Almost 100 per cent of Older Canadians Surveyed Plan to Live Independently in their Own Homes, But Is This Even Possible?
Independence is key for older adults. Indeed, a recent National Institute of Ageing (NIA)/TELUS Health Survey found that 91 per cent of Canadians of all ages, and almost 100 per cent of Canadians 65 years of age and older, report that they plan on supporting themselves to live safely and independently in their own home as long as possible.
As we age certain activities of daily living that are essential to maintaining our independence may become more challenging such as getting around our communities, getting our groceries, making our own meals, maintaining our homes and remaining able to personally clean, dress and feed ourselves and move around safely and with confidence. Ageing, with its associated complexities, however, can quickly threaten these abilities and put our ability to remain healthy and independent at risk. Indeed, as a geriatrician, I have to appreciate that what my patients value above all else is preserving their independence when it can mean the difference between staying at home and having to move somewhere else.
Significantly, about one-quarter of Canadians aged 75 and over has at least one unmet need with respect to their activities of daily living, and the number of older adults with unmet needs could be underestimated because they may not know what supports are available or how to best access them. This unfortunate reality is not just a challenge for older adults and their families, it affects all of us. Unmet needs among older adults are associated with personal adversities, such as an inability to prepare meals, injuries, depression and death, but are also correlated with growing systemic health care costs, including higher rates of hospitalization, increased risk of falls and institutionalization.
More recently, a landmark research study demonstrated that once older people become ‘homebound’ they have a significantly greater risk of death. The study concludes that we “need to extend health care services from hospitals and clinics to the homes of vulnerable individuals.” Therefore, the more that we can offer home-based support for older adults that promote healthier and more independent living, the more we will likely see better patient and system outcomes, including greater savings for our health care system.
The desire for greater cost savings is especially motivating governments to provide more home- and community-based care. Currently, 15 per cent of hospitalized Canadians are designated as Alternate Level of Care (ALC) patients. These are patients who are ready to be discharged from hospitals but for whom no appropriate home, community support or long-term care services are immediately available. In Ontario alone, the daily cost of waiting in an acute care bed costs $730 per day. The costs of thousands of Canadians having to wait in hospital to go elsewhere adds up quickly. Indeed, the Canadian Medical Association says that by freeing acute care resources by providing more appropriate levels of care for older Canadians, Canada could save $2.3 billion annually that it could reinvest in other areas of the health care system.
In fact countries like Denmark don’t have an ALC problem because they have appropriately invested in the provision of more home care to help people live in their own homes. If you do the math, it actually makes a huge amount of sense, as home care on average costs about $103 per day for a high needs person which is also almost half the $182 per day it would cost to care for them in a publicly-funded nursing home in Ontario. This is partly why one of the proudest things I was able to put forward in developing the Government of Ontario’s Seniors Strategy in 2012 was a new push to significantly grow its spending on the provision of home and community care to help more people live in their own homes. As a result, Ontario is now the only province in Canada that spends more of its long-term care budget on keeping people in their own homes rather than in nursing homes.
The federal government also jumped on board in focusing a $6 billion investment over 10 years in its latest health accord with the provinces to strengthen the provision of more home and community care. But with Canada overall still spending 87 per cent of its long-term care dollars on institutionalizing people in nursing homes rather than caring for them in their own homes, we have a lot of catching up to do to get the balance of spending right. Indeed, the NIA’s 2019 Report Enabling the Future Provision of Long-Term Care in Canada showed that the fact that over 430,000 Canadians report having unmet home care needs likely explains why over 40,000 are on wait lists for a nursing home placement. Our own Canadian Institute for Health Information recently published its findings that in 2018–2019, about 1 in 9 newly admitted residents in nursing homes potentially could have been cared for at home - representing more than 5,000 nursing home spaces.
Not only do we have the math to show us that caring for Canadians in their own homes whenever possible is far cheaper than warehousing them in a nursing home, but the COVID-19 pandemic has only reinforced this view further. Indeed, the fact that 80 per cent of Canada’s COVID-19 deaths so far have occurred in Canadian nursing and retirement homes has clearly prompted Canadians to change their perspective on where they might want to receive their long-term care in older age. A recent survey has shown that 90 per cent of Canadians report being aware of the significant number of COVID-19 deaths that have occurred in Canadian nursing and retirement homes. Furthermore, the ongoing measures that have limited or prevented family members from visiting and caring for and monitoring the well-being of their loved ones in care homes has further impacted the health and wellbeing of many living in these settings. As a result, it’s not surprising that our recent NIA/TELUS Health Survey demonstrated that approximately 60 per cent of Canadians in general, and almost 70 per cent who are 65 years of age and older, report that COVID-19 has changed their opinion on whether or not they’d arrange for themselves or an older loved one to live in a nursing or retirement home.
It’s clear now that more people have become interested in doing whatever is necessary to stay active and maintain their optimal health and independence, and to live safely and independently in their own homes for as long as possible. As older Canadians have the highest voter participation rate, this may finally be our chance to finally re-align the $21 billion we are currently spending on long-term care in Canada in a more cost-effective way that will allow all of us to both win as taxpayers and to know that our desires to age in place are actually being enabled by our elected governments as well.
About the Author:
Dr. Samir K. Sinha MD, DPhil, FRCPC, AGSF
Dr. Samir Sinha is the Director of Geriatrics at Sinai Health System and the University Health Network in Toronto and an Associate Professor of Medicine at the University of Toronto and the Johns Hopkins University School of Medicine. He is also the Director of Health Policy Research at Ryerson University’s National Institute on Ageing.
A Rhodes Scholar, Samir is a highly regarded clinician and international expert in the care of older adults. He has consulted and advised governments and health care organizations around the world and is the Architect of the Government of Ontario’s Seniors Strategy. In 2014, Maclean’s proclaimed him to be one of Canada’s 50 most influential people and its most compelling voice for the elderly.