Seniors’ housing and care requires a major rethink

Pandemic has put a spotlight on what’s wrong with the status quo, Janet Torge says.

If there hadn’t been a pandemic, most of us would continue to see long-term care facilities as an unfortunate inevitability if one lives too long. When you can’t take care of yourself or afford a full-time nurse, your only choice, it seems, is the Last Stop Resthome.

But COVID -19 has put a spotlight on a few things that can and should be addressed, and could serve as an impetus for some fundamental rethinking of what options should exist for seniors, including those who are not fully autonomous.

First, it has become clearer than ever that caring for the elderly should not be a profit-making business. The only way you can make money off housing the elderly is to build larger and larger buildings — to get efficiencies of scale — and to scrimp on food, services and labour. During the pandemic, we learned about under-paid, over-worked caretakers who weren’t given proper PPE and ended up walking off the job to protect themselves and their families. They are not to be blamed. The whole setup was dangerous in the first place.

Second, seniors’ homes create a completely artificial reality. Normally, people live in neighbourhoods. You can sit on your front porch or balcony and watch all manner of people pass by: parents with their kids, young adults, older people, babies being pushed in strollers, kids on bikes and skateboards. In seniors residences, everyone is more or less the same age with varying degrees of fragility. There’s no sense of community diversity. No wonder many elderly feel isolated even though there are dozens, sometimes hundreds, of people around them.

Third, institutions are the most expensive housing option. According to the Régie de l’assurance maladie du Quebec, the real cost for each person in a CHSLD is around $10,000 a month (2019 statistics). Of course, very few can afford that, so the government picks up all but $2,000 of the tab in most “affordable” facilities. It makes you wonder where all that money goes, given what we’re learning about the paltry wages of the staff.

As the COVID -19 death toll climbed, one imagines scores of elderly, their children and relatives wishing there had been more options when a move was being considered.

Other countries seem to be more imaginative (and, dare I say, more compassionate) in their seniors’ housing options. In the Netherlands, there’s Dementia Village, where people live in small houses, in a closed environment, giving them freedom of movement. In Norway and Sweden, buildings are designed for all age groups, including the elderly, who can stay in their homes until they die. Both countries have moved elder care out of the hospitals and into a home-care program (like Canada, only a very small proportion of elderly actually need 24-hour care).

It’s surprising we have so few alternatives to institutional long-term care.

Creative housing choices are showing up all over Canada: co-housing, co-living, home-sharing, multi-generational pairings. Where are the innovative housing ideas for the elderly?

We need to be bolder, to look around the world and put less isolating, more creative ideas on the table. We need to reconsider home care — this time seriously — not only as a way to keep the elderly in their communities, but as a potential employment opportunity.

Changing how we think about seniors’ housing is not going to be easy. It’s going to take a monumental effort for government, developers and health professionals to think outside the institutional box. In my experience of trying to get a less traditional seniors’ housing model off the ground, those groups don’t do “innovative” easily or take risks of any kind. They tend to focus on numbers and costs, a focus that has got us where we are today.

The pandemic offers us a chance to reconsider what the elderly might want and need … not merely where to put them.

It has become clearer than ever that caring for the elderly should not be a profit-making business.