…by Terrance Hunsley
Seniors care is an iceberg and provincial governments look like the Titanic. COVID showed us that the long-term care system is a disaster in the quality of care, readiness for emergencies, and exploitation of precarious workers. The federal budget allocated $3B over five years to help improve standards of care in long term care homes. A pittance when you consider the scope of need. And it said very little about the need for a massive investment in home and community-based supportive care.
A National Institute on Aging (NIA) study, projects a tripling of the cost of long-term care in constant dollars over the coming thirty years. That is the best case scenario. The study did not factor in needed improvements in service standards or labour standards. Nor did it anticipate the increased long-term need resulting from COVID.
The NIA study points out that far more care is provided by family and friends than by the formal care system. But informal caregivers will not increase at the same rate as those needing care.
Seniors care should respond to the person in their home and neighbourhood. But the health care system is fragmented, designed top-down for institutions and the locational preferences of private providers. In Ontario any focus on communities was lost about 2010. The development of community health centres ground to a halt. Capitation funding to encourage physicians to provide more holistic services, stalled. The development of multidisciplinary teams stalled.
Now retired baby boomers are finding that their doctor is retiring too. While primary care should be fully integrated with home care and community health services, elderly people in central city neighbourhoods are being told to get into their cars and drive to the suburbs. That’s where new doctors are setting up to make the best of a fee-for-service pay model.
It should have been different. In 2006, a Public Health Agency of Canada document for federal and provincial officials identified the need for …“age- friendly” communities that facilitate social interaction for seniors and provide safe, attractive places to walk and be physically active; accessible transportation that encourages social engagement; smoke-free public places; senior-friendly restaurants and grocery stores that enable and encourage healthy eating; and policies that reduce inequalities related to socioeconomic status. The governments agreed on these needs and then ignored them.
How could age-friendly communities help? We have a good example
Health departments could take a lesson from the work of Canadian communities in settlement assistance for immigrants and refugees. Community groups and organizations provide highly effective informal help for newcomers. They help them to find housing, access government services, find educational opportunities and jobs. Connections are made with dentists and doctors. They are included in informal sharing networks. Their kids get volunteer tutoring. Community support helps them adapt and thrive. And our economy and tax revenues benefit hugely from it. This successful humanitarian outreach is also one of the best financial investments the country could have made.
Why should we serve people where they live?
Providing care in the home and community is cheaper than institutional care, and it is where most people want to stay. Generously provided and coordinated with community support, it improves life for all. People are more active and provide support for their children, friends and grandchildren. They volunteer to help others. They require less intensive services when they are needed, and they require them at a later age. All of these things reduce public costs.
Supportive communities are essential to healthy aging. Social relationships and inclusion, safe neighbourhoods, safe walking, accessible facilities, educational and recreational opportunities and caring neighbours contribute significantly to well-being. Age-friendly communities broaden the web of people willing to provide informal care. They don’t let people fall through the institutional cracks.
But Canada is behind other countries. We spend 87% of our care dollars on institutional care, compared to an OECD average of 65%, and 36% in an advanced country like Denmark.
Facing a tsunami of need for care, we should provide innovative seed funding and credit for community action. Community associations could plan configurations of services and retirement living options that are integrated with the community. Nonprofit organizations could develop facilities near or adjoined to existing public or community facilities, like recreation centres, schools, churches and libraries. Seniors could have the same choices available in high-end for-profit facilities, from fully independent living to various levels of assistive services. But the costs would not have to cover corporate profits. The long-term growth of capital value of those facilities would accrue to the community rather than venture capital corporations.
Accommodation for doctors, nurse practitioners and other health services which intersect with home care could be integrated into the living spaces or community, providing the holistic health care that the health planners have talked about for decades.
Models in other countries show us that a community focus not only improves life for seniors but also for the community. We can’t avoid the coming increase in costs, but we can flatten the curve a bit and build happier, more resilient communities. More importantly, quality of care decisions can be made from an ethical rather than profit-based perspective.