path toward the provision of the kind of care that seniors look for — and how it’s also more fiscally sustainable. The institute’s October 2022 report, entitled Ageing in the Right Place: Supporting Older Canadians to Live Where They Want, is comprehensive and instructive. Its authors propose 10 recommendations to support aging-in-the-right-place policies and practices. These include the adoption of a deliberate public policy response that shifts more long-term care resources from the provision of institutional care to home care and community-support services.
I couldn’t agree more. It defies logic that we spend so many of our resources funding care that so many seniors do not want.
It’s time that we listen and reshape our policies to better serve them. Doing so will ensure that our health-care system works for all Canadians and gives seniors the option — and the right — to live where they choose to live.
Senator Judith G. Seidman is an epidemiologist and health researcher. She lives in Montréal, Quebec.
A version of this article was published in the February 6, 2023 edition of The Hill Times.