klaus
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Dec 8, 2009, 8:46 AM
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Increased demand for LTC needs creative solutions
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(Following is the text of a speech I gave at a seminar in Brockville Ontario, Dec. 5th, 2009).
We are living in a society that is rapidly aging. As of the 2006 census, the population of Ontario was just over 12 million people with a median age of 38. Of that total population about 780,000 people were over the age of 75. What’s so significant about people over the age of 75? It’s that about 10% of that number are in need of LTC.
By the year 2021 StatsCan projects that the population of Ontario will climb to 14 million with 1.1 million people being over the age of 75. By then the median age is expected to be 42.
With Baby Boomers reaching retirement age, the percentage of the population considered “mature” is growing at 2.5 times the rate of all other age groups. Today Ontario has more people over the age of 40 than under that age. This is the first time in history that our adult population has more parents than children. What’s more, improvements in lifestyle and medicine mean that people are going to be living longer-- a lot longer. Most of us now exercise regularly, we watch what we eat, we’re stopping smoking and we’re getting regular check-ups.
Today the average age of a nursing home resident in Ontario is 87. But given these improvements in lifestyle and healthcare it’s not unreasonable to expect that average age to be extended by 10 years or more in the near future.
When old age pensions were first conceived back in the late 1920s there were some 30 people working for every person who was retired. Today there are only 5 workers for every retiree and in the next decade and a half that number will fall to only two workers per retiree.
What all this signifies is that our population is rapidly aging, which will place a huge burden on the province’s social and healthcare services. In the future the demand for long-term care is going to increase dramatically, which will present momentous challenges to the province’s healthcare system.
Today there are nearly 76,000 adults living in Ontario’s nearly 600 long-term care facilities. If we use the projections set forth by StatsCan, the number of long-term care residents in Ontario’s nursing homes will easily exceed 110,000 by the year 2021. That’s an increase of over 30%!
Getting into a long-term care facility today isn’t exactly easy, either. Once the need for long term care accommodations has been established it’s not unusual to go onto a waiting list that can easily take six months and in many localities as much as two years before a space becomes available. For instance, in Toronto and in Cobourg the normal wait time to get into an LTC facility is two years. Where do most people waiting for a long-term care space to open spend their wait? In a hospital bed, which has created a crisis in hospital care, as people waiting for LTC are occupying beds that could be used to treat sick people. On average a hospital bed in Ontario costs between $800 and $1,000 per day for acute care patients. There are a total of 15, 927 acute care beds in the province and 2,803 (or 18%) are currently occupied by what are considered “alternative level of care” patients, half of whom are waiting for LTC beds.
The Province of Ontario regulates long-term care facilities. As of July 1st of this year the province mandated that the average charge for standard accommodations in a long term care facility will be $142.07 or approximately $4400 per month, of which the resident is obligated to pay $52.00 per day or $1614 per month. That’s for “standard accommodations”, which usually means a room shared with another resident or a ward shared with several others. For private accommodations, the resident pays extra. Of course in cases where the resident is indigent, the government would cover the full amount of care.
So what can you buy for $4200+ a month? It includes a bed, cleaning, medical supervision, assistance with personal care, full time nursing staff and meals, among others. The province mandates meal allowances in long-term care facilities at $7.31 per day per resident. Ironically Ontario’s prisons are allocated a daily meal allowance more than twice that amount per inmate.
There are two types of long term care facilities, for profit and not-for profit. I’m a firm believer in private enterprise and think that businesses should earn a profit. But if the government regulates what a business can charge for its goods and services, does it really make sense to have nursing homes operated by corporations that are looking for a profit? If both profit and non-profit facilities are mandated by law to charge the same amount one would think that the care residents of non-profit nursing homes receive would be better than that found in for profit nursing homes.
Both types of facilities have equal mandates to provide specific care for their residents and both are regulated and inspected by the government. Naturally, all nursing homes, whether for-profit or non-profit, often find themselves facing financial constraints that can affect the quality of care they are able to provide. A recent expose by Sun Media claimed that the majority of nursing homes in Ontario do not meet even the minimum standards mandated by the Ontario Ministry of Health and Long-Term Care.
This has prompted many people who have family members in Ontario’s long-term care facilities to augment their loved ones’ care by hiring private personal support workers to ensure that their loved ones are properly cared for and all their needs are met.
Given that the number of older people is growing faster than any other cohort in the province, it’s clear that there really aren’t enough long-term care spaces available, unless the province prioritizes this issue, which is doubtful. Why? Because the generation following the baby boomers is smaller in number and the generation following that generation is even smaller. So it doesn’t make sense to the government to build facilities that in a decade or two will be empty. But it matters to you and me because it’s our parents, and eventually us that will be in need of care.
Many families find themselves in a quandary when an aged loved one suddenly finds him or herself in need of care. What with a six-month + waiting list for long-term care facilities the available choices are quite limited. The loved one either stays in a hospital or is cared for by family members, which in most cases represents real hardship. A study conducted by BMO shows that it can cost between $5,000 and $50,000 per year to care for a loved one in one’s home. The National Union of Public and General Employees pegs the figure at between $40,000 and $70,000. Clearly, we need to be thinking about alternatives to traditional nursing homes to forestall what could be a disastrous future.
Home Solutions for Seniors Care is one such alternative and one that I am personally “high” on, given my own experience with a family member in a nursing home. I am particularly enthralled with the idea of family-based care in a home setting precisely because it is not institutional in nature. While there may be some disadvantages to the family-based care model, the advantages far exceed the disadvantages. What’s more, the cost of family-based care to seniors isn’t dramatically higher than that of traditional long-term care. And the way HSSC has structured its services ensure that our loved ones receive qualified, compassionate and loving care in an intimate venue.
But we need to put our heads together to come up with other ideas as well, because the HSSC model isn’t for everyone and the financial well currently providing the resources for long term care is in danger of running dry.
The provincial government is looking in the right direction in establishing their much-vaunted Home Care Initiative. Unfortunately that the program seems to be getting off to a slow start, as the government has announced the same funding for this Initiative over several years. This program is earmarked to be managed by Ontario’s 14 Local Health Integration Networks and is designed to keep seniors living in their own homes independently for as long as possible. It’s a great idea and if we can make it work it will alleviate some of the problems.
Other concepts could include family cooperatives that work in association with government agencies to provide long-term care for small groups of seniors living in a regular home. The idea being that family members of the residents as well as individuals within the community volunteer on a rotating basis to care for the aged residents.
The up side of such a plan would be that seniors would not be subjected to being institutionalized and would enjoy a higher level of care than that provided in a long term care facility.
The down side, of course would be increased cost and a limitation of access to qualified nursing staff. But even that down side isn’t insurmountable as most jurisdictions have a community care organization such as the CCAC already in place to provide some level of nursing care to those in need.
I believe that the best solution doesn’t necessarily entail just one answer, but a melding of a number of different concepts. It’s clear to me that larger and ever more extensive nursing homes are not the answer, given that these tend to breed blind and unbending bureaucracies exacerbated by employees that fall under the auspices of public sector unions. I think that’s why long-term care has become so prohibitively expensive and has often yielded mediocre results.
Another good idea would be to get involved with advocacy groups such as the Canadian Association of Retired Persons, who have close to 200,000 members. This organization is very active in lobbying both the federal and provincial governments to advance the cause of older Canadians.
If we are going to meet the challenges this demographic shift will pose and solve the problem, it’s important that we look beyond what we currently know. We need to explore options that focus on the health and wellness of those being served in an open and holistic manner, rather than looking for the most expedient way to make the problem go away. After all, as a compassionate and enlightened society this is the least we can do for our elders.
Klaus Rohrich is President and Creative Director of Taylor/Rohrich Associates Inc., a marketing and advertising firm that specializes in niche marketing retirement real estate developments
http://www.maturitymarketing.com.
(This post was edited by klaus on Dec 10, 2009, 6:51 AM)
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