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Four Ways to Fix Canada’s Long-Term Care System

From cohousing to dementia villages, here’s how we can put humanity back at the centre of senior care.

Sarah Tranum 27 Jan 2022The Conversation

Sarah Tranum is an associate professor of social innovation design in the faculty of design at OCAD University. This article originally appeared in the Conversation.

COVID-19 has amplified existing cracks in the long-term care system in Canada. We need socially innovative solutions to help seniors age safely and with dignity.

From cohousing to community paramedicine programs, from home-based primary care to publicly funded dementia villages, there is hope on the horizon.

As a social innovation designer, I study complex challenges with the aim to find the common approaches needed to solve these issues and not just manage the symptoms.

To better understand the challenges of the long-term care system in Canada, I interviewed stakeholders involved in approaches attuned to individuals’ needs at different stages of aging — all of which are socially innovative.

Here are some solutions that can help when it comes to redesigning the long-term care system.

Senior cohousing

One of the goals outlined in the National Institute on Ageing’s National Seniors Strategy is to help seniors stay active, engaged and maintain their independence. But many seniors struggle to find suitable housing — especially affordable housing.

While retirement homes exist, for many the costs are out of reach — so some are choosing cohousing.

Louise Bardswich is a retired college dean and co-owns a home in Port Perry, Ontario. She and three other women pooled their resources to build a shared home.

Their home features design elements that will allow them to age in place — like wheelchair accessible bathrooms, a spacious kitchen and a guest room that can be used for a live-in caretaker. The housemates pool their resources to cover costs; Bardswich estimates her monthly costs at $1,100.

While $1,100 is not affordable for everyone, its considerably cheaper than a long-term-care facility in Ontario — the long-stay semi-private option is $2,280 per month.

Cohousing can be difficult due to zoning bylaws, but Ontario legislation introduced in 2019, called the Golden Girls Act, aims to make it easier for seniors to create cohousing by preventing municipalities from blocking such projects.

Community paramedicine programs

An integral part of supporting older adults to continue living safely in their homes is ensuring that they have access to the services they need. One innovative example is community paramedicine programs. These programs use existing trained emergency medical personnel to provide primary health care to people who may have a difficult time leaving the home to see a doctor.

J.C. Gilbert is the deputy chief in charge of operations at the County of Simcoe Paramedic Services. In the five years since the launch of its community paramedicine programs, Gilbert says there’s been a positive impact on patient’s overall well-being and fewer emergency calls. “We’re seeing people able to cope with their illness much better at home.”

The Ontario Ministry of Health currently funds the development of community paramedicine programs across every region of Ontario.

Home-based primary care

House Calls is a primary health care practice for home-bound seniors living in Toronto, led by Dr. Mark Nowaczynski and SPRINT Senior Care.

Nowaczynski explains that seeing people at home gives health practitioners the ability to gain a holistic understanding of a patient’s health and well-being that is not possible during an office visit. The level of care he and his team provide can prevent hospitalizations and admissions to nursing homes.

According to Nowaczynski, House Calls serves 450 seniors with an average age of 89. “We make it possible for our patients to live out their days at home and die at home,” he says.

Nowaczynski estimates that in Toronto there are 100,000 to 150,000 seniors who would benefit from home-based primary care.

House Calls and other programs are likely meeting the needs of less than two per cent of that population, he said.

“We are barely scratching the surface and the consequences of that are that there’s a large population of seniors who are receiving inadequate ongoing care.”

Making it possible for people to age at home has been shown to reduce reliance on the health-care system and be cost effective. Some countries have even shifted more of their health-care budget to community and home-based care. Denmark spends 36 per cent of its long-term-care funding on care in designated buildings (like nursing homes), and the rest on home and community-based care.

In Canada, only 13 per cent of its long-term care budget goes to home and community-based care.

Dementia villages

Dementia villages are communities of care designed to give their residents freedom and choice within a safe and supporting environment.

The first dementia village in the world opened in 2009 in the Netherlands. The Hogeweyk is an intentionally designed village with 23 houses for 152 seniors living with dementia. The village has a bar, restaurant, theatre, grocery store, streets and gardens for residents to use and enjoy. It is publicly funded and runs on a budget comparable to conventional nursing homes.

Providence Living, in partnership with Island Health, will open Canada’s first publicly funded dementia village care model in Comox, B.C. With construction starting this year, it will feature smaller households that support freedom of movement, access to nature and connection with the community.

Candace Chartier, CEO of Providence Living, explains that this village concept is not just about the physical design but encompasses a shift in the model of care in which residents, staff and family members work together to create a home environment where residents can thrive.

These examples show potential for the future of long-term care in Canada. The challenge is to make them the new standard of care instead of a patchwork of services that result in waitlists, drive up health-care costs and create confusion for seniors and their caregivers.

Canada’s long-term care can become a human-centred system that helps seniors get the care they need. But first we need to make humane, dignified care for seniors a top priority.The Conversation  [Tyee]

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