Most older Canadians want to age at home. Why are we making it so hard for them?

Posted on November 6, 2022 in Child & Family Delivery System

Source: — Authors: – Opinion/Contributors
Nov. 4, 2022.   By Adrienne Clarkson, Special to the Star

I want to remain independent in my community for as long as I am alive, writes former governor general Adrienne Clarkson

How do you want to spend the final years of your life? This is the focus of The Third Act, an ongoing series the Star is producing in collaboration with Toronto Metropolitan University and the National Institute on Ageing. It will challenge governments, institutions and individuals to reframe our later years as a time when older adults can flourish and contribute, instead of being left to face decline and dependency.

As I become older, I become more and more certain that the one thing I want is to stay in my own home for as long as I can. I want to be among my familiar things, do my regular shopping, and watch my neighbours walk their labs and cockapoos.

To make it a little easier, I can get cleaning help for a few hours a week, and somebody who will help me to get my groceries and do the occasional gardening.

But the essential fact is unchangeable: I want to remain independent in my community for as long as I am alive.

Eventually, I think, I will need what everyone needs: home care and home-support services. If I have some health issues, which many of us over 60 do, I’ll need to make sure I get health-care services from trained professionals — nurses and paramedics. If things become a little more difficult, then I will need home-support services, which may include personal care, such as help to shower or to do dishes.

Most Canadians share my feelings: research from the National Institute on Ageing and the Canadian Medical Association shows that 85 per cent of Canadians, and 96 per cent of Canadians aged 65 and older, said that they would do everything they can to avoid going into a long-term-care home.

Our homes are our nests: they’re where we’re used to living and where we should be able to stay until we are no longer able. But in order to stay at home, rather than in a hospital or a long-term-care home, more must be done to facilitate care given to us in our homes.

When you think of the amount of money that is spent on publicly funded long-term-care services in Canada, including home care and long-term care, we are talking very big bucks. In 2019, $22 billion was spent. And that is expected to triple over the next 30 years — which means it will be $71 billion by 2050.

But right now, the share of that big spending that is dedicated to home care is far smaller than it should be. As Canadians, we spend 33 per cent of our total long-term-care budgets on home and community-care options and a whopping 67 per cent on long-term care homes.

The situation is dramatic and what we do about it is going to determine the health of our aging population in the next two decades. We’re talking about people’s lives here, not a bunch of statistics. And they are the lives of people who contributed to the economy and social fabric of our country by bringing up children and contributing income and property taxes for three or four decades.

The older you get, the less you want to be told what to do. And currently, we are telling most older people what to do. We tell them that, if they have medical conditions, they should be put in long-term care, because that’s the easiest way for the system to accommodate their needs. But the system does not respond by giving them better care — it just responds by deciding the form that care should take and making us pay the bill for it.

Why do we insist on delivering long-term care through long-term care homes, which already have problems getting good staff and maintaining their infrastructure? Why do we support long-term care provided by profit-making organizations for shareholders who are looking at the bottom line? When the bottom line is older people’s lives, this is morally unjustifiable.

We know that home and community-based care is less expensive and more adaptable. There is living proof to that in countries such as Denmark. And since nearly all of us older Canadians say it’s our preferred option, why can’t our governments invest in delivering this kind of care?

About a decade ago, I came home from hospital and had to have daily nursing care for a couple of months. This took roughly 25 minutes a day. One day, I asked my caregiver how many people she was able to look after in a day, and she said about six or seven. She was assigned to a certain geographical area of Toronto, which included my neighbourhood, and drove her own car to see patients in that area.

When I think of how efficient that system was, I shudder to think of what it would have looked like if we hadn’t had that option. I would have gone to the emergency department every day, and my husband would have needed to take time off work for at least two to four hours every day, including the drive and the waiting. I would have been exposed to other germs in emergency.

The Canadian Institute for Health Information estimates that every visit to the emergency department costs about $300. It seems to make eminent sense to me that being treated in one’s own home is preferable to institutionalizing that cost.

In addition to more investment in home care, I would also like to see some flexibility in city bylaws to allow for different options for aging at home. That way, if a couple of friends and I decide to sell our homes and buy a new one together to build our own community life, we could do that without being classified as a rooming house.

Aging in the right place can have different forms, but all of them should respect human beings, treat them with dignity and give them what they need and prefer. Let’s make that possible by using our resources properly and humanely.

This article is part of an ongoing project in support of healthy aging that the Toronto Star is working on in partnership with the National Institute on Ageing and Toronto Metropolitan University.

Adrienne Clarkson is the Honorary Chair of the Advisory Board for the National Institute on Ageing. She was Governor General of Canada from Oct. 7, 1999, to Sept. 27, 2005, and has had a distinguished career in broadcasting, journalism, the arts and the public service.

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