Missing the forest for the trees – bricks and mortar versus services

When we focus on building more nursing homes, we miss the forest for the trees.

On March 18, the Ford government approved funding for 80 projects to create 7,510 new nursing home beds and upgrade 4,197 older ones. It will provide nearly $80,000 in public subsidies to build each bed. Some of these new spaces will be for Indigenous, Francophone, and other cultural communities. It’s welcome news that these communities will have residential services that are culturally appropriate and supportive.  

What’s still missing is meaningful thought about the people who work in long-term care. With the exception of $121 million to accelerate training of 9,000 personal support workers for nursing and retirement homes, the March 24 Provincial Budget continues to focus on bricks and mortar responses to the needs of seniors. We do need safer residential facilities, but if we really want safe spaces for ageing Ontarians, we need to improve working conditions in those facilities. This is the only way to attract new staff and keep the ones we already have.

Also, new beds aren’t the only way to reduce nursing home wait lists and ease pressures on hospitals. When home and community care services are available and strong, more people can remain in their homes. For many, this means delaying, or even preventing, the need to move into a group setting. It also relieves the pressure on their unpaid caregivers. We need to expand our home and community services, beyond temporarily boosting the Meals-on-Wheels program and offering a home safety tax credit. We also need to improve working conditions for the people who provide home care services. Just as much as those who work in long-term care homes, these workers need stability, a living wage, and benefits.

Many residents of long-term care homes and those on waiting lists could live in the community with some support. If we use the figures from the Canadian Institutes of Health Information (CIHI), “…1 in 12 (8%) individuals being admitted to Ontario’s LTC homes could likely have remained in the community with existing home and community supports.” Eight per cent of the 30,000 people currently on wait lists for nursing homes is 2,400 people. That’s 2,400 people who could have stayed in their homes. Ontario plans to spend $933 million for 11,707 new and upgraded spaces. If we reallocated 8% of that amount, we would have nearly $75 million for more home and community care. We could also improve pay and benefits for community-based workers. Within months, nursing home wait lists would shrink by thousands. Hospitals could have some breathing room.  The Budget misses these opportunities!

Recent research confirms that most Ontarians 65 years and older want to live safely and independently in their own homes as long as they can. Premier, please listen to the people.

Thinking beyond nursing homes

For the last year, we’ve been hearing about the impact of COVID-19 on nursing homes. We’ve heard almost nothing about the impact on home and community care. The debate rages about suffering and deaths in for-profit homes compared with non-profit and municipal homes. Those for and those against for-profit nursing homes can cite statistics, but the differences are more fundamental. Differing values and assumptions underlie these positions, and we don’t expect a common conclusion anytime soon.

For-profit corporations also have a 60% market share of home and community care services. So, the role of for-profit corporations in providing essential care to vulnerable seniors is an important public policy discussion. But a more immediate issue is, “What services do we need most now and in the future?”

It will take time to re-examine our priorities and options.  In the process, we should remember that the vast majority of Ontario’s seniors do not now and will never have access to nursing home services – for-profit or otherwise. Most of us cannot afford it as individuals. We cannot afford it as a society.

So, we need to think beyond nursing homes to other ways of providing care.

Seniors want to live in their own homes. The COVID pandemic and the inadequate, dangerous non-response of too many nursing home companies have made their feelings even stronger. Recent National Institute on Ageing research found that 91% of Canadians of all ages, and almost 100% age 65+, now say they plan to live safely and independently in their homes as long as they can.

We know that, per day, home and community care costs about 10% – 12% of a hospital bed and 40% – 42% of a long-term care bed. The capital costs of building and upgrading residential facilities are astronomical. When we care for and support seniors to live safely in their own homes, we don’t have to incur those costs. 

The Ontario government committed to giving nursing home corporations $16.1 billion to build and upgrade beds. Redirecting even 10% of that amount to home and community care could do so much. We could offer more services to more people. We could also recruit, train, and improve working conditions and benefits for personal support workers. Far fewer people would occupy alternative level of care beds in hospitals. Far fewer people would languish on nursing home waiting lists.

We could decrease the risk of facility-based COVID infection and the deaths that go with those infections. We could save taxpayers millions while supporting more people. We could also take the time to re-examine how we can provide better congregate services for the Ontarians who need these services and will need them in the future. We could use this time to have a real debate on how, or whether, for-profit corporations should provide long-term care.

Note: There are about 77,000 registered nursing home spaces, which serve about 100,000 people annually. In contrast, some 700,000 Ontarians rely on home and community care services. Unpaid caregivers are supporting many of these Ontarians.