Jacquelyn Shields has seen what happens to seniors when they cannot afford care in their home.
She’s seen it many times. The senior’s health deteriorates and they lose the ability to live independently, said Shields, who has worked as a personal support worker for the past 15 years.
Then they end up at the hospitals, often awaiting a spot in a subsidized long-term care home.
“That’s why our hospitals are full of people waiting for long-term care — because so many Canadians can’t afford the care,” said Shields.
It should be easier for seniors to get care while they are still in their home, she says.
Major and minor policy changes will be required to address the desire of baby boomers to stay in their homes and afford long-term health care, experts say. Long-term care for seniors involves helping them meet medical and non-medical needs when they can no longer care for themselves due to illness or restricted mobility, including home care and care in long-term care homes.
“We haven’t really started to see the consequences of baby boomer health-care needs,” said Bonnie-Jeanne MacDonald, director of financial security research at the National Institute on Ageing at Toronto Metropolitan University. Baby boomers are defined as those born between 1946 and 1965, putting them between ages 59 and 78.
“That’s something that will be seen over the next five to 10 years,” said MacDonald, whose research focuses on retirement affordability and policy.
Most costly option
Canada spends little on home- or community-care for seniors compared to what it spends on hospitals, says Rosalie Wyonch, senior policy analyst at the C.D. Howe Institute. And yet, keeping seniors in their homes is the best and cheapest way to care for them.
“If they had access to care at home they might not have ended up in the hospital in the first place,” said Wyonch.
Rebekah Young, head of inclusion and resilience economics at Scotiabank, agrees. “We end up sending people to the most costly options when the most desired ones are staying at home,” she said. The vast majority of seniors — 88 per cent — say they would prefer to age in their homes.
Despite the overall higher public cost of hospital stays, Canadians are incentivized to rely on hospitals for their medical needs since hospital care is covered by provincial insurance plans. In contrast, home-care coverage varies by province and often needs to be funded privately.
“A lot of people think long-term care is covered by the Canada Health Act, but it’s actually not,” said MacDonald. “And that’s why we have so much variety. It’s something the provinces elect to do, but it’s not mandated.”
The varying health-care benefits that provinces and territories offer to seniors, as well as the highly variable cost of care required, makes it difficult for Canadians to know how much they need to save for health-care costs in their senior years.
Fewer children
Historically, when a senior needed live-in support their family stepped up. A study MacDonald co-authored in 2019 found that for every four hours of care older Canadians receive in their home, three of those hours are done by family members.
“That’s still true today,” she said.
The problem is baby boomers have fewer children than earlier generations. Canadian families decreased from 3.1 children per woman in 1965, to about 1.7 children per woman born during the baby boom, according to Statistics Canada.
“We’re going to have double the population needing support, but they’re not going to have the family to give them that support,” said MacDonald.
Middle to upper income Canadians are most likely to be able to afford private care that enables them to stay in their homes.
A 2021 Canadian Medical Association report said it can take 22 hours of home care per week to keep patients out of long-term care homes. This care can cost at least $3,500 a month.
Seniors could benefit from tax credits to afford services such as housekeeping, meal delivery and attendant or nursing care, which can cost upwards of $30 an hour, said Wyonch.
But for lower income families, private care options may be unaffordable even with tax credits.
“Those that are at lower levels of income won’t have nearly as many options,” said Wyonch. They “will likely be more or less fully dependent on publicly provided services.”
Peace of mind
Another policy response to cover seniors’ long-term care costs would be to create a long-term care insurance program, MacDonald says. This could be a scheme Canadians pay into as workers or that is funded by general government revenues.
A public insurance scheme would have “the benefit of potentially spreading risk across the population so that those that have higher care needs can then have lower costs,” said Wyonch.
Private insurance is another option that’s already available to Canadians.
Shields, who has a disability herself, has paid into a long-term care insurance plan for the past 15 years to cover some of the care she expects to need into old age. The insurance covers some hours of home-care services if she becomes incapable of completing everyday tasks independently.
A plan like this can offer peace of mind, especially when navigating public benefits for seniors.
But many who need care do not plan ahead. “People don’t plan soon enough in advance. What happens is they start planning when they need help right now, and it’s too late then,” said Shields.
Improving the accessibility of information could help seniors get the care they need, as some home-care services can be difficult to research and apply for, Shields says.
Shields’ family chose to sponsor a foreign home-care worker to assist in the care for her father, who had dementia. Later, as his condition progressed, they also applied for provincial home-care services.
“It’s really hard to do it on your own,” said Shields.
Creating new policies to make it easier for seniors to stay at home helps every age group of Canadians, says Wyonch. Decreasing the number of hospital beds used by baby boomers waiting to get into long-term care homes frees up space to address other needs.
“Solving this issue shouldn’t just be a concern for seniors,” Wyonch said. “It should be a concern for everybody.”
This would be a better article if it also considered the effect of helping seniors in their (often oversized) homes on the crisis of housing affordability. If a government dollar is available, should it be spent on home-care or on a long term care home ? This is not a rhetorical question.
A tsunami of seniors requiring long term care is pending. Whether public or private care, I wonder if there will be enough long term careworkers available meet the needs of this huge and demanding demographic. Increased immigration may solve this problem.
Thank you for providing this valuable range of topics.
I spent 8 months in a Care Home in Nanaimo in 2018- 2019. The facilities were decent; but the food was pathetic. The dining roo. Was crowder with 4 people to a small table.