Not all facilities offering long-term care are created equal
By Olev Edur
According to 2021 census data, more than seven million Canadians were aged 65 or older last year, more than 860,000 were 85-plus (double the 2001 figure), and 9,500 were centenarians— evidence of how much longer we’re all living. Moreover, a Statistics Canada analysis released in spring 2022 reported that the 85- plus cohort is “the fastest-growing age group in the country.”
That’s the good news. The not-so-good news is that almost 238,000 of those 85 or older (28 per cent) were living in “collective dwellings”—that is, seniors’ residences, nursing-care homes, and long-term-care (LTC) facilities.
“As more seniors are living to 85 and beyond, an increasing number will face limitations and long-term health challenges,” the StatCan report concluded. “This will put increasing pressure on all levels of government to ensure adequate support, in areas such as housing, health care, and home care, as well as transportation, among other things.”
While the COVID-19 pandemic may have ravaged some LTC facilities and revealed shortcomings, all levels of government are responding with substantially increased funding, particularly incentives and supports for added personal-care and nursing staff. Belatedly realizing that home care is much less costly than institutional care, most jurisdictions are also promising more funding for such arrangements.
“For the first time in years, governments are investing billions in all aspects of long-term care, in both long-term-care facilities and home care,” says Karen Henderson, founder and CEO of the Long Term Care Planning Network in Toronto and a geriatrics consultant, author, and public speaker in the United States and Canada. “This is important. These budgets have not yet been passed so at this point they’re just promises, but it would be great if it all did happen.”
Choosing the Right Facility
The prospects for LTC look pretty good, but whatever happens, the variations in COVID response demonstrated that all LTC facilities are not alike. So how do you go about choosing the right home? Where do you start, and what kinds of things should you look for? What should you avoid?
“What to look for could in itself be the subject of a book,” Henderson says. “The first step is to create a list of homes that are accessible to family members and friends and that have parking or are on transit lines. Bear in mind, too, that some homes cater specifically to certain cultures. Do the staff speak the right language? And what kinds of treatment do they provide? Some homes specialize.
“Find out who owns the home,” Henderson adds. “You want to know who runs the home and how they did during COVID—for-profit homes had more challenges to their reputations than non-profits— so check on the owner’s track record during the pandemic. This information is all out there now in press coverage.”
In the case of a private (for-profit) home, the process for securing a space may be straightforward—getting on a waiting list, perhaps, and settling the matter of money; it’s really just a matter of applying. In the case of non-profits, the application may not be so straightforward and can vary from one province and even region or municipality to the next. As a result, if you’re considering publicly run facilities, you also should first familiarize yourself with the relevant local rules and procedures.
Local Practices and Subsidies
Vancouver Coastal Health (VCH), for example, is the health authority for 1.25 million residents in and around the city and up the British Columbia coast, and getting into a residence can require effort. “You can’t just jump onto a waiting list to get into a residence,” says Sanam, a nurse at VCH’s central intake unit in Vancouver. (Last names aren’t used among VCH staff.) “The process [at VCH] is one of the hardest things for people to understand. There’s a lengthy assessment and placement process. First, you have to apply for home support. You need to call us, and we can do a phone assessment to determine if you are eligible.
“Once you have qualified, then if that level of care is no longer sufficient, you can be transferred to an assisted-living facility,” Sanam says, adding that “assisted living” refers to services such as cleaning and meals, while “residential care” means total care.
Sanam says that if there are waiting lists at the transfer stage, requests are processed on the basis of urgency. “That would mean, for example, that someone with no family to help provide care for them would be placed sooner than someone with family supports. Their needs are more urgent.”
As for costs, Sanam says VCH subsidies are based on an applicant’s previous year’s income, with assisted-living costs set at 70 per cent of income and residential care at 80 per cent. “If your income is high, then our prices are as high as it would be to hire privately,” she explains. “Sometimes people will go to a private residence and pay five, six, seven, or eight thousand dollars a month until they run out of money, then they call us and go through the reassessment process.”
Checking Out the Premises
Whatever the procedures, in the end you must go out and tour the premises, and forewarned is forearmed. “Once you know the owners, you need to make a list of questions,” Henderson says. “It’s important to ask the same ones at each home so you can make apples-to-apples comparisons afterwards, such as: What does it look like? Is it clean and well lit? How does it smell? What are the rooms like? What about the layout of the facility? Is there a secure outdoor area? What activities are provided? What are the visiting policies, and how are you welcomed at the door?
“You have to use your senses—eyes, ears, and nose,” Henderson adds. “You have to find out about things like staffing ratios: how many personal-support workers are provided per resident? This ratio is particularly important at night. And how do staff interact with residents? Are they attentive and respectful, or are they hanging around their desks doing paperwork or whatever?”
She also suggests that you interact with some of the residents. “How do the residents look? Are they healthy? Talk to other families, too. Are they pleased with the facility?”
The list goes on, and to help with that, VCH has published the Introduction to Long-Term Care Handbook. (It’s available online at vch.ca; search for it using the title.) While some of the information is local in nature, the guide includes an extensive checklist of questions to ask about LTC that would be applicable anywhere and could be readily adapted to any special needs you may have. Thus armed, you’ll be better prepared to make a choice as to which of your prospective residences is most suitable.