A recent report says Canada’s long-term care homes need to be managed more consistently coast to coast, the way Australia manages its care homes.
“With no established minimum standards for the delivery of [long-term care] services across Canada, there remains a provincial and territorial patchwork of [long-term care] programs and variations in funding levels, service availability, eligibility criteria and out-of-pocket costs for older Canadians,” says the report, released last month by the National Institute on Ageing, a public policy think tank.
The report compares Canada’s and Australia’s long-term care systems, which make a good case for comparison. The countries have similar population demographics and both countries have publicly-funded health care systems that include long-term care.
But their models of oversight for long-term care are different.
In Australia, the federal government is responsible for long-term care, which creates greater consistency in the long-term care residents receive. In Canada, the provinces and territories are responsible for their own long-term care systems.
Australia’s “consistency is a strength that Canada can learn from,” said Kristina Kokorelias, an associate fellow at the National Institute on Ageing and one of the report’s authors. The institute often hears from caregivers and patients who say there is a “lack of transparency” about Canada’s long-term care, she said.
Cannot improve?
The report outlines ways to improve long-term care in Canada and Australia. Recommendations include increasing overall spending, investing in smaller long-term care facilities, paying long-term care staff more, supporting unpaid family caregivers and increasing the amount of home-care services people can receive.
Not everyone agrees reforming long-term care is the best use of resources.
Putting older adults into institutions like long-term care facilities is wrong, says Patricia Spindel, chair of Seniors for Social Action Ontario, which advocates for ending long-term care institutions and increasing supports to help seniors live at home.
A survey of nearly 6,000 seniors, conducted by the National Institute on Ageing in 2023, revealed only two per cent of those aged 50 and up would like to move into a long-term care home, and just one per cent would like to live with family.
“You cannot improve long-term care,” Spindel says, because institutionalization does not work. Instead, research organizations need to study alternatives, including providing more access to home-care services and paying family caregivers, she says.
The report is the first in a series to compare Canada’s long-term care system with systems in other countries. The goal is to see what international practices Canada can adopt, says Kokorelias.
The report acknowledges it may be impossible for Canada to make long-term care a federal responsibility. But provincial and territorial governments “need to consider bold and creative policy options” to make long-term care eligibility, costs and standards of care consistent across the country.
Canada has voluntary standards for long-term care. Each province and territory can decide if they want to mandate them. There needs to be national standards for long-term care, says Kokorelias.
The costs for long–term care in Canada also vary across the country. In 2019, Canadians spent approximately $9.4 billion in co-payments for long-term care facilities.
Often Canadians do not know how much it costs to live in a long-term care facility, the report says. This means many are not prepared to move into one.
The report notes that programs such as Old Age Security and the Guaranteed Income Supplement do not provide enough funding to cover many seniors’ living costs.
Australia posts long-term care fees publicly on My Aged Care, a government website with information about long-term care facilities and home care.
‘Dehumanizing’
The report emphasizes the need to invest in family caregivers and better home care so seniors do not need to move into long-term care facilities. Older adults have better quality of life when they are supported to live in their homes as long as possible, the report says.
“While the arguments for providing more home-based care appear to be straightforward, neither Canada nor Australia have made this a key priority, although other countries have,” the report said. Both Canada and Australia “continue to be overly reliant” on long-term care facilities.
Spindel, at Seniors for Social Action Ontario, says the report’s recommendations do not go far enough. Long-term care institutions are “dehumanizing to people,” she said. They are “also very expensive.”
Talking about seniors living at home as long as possible assumes that they will end up living in an institution eventually and that that is acceptable, she says.
Penny MacCourt, chair of the Association for Reform of Residential Care, a B.C. organization that advocates for long-term care reforms, says some people will always need care that can only be provided in facilities.
Reforming long-term care systems is difficult, especially because of the strict power structures in much of it, she says. Staff are also often juggling multiple part-time jobs, she says, which makes it difficult for them to get to know the residents and what they need.
Governments need to invest more in making sure long-term care provides a good quality of life and not just good quality of care, she says. This means supporting staff with fair wages and stable jobs so they can get to know long-term care residents and better meet their needs, she says.
The goal is “providing people not just a place to live till they die, but actually providing care in an environment that’s supported by staff who are in turn supported in an environment that actually enhances life,” she said.
But attitudes toward seniors also need to change, the report says.
“Respecting older adults’ autonomy by providing them with genuine choice and supporting their active involvement in communities will not only enrich individuals’ lives, but also enrich our societies as a whole.”
The statement that there are some who will always need an institution shows the ignorance of those who should know better. Needing residential care does not equal needing an institution. We have closed institutions for every other disability group except older adults, and they are also still the only ones kept in locked wards besides prisoners. It is time so-called advocates and researchers work up the the many alternatives – in-home, in-community, and residential that are available long before anyone should have to be forced to enter an institution. Try looking up PACE (Program of All Inclusive Care of the Elderly) and Hub and Spoke models that bring services to where elders live. How about the AARP endorsed community-based, non-profit group homes – available to other age groups but not to elders? Staffed condos and apartments? Everyone just assumes residential care = and institution. It doesn’t. Time to educate yourselves folks. There is nothing provided in a nursing home that cannot be done in a small, neighborhood based home that is staffed 24/7. In fact, it can be done better and in a more humane way.