Time to transform elder care

They do not need more of the same system we already have

When more than 4,800 people died in Ontario longterm-care institutions in the first two and a half years of the pandemic, seniors’ advocates thought governments would be poised to transform elder care.

The pandemic tragedy showed how unbalanced elder care is, with far more being spent on long-term care institutions than on community supports and home care.

Reflecting on the pandemic, Dr. Samir Sinha, wellknown Toronto gerontologist, wrote that elders “do not need more of the same system we already have — we need a transformed system that will … keep more funding available for the actual delivery of health and social services, rather than building more warehouses to provide care.”

The long-term-care institution is the master narrative in elder care. Successive Ontario governments have assumed vulnerable and frail seniors need a total institution.

Unfortunately, instead of initiating transformation, the current government reinforced the master narrative by passing the Fixing Long-Term Care Act, which has provided massive new funding to build many more large institutions.

Elders themselves and seniors’ groups have been adamant older adults do not want to end up in a long-term institution. Research is increasingly showing community alternatives are not only possible, but feasible to implement in a cost-effective way. From research and best practices, we can identify five key components of a transformed elder care system:

Reliable, robust and flexible home care

This will contribute greatly to elders being able to age at home. Direct funding can help reform home care, by providing support dollars to the person and their family. This enables people to decide who, when, and how home care supports will be delivered. The Ontario Family Managed Care program provides direct funding and needs to be greatly expanded.

Affordable and accessible housing

This is vital for many seniors and people with disabilities. Some housing will also need a social support component to ensure people have meaningful care in their lives. The government could provide directives to ensure all new housing includes a percentage of affordable and accessible units.

Smaller neighbourhood support homes

These are rare in Canada, although there are positive examples that could be replicated. Memory Lane Home Living is a small housing initiative in Richmond Hill for women with dementia. The home supports the women to live productive and engaged lives, experience healthy active living, provide care closer to home, and support the residents’ caregivers. Smaller staffed homes in every community could also include apartments, condos and co-ops.

Comprehensive community support associations

These are an important pillar in creating alternatives to long-term care institutions. In Ontario, they provide a range of care and support, including nutrition support, Meals-on-Wheels, home support such as housekeeping, friendly visiting, and transportation support. In many communities, these supports are vital for elders who require support to stay at home.

Unfortunately, the community care sector is vastly underfunded. The Ontario Community Support Association has been calling for changes that would help transform the sector. A positive example of change is the Hub and Spoke model, part of Peel Senior Link, that provides care in apartment buildings and surrounding neighbourhoods. This approach is highly effective and could be expanded across the province.

Natural supports from family, friends, neighbours

This enables elders to age in community. People with strong social networks are less likely to be vulnerable, isolated and at risk of institutionalization. We know how important it is to be “intentional” to stay connected with family and friends as we age. With proper funding, community support associations could develop “connecting initiatives” that would assist seniors who are isolated and lonely. Neighbourhood associations can also build natural supports by nurturing relationships among neighbours. All this work can enhance people’s participation and sense of belonging.

As we listen to elders, base our efforts on research, and organize community groups committed to change, we can build local capacity for transformation and change. At the same time, governments at all levels need to be thinking about how they can design an elder care system that honours people’s rights, choices, and participation.

As several other countries have shown, it is possible to transform supports for elders and create meaningful community alternatives.