Navigating Choices for Ageing Canadians: Home Care vs Institutional Care

Elder man laughing with daughter

By Joyce Wayne

When my father fell ill with chronic heart disease, I was in my mid-twenties. When my mother was diagnosed with dementia, I was in my early thirties. In both cases, I was woefully unprepared. My mother was in her forties when I was born, and my father was in his fifties. I was the only child to older parents who didn’t have a large social or family circle to support them. I was lost when they became ill. Today, if I were in that same position, I could rely on up-to-date information to help me handle an increasingly difficult situation, but I still wouldn’t be out of the woods when managing their long-term care.

Recently, the National Institute on Ageing (NIA) re-released its report for #NationalAccessAbilityWeek.  Ageing in the Right Place: Supporting Older Canadians to Live Where They Want is a treasure trove of expertly researched and detailed material aimed at ageing Canadians and their families that can help them prepare and make sound decisions about managing the ageing process. In the introduction, the report’s contributors say:

“Developing more accessible and safer living environments is one of the fundamental pillars of Ageing in the Right Place.”

Ageing in the Right Place

The report clearly and concretely describes the NIA’s mission:

Supporting older adults to age in their own homes and communities for as long as possible, commonly referred to as “ageing in place”, can help Canada’s already-strained LTC (Long-Term Care) systems. Yet, doing so effectively also requires responsive systems and services that can enable what the NIA calls “Ageing in the Right Place.” Recognizing the growing importance of supporting older Canadians’ ability to age successfully while remaining engaged members of their communities, this report presents a practical definition and framework to understand what ageing in the right place (AIRP) is and what is required to make it work. It also highlights existing best practices and opportunities that can reduce unnecessary LTC home admissions and better support the implementation of successful AIRP policies and programs across Canada and beyond.

The Ageing Population in Canada

The issues are clear. In Canada today, those aged 65 years and older now represent the fastest-growing demographic. In seven years, when the oldest baby boomer turns 85, nearly a quarter of Canadians will be 65 years and older. “Supporting our older population requires the right combination of health and social services to meet their unique and complex care needs,” according to this report.

I can attest to the barriers I could not overcome more than 40 years ago when my parents required these kinds of support. Decades later, the NIA confirms that “Canada’s health care and support systems have not kept pace with its rapidly ageing population.” Yet there are solutions, and it’s not too late to help older Canadians, the baby boom generation and their children cope with the complexity of the ageing process.

Challenges of Long-Term Institutional Care

My parents lived in a split-level home in suburban Windsor. Back then, there was almost no available home care, so they relied entirely on the volunteer Victorian Order of Nurses to provide care. When my father became bedridden, I was completing my Master’s degree in Ottawa, and later, when my mother was experiencing difficulties at home, I was working in Toronto. In both cases, my parents ended up in long-term care facilities, my father in a private retirement home and my mother in a public municipally-funded facility. Back then, private care homes weren’t interested in housing and caring for those with dementia.

The State of Home Care and Institutional Care Today

The situation has improved today, but it is not enough to solve the problems of those who can and wish to age at home. According to the NIA report, Canada spends a significantly larger share

of its LTC expenditures on institutional care in LTC homes compared to home and community-based care, despite the latter being overwhelmingly preferred by Canadians. Moreover, not all adults with complex care needs require care in LTC homes, with estimates suggesting that between 11 and 30 percent of Canadians admitted to LTC homes could have potentially remained at home and in their communities if adequate home care and community support were available.

The NIA emphasizes, “Prioritizing institutionalized care despite the higher costs makes Canada’s current LTC systems both inefficient and unsustainable. Governments need better, more cost-effective solutions to meet the LTC needs of their ageing populations.”

Choosing Between Home Care vs Institutional Care

So, today, where does that leave our ageing population and their children? If my parents fell ill in 2024 rather than in the 1970s and 1980s, would I be able to arrange more appropriate care options for them at home? My father thrived in a private long-term care home. He could be a genial and often charming fellow who got on well with the nurses and other support workers. He preferred the attention and the prepared meals. He adjusted to the daily routines.

My mother was completely the opposite. She preferred to run her own life. In the early stages of dementia, she walked downtown and did her own grocery shopping and banking. With a short daily visit from a PSW, she might have remained in her home for years. In her extended-term care facility, she didn’t get along with the other residents, nor did she approve of the nurses and other care workers. She became a problem patient who spent an increasing amount of time alone in her room.

If we baby boomers wish to enjoy the option of ageing in our own homes, we’ll need to take the bull by the horns and, along with the NIA, advocate for ourselves and for how long and how comfortably we’ll be able to age in place without expecting our children to carry the burden on their own.

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