When Martha Casson moved into her dream home in 2021 — a house on the shores of Lake Scugog, about an hour east of Toronto — she wanted more than picturesque scenery.
To be sure, the 75-year-old’s home gives her an unobstructed view of the water. When she stands on her balcony and looks out her windows, she “feels like I could scoop a cup of water right out of the lake.”
She wants to enjoy this view for as long as possible. The windows were not the only feature that made the cottage attractive; it is also a home where she believes she could live as she gets older.
“When I moved here, that was one of my considerations,” she said. “How do I age in this house?”
The cottage has an apartment where, if needed, full-time caregivers could live.
Casson has a very active life. She is not looking at applying for home-care services any time soon. But she lives in a rural area, and she knows health-care services are limited. She would like more accessible health care, preferably within 15 minutes of her home.
She definitely does not want to move to a retirement home or long-term care facility.
“There are lots and lots of us who do not want to be in a retirement home,” said Casson. “We don’t all want to come down for dinner at 5:30.”
“But we sure as hell would like access to medical care or paramedical care.”
Her municipal government is hoping to make that possible.
The mayor of Scugog, Wilma Wotten, is one of a growing number of municipal leaders in Ontario who are considering PACE, a community model designed to keep seniors out of long-term care facilities and hospitals.
PACE stands for Program for All Inclusive Care for the Elderly. It started more than 30 years ago in San Francisco’s Chinatown. In this model, health and social service organizations are clustered in one building. Seniors choose which services they need, and a coordinator helps them access those services. Seniors need to explain their needs only to the coordinator, and not to multiple staff from multiple agencies.
Residents are not required to participate in the social programs offered by PACE or to use the health-care services. But the program enables seniors like Casson, who live in their own homes but want health care to be close by, to stay safely in their own homes.
“It’s conceptual, right now,” Wotten said of Scugog’s plans for opening something like PACE. The biggest challenge is finding a building to house it. Scugog is located in Ontario’s Greenbelt, so it is tricky to build new buildings. But nearly a quarter of the township’s about 21,500 residents are over 65, and the area’s 100 or so long-term care beds will not be enough to serve their needs.
“I’m certainly optimistic it will happen,” said Wotten. “We have to find a spot for it.”
Keeping seniors out of long-term care
Across Ontario, PACE is catching on as municipalities look for alternative ways to meet the needs of an ageing population given lengthy waitlists for limited long-term care beds and home-care services.
Last month, Ajax town council passed a motion that supports having a PACE program in town. Other cities and regions, mainly in the Greater Toronto Area, are also looking at the model.
Burlington has emerged as a leader in PACE. The program has been running there since 2019 in what the city calls “community wellness hubs.”
The first hub opened in 2019 at a residence that is part of the Halton Community Housing Corporation. The corporation provides housing for people with low incomes. The building’s ground floor was renovated to make office space and a large meeting area. Currently, more than a dozen health and social service organizations use the space. They include a community paramedic clinic, dementia and mental health supports, many exercise classes and social events.
Staff from the partnering organizations run their programs in the building on a rotating schedule. The space is always in use with programs offered every day, says Andrew Balahura, CEO of the housing corporation. The agency that coordinates the services and seniors’ access to them is at the site every day.
“It’s somewhat unique to Halton, that we’ve been able to bring the housing world, the social service world and the health sector so closely together,” he said.
As the landlord, Balahura and his staff are equipped to help with building maintenance, problems that can be fixed with tools or paint, he says. They are not trained nor equipped to help with mental-health problems or dementia, he says.
“The only thing in my toolbox as a landlord is if somebody doesn’t pay the rent, or presents with antisocial behaviours … is we can either move them elsewhere or we evict,” he said.
“That’s never good to take those kinds of avenues with a senior.”
Community wellness hubs
Community wellness hubs are becoming more popular.
The first location, Wellington Terrace in Halton, serves 80 residents. Earlier this year, it started offering its services to people who live nearby, not in the building. Staff from agencies that serve Wellington Terrace started working at another community housing building in Burlington.
Another hub opened last year in Oakville. And another hub is set to open soon at a community housing building in the town of Halton Hills.
The model is popular because it works, says Balahura. A survey of residents at Wellington Terrace showed a decrease in loneliness and depression and an increase in overall health and well-being. Sixty-eight per cent of residents who used the program said their physical health had improved; 63 per cent noted an improvement in their general health.
Seventy-nine per cent said their mental health had improved, while 74 per cent reported fewer feelings of loneliness and 68 per cent said there was a decrease in feelings of anxiety and depression. There have also been fewer calls for emergency services.
Research has consistently shown seniors struggle with loneliness and isolation.
Often, seniors move to long-term care facilities, not because they have greater medical needs, but because they are lonely and want social activities, or they need help with daily tasks such as meal preparation, says Rosalie Wyonch, a senior policy analyst at the think tank C.D. Howe Institute who focuses on health policy.
“When people don’t have access to [social activities and community support], they can end up in long-term care ahead of time,” she said. “That’s both not where they want to be, and it’s more expensive for the government.”
The community wellness hubs in Burlington, and PACE in general, are an “interesting model,” she said, because “it both considers what are the patient’s needs but also meets the preferences that they have — which is to age in their own homes.”
A recent survey of 6,000 Canadian seniors showed a strong desire by seniors to stay out of long-term care. Only two per cent of respondents aged 50 and up said they would like to move into a long-term care home.
Even though the locations open so far in the Halton area focus on low-income seniors, Paul Sharman, a Burlington city councillor who spearheaded the creation of the community wellness hubs, says the model can be used for people of various ages and all incomes.
In the United States, PACE is restricted to seniors who qualify for publicly paid health-care. In Canada, though, “we can provide these services to everyone who needs these services irrespective of age,” he said. “They just have to have multiple morbidities or certain conditions.”
Martha Casson in Scugog wants to stay in her dream home as long as possible. But if she ever needs to move into a community designed specifically for seniors, it will need to include health-care services.
“I think that bringing the care closer to the people would make some good sense,” she said.
The Ford government put 6 billion into nursing homes private and public in their budget in spite of seniors wanting to age at home. Their budget gave about 1 billion to home care services which is inadequate as this money is needed to bring up salaries. This government funds business not people.