A Care Watch Position Statement
January 2, 2025
Context
As the demographics of Canada and Ontario continue to change and the population continues to age, it becomes ever more important to rely on evidence for designing policies, programs, and services for older adults. Ontario, specifically, expects that by 2046 more than a fifth of its population will be aged 65 or older, outpacing the average growth of this demographic throughout Canada.[i]
Older adults have specific needs and perspectives that need to be considered in design and implementation of policies and programs related to them. One perspective that influences many issues important to older adults and which influences health, social connections, and dignity, is “ageing in place.” Surveys and research have consistently confirmed how older adults feel about how and where they want to grow older. Almost 97% of Ontarians aged 65 years or older have indicated their strong preference to age at home and have stressed their willingness to do everything to avoid moving into a long-term care institution.[ii] This strong preference has remained consistent and grew even stronger following the experiences of many older adults in care home facilities during the COVID-19 pandemic.[iii] [iv]
However, despite this clear desire to age in place, our current system is failing the many in our community who experience barriers to access, unaffordability, and inconsistencies in the level of service required to make ageing in place possible. These older adults may eventually be left neglected or be forced to turn to alternative options. For example, recent analysis estimates that about 6% of newly admitted long-term care residents in Ontario could have been cared for at home with proper support.[v]
Ageing in place would not only improve the quality of life of older adults, but could also result in significant savings for our public service systems. Evidence clearly demonstrates the cost-effectiveness of this approach compared to the investments required to provide adequate placements in care facilities.[vi] Findings that demonstrate the benefits of ageing in place are not limited to Canada and have led many countries to make advancements in promoting and supporting such approaches. However, Canada is also lagging behind its international peers, with only 18% of its long-term care expenditure dedicated to home care, as opposed to Scandinavian countries that spend about 50%.[vii] This is a significant missed opportunity to correlate government spending with the values and interests of our communities. This should be a point of consideration to government officials given the importance of ageing in place for this demographic, a demographic that attends to public policy issues and tends to be particularly active at the polls.
Support for Ageing in Place
Family members, friends, and private and non-profit organizations can provide a wide range of tailored and culturally relevant care services that help older adults remain in their own homes and connected to their communities. However, not all older adults in Ontario have access to, or can afford, these services. Many also do not have family members who have the time or financial capacity to provide this support.
Currently, family members and friends provide the vast majority of this type of care and contribute close to $10 billion annually to Canada’s health system in unpaid labour, care on which many older adults from more disadvantaged backgrounds (for example, geographically or economically) rely.[viii] However, in recent years, these unpaid caregivers have experienced increased pressures and burnout. Research indicates a noticeable deterioration of the conditions under which they work. As a result, almost a third of them report feeling unable to cope with their responsibilities, and 7 out of 10 signal that burnout may prevent them from continuing their roles.[ix] These issues, as well as other broader factors that reduce the pool of these supports (for example, shrinking family sizes and increases in the number of individuals moving away from home), pose significant threats to the sustainability of the current arrangements that many older adults depend upon in order to age safely, successfully, and with dignity at home.
In addition to these unpaid networks, community-based and non-profit providers play an important role in enabling ageing in place. These organizations draw on long-standing relationships and accumulated local knowledge to implement highly creative care plans that are more accessible and affordable.[x] Accessing these services could allow a large number of individuals to stay in place and free up space in long-term homes for older adults with more complicated support needs. Researchers have identified that up to 50% of individuals on long-term care home waitlists could age in place safely and cost-effectively with affordable and available community and housing services.[xi] Even though these community-based and non-profit organizations provide governments with an effective way to reduce costs and increase quality of services for older adults, many are facing challenges in securing adequate funding to support their operations.
Although limited research has been done in Ontario, investigators from other international jurisdictions have examined the quality of service of for-profit and non-profit organizations. The existing evidence points to the higher quality and operational advantages of non-profit home care organizations.[xii] These advantages are not limited to the services provided, but apply also to the employment conditions of the care providers and staff.[xiii] The advantages of non-profit and community-based home care service providers can be summarized as their tendency to reinvest in their services, operations, personnel, and community compared to a for-profit organization’s need to extract value and pay out profits to its shareholders.
In addition to barriers to access, there are inconsistencies in the quality of services and accountability of corporate, for-profit home care service providers. Quality of service, in particular, can depend on clients’ income, socio-economic status, immigration status, education, and locality – factors that influence private for-profit services more compared to non-profit community-based agencies.[xiv]
Furthermore, caregivers working in homes are compensated at a significantly lower rates than their counterparts in long-term care institutions and hospitals. Lower compensation and the professional pressures they experience (such as the need to be skillful in areas ranging from medication management to infection control to mental health and chronic disease, as well as the need to deal with cultural and interpersonal complexities)[xv] have resulted in alarming burnout rates. Ontario alone loses about 40% of its personal support workers within one year after graduation, and of the personal support workers who have two or more years of experience, 25% leave long-term care annually.[xvi]
Call to Action
Care Watch Ontario calls upon all policy makers – federal, provincial, and municipal – to recognize the value of ageing in place and to make investments to afford dignity and respect for older adults and their caregivers, which responds to their clear preferences. These investments would not only enhance the quality of life for older adults but also would be a fiscally prudent approach for any government that is concerned with health care expenditures.
In our call to action, we echo the recommendations by federal and provincial bodies in studies and reports, including the Enabling Older Adults to Age in Community[xvii], the National Seniors Council report[xviii], the Long-Term Care Staffing Study[xix], and the Report on Challenges, Possible Solutions, and Visions for the Future from PSWs across Ontario.[xx] We specifically ask governments to consider:
- Creating and strengthening vehicles and incentives to support ageing in place, such as age-at-home benefits and caregiver credits
- Committing to strategies and funding to attract, retain, and expand human resources to support ageing at home
- Developing guidelines for home care services to require and enforce quality of service and accountability of service providers
- Prioritizing non-profit organizations in procurement processes
- Dedicating sustained and long-term investments in community and non-profit organizations that support older adults and both paid and unpaid caregivers
Endnotes:
[i] Ontario Ministry of Finance. (May 2024). Ontario’s Report on the Economy 2024. Chapter 1: Demographic trends and projections. https://www.ontario.ca/document/ontarios-long-term-report-economy-2024/chapter-1-demographic-trends-and-projections-2024
[ii] National Institute on Ageing. (March 2021). Pandemic Perspectives on Long-Term Care: Insights from Canadians in Light of COVID-19. Toronto, ON. https://carewatchontario.com/wp-content/uploads/2025/01/e7e24-englishniacmareport.pdf
[iii] Fenton MR, Hoppmann CA, Boger J, et al. (2014). Growing Older at Home: Canadians’ Meaning of Aging in Place. Journal of Aging and Environment, 1-23. https://www.tandfonline.com/doi/full/10.1080/26892618.2024.2329869
[iv] Achou B, De Donder P, Glenzer F, et al. (2022). Nursing Home Aversion Post-Pandemic: Implications for Savings and Long-Term Care Policy, 201, 1-21. https://www.sciencedirect.com/science/article/pii/S016726812200230X
[v] Canadian Institute for Health Information. (2023). New Long Term Care Residents Who Potentially Could Have Been Cared for at Home. https://yourhealthsystem.cihi.ca/hsp/inbrief
[vi] Clavet N-J, Hébert R, Michaud P-C, Navaux J. (2021). The Financial Impacts of a Shift Towards Home Support in Quebec (2021s-20, Cahiers scientifiques, CIRANO). https://cirano.qc.ca/fr/sommaires/2021s-20
[vii] National Seniors Council. (2024). Final Report of the Expert Panel: Supporting Canadians Aging at Home: Ensuring Quality of Life as We Age. Government of Canada. https://www.canada.ca/en/national-seniors-council/programs/publications-reports/aging-home.html
[viii] Webber J, Mulroney E, Tatasciore M, et al. (2024). Post-Pandemic Needs of Unpaid Family and Friend Caregivers to Effectively Continue Caregiving Duties in one Northern Ontario Health Authority. Patient Experience Journal, 11(3), 106-116. https://pxjournal.org/journal/vol11/iss3/14/
[ix] Ontario Caregiver Organization. (2024). Spotlight Report. https://ontariocaregiver.ca/wp-content/uploads/2024/12/OCO-SpotlightReport-2024-ENG-FINAL-121024.pdf
[x] Webber J, Finlayson M, Norman KE, Trothen TJ. (2024). How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada. Qualitative Health Research, 34(10), 977-988. https://journals.sagepub.com/doi/full/10.1177/10497323241231425
[xi] Rosenberg MW, Puxty J, Crow B. (2022). Enabling Older Adults to Age in Community. https://open.alberta.ca/dataset/793bf56c-1788-4076-bae6-5d23e0adc073/resource/813e9fe4-3818-430c-8d4e-8f2ea0cdf2c4/download/sh-fpt-enabling-older-adults-to-age-in-community-2022.pdf
[xii] Schmid H. (1993). Non-Profit and For-Profit Organizations in Home Care Services: A Comparative Analysis. Home Health Care Services Quarterly, 14(1), 93–112. https://www.tandfonline.com/doi/abs/10.1300/J027v14n01_06
[xiii] O’Neill N, Mercille J, Edwards J.(2023), Home Care Workers’ Views of Employment Conditions: Private For-Profit vs Public and Non-Profit Providers in Ireland. International Journal of Sociology and Social Policy, 43(13/14), 19-35. https://www.emerald.com/insight/content/doi/10.1108/ijssp-10-2022-0276/full/html
[xiv] Lee J, Watt JA, Mayhew A, et al. (2024). Equity in Home Care Use in Canada: A Cross-Sectional Analysis of the Canadian Longitudinal Study on Ageing. BMJ Public Health,2, e000812. https://bmjpublichealth.bmj.com/content/2/2/e000812
[xv] Lum J, Sladek J, Ying A. (2010). Ontario Personal Support Workers in Home and Community Care: CRNCC/PSNO survey Results. Canadian Research Network for Care in the Community, Toronto ON. https://www.torontomu.ca/content/dam/crncc/knowledge/infocus/factsheets/InFocus-Ontario%20PSWs%20in%20Home%20and%20Community%20Care.pdf
[xvi] Long-Term Care Staffing Study Advisory Group. (2020). Long-Term Care Staffing Study. Ontario Ministry of Long-Term Care. https://www.ontario.ca/page/long-term-care-staffing-study
[xvii] Rosenberg MW, Puxty J, Crow B. (2022). Enabling Older Adults to Age in Community. https://open.alberta.ca/dataset/793bf56c-1788-4076-bae6-5d23e0adc073/resource/813e9fe4-3818-430c-8d4e-8f2ea0cdf2c4/download/sh-fpt-enabling-older-adults-to-age-in-community-2022.pdf
[xviii] National Seniors Council. (2024). Final Report of the Expert Panel: Supporting Canadians Aging at Home: Ensuring Quality of Life as We Age. Government of Canada. https://www.canada.ca/en/national-seniors-council/programs/publications-reports/aging-home.html
[xix] Long-Term Care Staffing Study Advisory Group. (2020). Long-Term Care Staffing Study. Ontario Ministry of Long-Term Care. https://www.ontario.ca/page/long-term-care-staffing-study
[xx] Ontario Centres for Learning, Research & Innovation in Long-Term Care. (2021). PSW Perspectives on the Staffing Challenge in Long-Term Care: Report on the Challenges, Possible Solutions, and Visions for the Future from PSWs across Ontario. Research Institute for Aging, Waterloo ON. https://clri-ltc.ca/files/2021/02/PSW_Perspectives_FinalReport_Feb25_Accessible.pdf
Care Watch 