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.