THE FUTURE OF LONG-TERM CARE IN CANADA
Setting a path forward to improve quality, access, and affordability of long-term care in Canada
Setting the Context
Each year the National Institute on Ageing (NIA) identifies a key challenge to address through expert research, broad engagement, and actionable reports. In 2019, the NIA has been examining the provision of long-term care in Canada in a series of three reports. The first two reports in the series describe the present state of long-term care in Canada and project the future costs of long-term care over the next 30 years, if nothing is done to alter the status quo.
First Report
The first report by Dr. Samir Sinha, Enabling the Future Provision of Long-Term Care in Canada (https://tinyurl.com/y6bk9skn), released in early September profiled the current provision of long-term care across Canada compared with other major countries, and the challenges of meeting the needs of our rapidly ageing population.
Using a broader and more inclusive definition to explore the current landscape of innovations in long-term care service provision across Canada, this report outlined a framework and four key enabling areas of focus that could create a path forward. This could help to determine how Canadians can be best supported to age with greater quality of life, better health outcomes, and dignity through appropriate models of long-term care, support, and best practices.
Second Report
The second report by Dr. Bonnie-Jeanne MacDonald, Dr. Michael Wolfson, and Dr. John Hirdes, The Future Cost of Long-Term Care in Canada (https://tinyurl.com/yyfurcxw), released in October builds on Statistics’ Canada population microsimulation model to project the future costs of long-term care in Canada to both the public purse as well as the care support provided to older Canadians by their families.
The report projects that long-term care costs will more than triple within 30 years, from $22B today to $71B by 2050. The projections also show that between 2019 and 2050 there will be 30 per cent fewer unpaid caregivers in Canada available to provide unpaid support to seniors in need. By 2050, the average Canadian unpaid caregiver would need to increase their efforts by over 40 per cent to keep up with current levels of unpaid care being provided today.
Third Report
Building on the findings of the first two reports, the NIA is now consulting experts and stakeholders to explore solutions and options that can begin to move Canada onto a new course for the provision of long-term care in Canada – a course that seeks to improve quality, access, and affordability for Canadians, governments, and providers. The consultation process will support the third and final report in our series on the Future of Long-Term Care in Canada. Our goal in the third report is to present feasible and fiscally responsible options and recommendations to help improve quality, access, and affordability long-term care for Canadians. As we develop this report, we will scope and emphasize proposals that can be accomplished in the short, medium, and long-term.
The NIA would like your feedback to inform the directions of the third report. Below are four enablers for the future of long-term care that we presented in the first report, with some examples of opportunities to further explore under each enabler. We want you to let us know what you think about each issue, what should be emphasized, and what can be accomplished in the short, medium, and long-term – and proposals that hold promise, but require more research. Please feel free to add additional ideas, feedback, or links to resources or other materials.
ENABLER 1
Enabling evidence-informed integrated person-centred systems of long-term care, accounting for the expressed needs and desires of Canadians.
Under this enabler, we explored the idea of re-thinking our collective approach to the provision of long-term care and ensuring the system prioritizes the preferences and needs of clients, residents, and their unpaid caregivers.
Some examples of potential solutions identified include:
Providing more supports, training, and respite for clients and caregivers
Prioritizing care models that are flexible, adaptable, coordinated, integrated, and inclusive of needs and preferences of older adults and their unpaid caregivers
Emphasizing the provision of self-directed or self-managed care as a person-centered approach to the provision of long-term care
Please see pages 114-121 in our first report for additional details (https://tinyurl.com/vp4zhk3).
ENABLER 2
Supporting system sustainability and stewardship through improved financial arrangements, a strong health care workforce, and enabling technologies.
Under Enabler 2, we noted that current long-term care systems are not adequately meeting the needs of many Canadians.
As the second report highlighted, the costs for long-term care are expected to more than triple over the next 30 years. It is clear that government funding will remain integral to the delivery of care, but this enabler will encourage a deeper, national conversation on the ways that the private and not-for-profit sectors, and Canadians themselves, can become more involved in the future delivery and funding of long-term care services. The projected shortages of unpaid caregivers is daunting as is the current labour shortages in the existing long-term care paid care provider workforce, and thus there is a growing interest on how technology can be leveraged to help address this gap as well.
Some examples identified for system sustainability for the long-term include new large-scale public funding mechanisms on the federal level such as:
Creating a public long-term care insurance program
Expanding existing Employment Insurance (EI) mechanisms to support caregivers
New Tax Exemptions related to long-term care
Developing Refundable Tax Credits
Introducing Caregiver Pension Credits
Providing Direct Benefits for the Provision of Care for Older Canadians
Some examples identified for strengthening and improving working conditions of those in the long-term care sector include:
Improving working conditions for personal support workers (PSWs)/care aides (CAs)/personal care aides (PCAs)
Leveraging the role of Unpaid Caregivers
Implementing more technological solutions to improve the reach of long-term care providers
Please see pages 121-133 in our first report for additional details (https://tinyurl.com/skouz8m)
ENABLER 3
Promoting the further adoption of standardized assessments and common metrics to ensure the provision of consistent and high-quality care no matter where Canadians need it.
Under enabler 3, we highlight the importance of common data standards and definitions in order to provide comparable and shareable information at the local, regional, provincial, territorial, and national level. Collection of this data would help understand the needs of Canadians and their caregivers and reporting on outcomes over time can support planning and decision-making.
Some examples identified include:
Adopting a national standardized long-term care assessment system
Harmonizing definitions to support the more comprehensive collection of metrics and measures.
Please see pages 134-135 in our first report for additional details (https://tinyurl.com/qp55urx).
ENABLER 4
Using policy to enable care by presenting governments with an evidence-informed path towards needed reforms.
Under enabler 4, we explored ways that policy approaches can provide an evidence-informed path forward towards needed reforms.
Some examples identified include:
Promoting ‘Reablement’ policies in the Provision of Long-Term Care
Promoting Co-Housing and Shared Living Policies
Improving Immigration Policies to enable the recruitment and retention of international paid caregivers
Please see pages 135-137 in our first report for additional details (https://tinyurl.com/sr2ca52).
The closing Deadline for our Consultation is January 31, 2020.
