Notes from Iceland: An International Perspective on Reforming Long-Term Care

Cultivating an international perspective helps us to gain deeper insights into what we are doing well and where we can improve our care systems serving older Canadians. It’s also an invitation to share our best practices on a global stage and to play a meaningful role in supporting the health and well-being of older adults the world over. As we look towards actualizing the UN Decade of Healthy Ageing here in Canada, we have both much to learn and offer.

Since 2015, I have worked closely with geriatricians and other health care professionals in Iceland to implement better models of care, that were developed by me and my team at Sinai Health and the University Health Network in Toronto. Through this partnership, the University of Iceland’s Landspitali Emergency Department adopted our Acute Care for Elders (ACE) ED Model of Care and has continued to see significant improvements in the quality of care it delivers to older patients. This includes helping to avoid unnecessary hospitalizations and better supporting people to access the right care that they need within the community.

Expanding on this work, I was recently invited by Iceland’s Minister of Health to deliver a keynote speech at Iceland’s Annual Health Care Congress that was focused on developing its first National Policy on Ageing and Long-Term Care. Over the past six years, my ongoing engagement with my colleagues in Iceland helped me to cultivate a deeper understanding of this country’s population, their attitudes towards ageing, and the challenges and opportunities they have been encountering as they age. When asked, this enabled me to provide more tailored, culturally relevant and appropriate, and achievable recommendations for improvements to support the reformation of Iceland’s long-term care system.

For example, Iceland (like Canada) performs poorly in terms of how it spends its long-term care dollars. For every króna (dollar) spent, 92 cents go towards warehousing older adults in its long-term care homes. And, despite being the recipients of the bulk of this funding, long-term care homes in Iceland today say they do not have sufficient resources to provide high quality care to residents.

Further exacerbating the current situation, Iceland (like Canada) provides few supports to enable older adults to age at home. One important step that Iceland can take immediately, is to invest more in high quality, comprehensive home and community care services for older adults. This could include assistance with personal care, household chores, meals and management of finances in addition to healthcare services.

Iceland and Canada share an important commonality in this regard. Both countries need to do much more to support older adults to age at home, within their communities, in safe and well-supported environments. Doing so, would be more financially sustainable in the long-term and it is also in line with what both Icelanders and Canadians want. 

At the National Institute on Ageing we have consistently shown—through reports like Pandemic Perspectives on Ageing in Canada in Light of COVID-19: Findings from a National Institute on Ageing/TELUS Health National Survey and The Future Co$t of Long-Term Care in Canada—older adults want to stay in their homes as long as possible and the provision of homecare is more cost effective and sustainable than long-term care. This makes it a win-win for older adults and policy makers.

An example of an international leader in the provision of long-term care, is Denmark. Denmark spends 65% of its long-term care budget supporting older adults to age safely at home, while the final third is funnelled into well-funded long-term care homes. This approach supports the independence and autonomy of older adults and is also significantly cheaper than providing the bulk of long-term care in LTC homes. In fact, providing intensive homecare can still cost approximately half as much as the equivalent care being provided in a long-term care home.

Rather than earmarking limited public dollars for renovating, building and furnishing LTC homes, a portion of these funds can be better employed by supporting older Canadians and Icelanders alike to remain in their own homes, in their own beds, where they want to be. Actualizing a robust homecare system would require greater flexibility in our public healthcare services, ensuring the provision of high quality care within the home. This includes supports like personal care workers, physiotherapists, doctors and nurses.

“Canada and Iceland have a rich history of collaboration and share many priorities and values. This includes the fundamental importance of a robust public health system in a democratic society, one that provides equitable care to people of all ages and at all stages of life,” says Jeannette Menzies, Ambassador for Canada to Iceland. “There is much that we can learn from each other, and much that we can achieve together, as we work to strengthen systems of care for older Canadians and older Icelanders. The results of our shared mission will certainly yield important insights for both countries and peoples.”

The NIA has explored many dimensions of ageing in place through our National Seniors Strategy including considerations like social isolation, poverty, affordable housing, accessible transportation, age-friendly communities and access to appropriate, high quality care. This is a unique public policy opportunity where governments can give people what they want and pay less for it. It is our position at the NIA that a high quality homecare system will be an integral part of the future of caring for older persons in Canada, Iceland and around the world.

On September 20, 2021, Canadians are headed to the ballot box. In the wake of this year of reckoning—when the COVID-19 pandemic laid bare our national and regional failures to protect the health, well-being and lives of older Canadians—we have real opportunity to be clear about the future of ageing in Canada. It is time to insist upon the adoption and implementation of a National Seniors Strategy, a plan that takes a comprehensive and equitable approach to ensuring the health, well-being and financial security of all Canadians as we age. This includes reforming the way we provide long-term care in Canada and establishing high quality homecare systems.

Let’s set the stage for a Decade of Healthy Ageing here in Canada with the creation of our nation’s first National Seniors Strategy, something our colleagues in Iceland are getting ready to embrace. Learn more at nationalseniorsstrategy.com and follow us on Twitter @NSS_Now.

Dr. Samir Sinha is the Director of Health Policy Research at the National Institute on Ageing.