April 19, 2017 – Accessible Long Term Care has the far-reaching potential to improve the lives of patients and their families, and efficient functioning of our health care system. Unfortunately, today in Ontario, the lack of timely access to Long Term Care and Home Care has serious repercussions on hospital care and emergency room capacity. It is also spilling tax dollars into bulging bureaucratic management instead of investing in much needed front-line care.
A positive change in Ontario’s Long Term Care will only come with a realistic look at the Province’s demographic shift towards an aging population with relatively fewer workers. It requires the government to understand the differences in rural, urban, and suburban Long Term Care needs. Finally, it demands leaders in the health sector to embrace the scientific and technological advancements and their limitations.
The Demographic Shift
It may seem dramatic to call the demographic shift we are undergoing a “Grey Tsunami” yet Canadians are facing an unprecedented event with our aging population in the coming decades. In 2011, the tidal wave of Baby Boomers began to turn 65 with the senior population anticipated to more than double in just over a decade from now. What is dramatic is that the older age groups consisting of the “oldest old” will experience the fastest growth among seniors. In Ontario, the number of people aged 75 and over is projected to double to over 2.2 million by 2036. The 90+ group will almost triple in size to approximately 333,000 people by 2036.
Associated with an aging population is the reality of increased numbers of people who, at advanced ages, have dementia requiring more substantial levels of care including Long Term Care. Approximately 1 in 3 people over the age of 85 will have some degree of dementia. For women, that ratio is closer to 1 in 2 over the age of 90.
Accessible Long Term Care is needed for patients whose mental and physical limitations leave no other options. Even a small fraction of the aging population with advanced care needs, who should be accessing Long Term Care services, will prove to be overwhelming for hospital and emergency room access, and overall wait times for other forms of care. Therefore, we need to plan now with strategies to allow more people to access the level of Long Term Care they will need– and this must include strategies for caregivers who run the risk of burn-out. Access to Long Term Care facilities will have to adapt to the demographic shift with a variety of care settings and support for care givers. Appropriate Long Term Care must be considered the backstop of our health care system rather than an after-thought.
Creating Appropriate Capacity in Long Term Care
Although many people want to stay in their own homes at advanced age, this may not be possible for several reasons due to physical frailty, cognitive decline related to illness such as dementia, caregiver burn-out, or the reality of geographic distances between family members. The trend toward smaller families with fewer children compared to previous generations also poses challenges for family care giving. More home care can assist people to stay in their homes longer than they would otherwise, but in many cases a setting with additional support may be required with advancing age and due to family need.
It is also essential to understand that the solutions to building Long Term Care capacity will differ geographically. A downtown setting with an apartment complex of elderly seniors requiring care may lend itself to day programs, respite care, and mobile care teams, while an area with less dense population may require community oriented homes that can address 8-10 patients under one roof and availability of virtual consultations when needed.
According to Statistics Canada, there is a 50% chance of requiring Long Term Care by age 75, with an average length of stay in a nursing home facility of 18.7 months and an average monthly accommodation cost of $2,608. Costs associated with dementia care are often much higher. In comparison, the average cost of a 24-hour nurse from a third-party service would be approximately $80,000 per year.
A responsible government can lead preventative efforts and research for treatment of dementia but it should also plan and build capacity for our most vulnerable citizens. Again, the Long Term Care facility and its services will be the backstop of our health system.
Advancements in Technology
With a government that is committed to working alongside Ontario’s health sector leaders, our Province may be better able to take advantage of the scientific and technological advancements in the health community today. It will take a collaborative approach and it has the potential for remarkable results.
There is no reason why we cannot better care for “Alternate Level of Care” (ALC) patients. The Ontario Ministry of Health needs to look harder at making possible home visits using physicians and/or teams who are mobile in the community and virtually based rather than office based. There is no longer a need to store large numbers of patient files in a clinic setting. Electronic storage capacity of smart phones or similar devices has potential to allow more personal care to our most elderly patients in the community through mobile health technology or “mhealth”. While this is a concept better suited to densely populated areas, modern communication technology creates the potential for more virtual care and consultations in more rural or remote areas. It may also benefit seniors who may not easily or comfortably travel. Ultimately, no matter where a person resides in Long Term Care, when they need acute care they must be able to access hospital and emergency care in a timely way. Improving Long Term Care access has potential to improve acute care capacity as well.
Another positive step would be to allow hospitals to coordinate their bed availability by allowing them to use data to assist in Long Term Care allocation. The current Liberal “Home First” program is not helping; it is placing families in precarious position with risk of caregiver burnout. Hospitals need to be able to coordinate with Long Term Care facilities and services to improve flow for acute care patients and patients who require chronic care.
The silver lining to the surging needs of our aging population is that it will pave the way for smoother experiences for the next generations. Access to Long Term Care beds requires the use of technology to adapt even at the macro level. Using building technology to create more Long Term Care beds could create a system that is more amenable to changing need and to future use of affordable housing. Micro-units are used in other countries where small individual units are formed around communal areas including kitchens and social areas. New affordable housing options have the added benefit of creating opportunity for direct social interaction so necessary for seniors’ happiness and mental well-being.
A Final Thought
There is a great deal our provincial government can do relating to Long Term Care that will have a significant impact on the future quality of life of many Ontarians including seniors, families, and the next generation. The federal government’s recent announcement of $2.3 Billion over the next ten years in funding targeted for Home Care in Ontario will result in only small amounts of support spread over many people with limited longer term effect. So, we absolutely require a provincial government with a better understanding of what is required to make our Long Term Care programs both accessible and sustaining.
READ MORE: Dr. Merrilee Fullerton on health care in Ontario