As COVID-19 exposes long-term care crisis, efforts grow to keep more seniors at home

Lucy Fernandez volunteered in a long-term care home for 20 years.

Although she saw first-hand how much of an effort staff and her fellow volunteers made to keep the residents happy, she also saw many seniors languishing in their rooms.

“While she was still, you know, fairly cognizant, [she] expressed her desire of not wanting to go to a long-term care facility,” her daughter, Laura Fernandez, said.

Lucy, now 85, suffers from advanced Alzheimer’s disease, with limited ability to speak and move. Because she’s one of 850 people in Ontario’s High Intensity Supports at Home program, announced by the provincial government in December, personal support workers come in for several hours a day — in addition to others who work with her on cognitive development — allowing Laura Fernandez to keep her mother at home in Toronto.

“She is in her own environment, she’s happy,” Fernandez said. “Just knowing that I’m there, I know is giving her comfort.”

That’s the level and quality of home care that should be much more widely available to seniors, according to several health policy advocates, including the National Institute on Ageing and the Ontario Community Support Association.

In addition, they say, it would ultimately save governments money by keeping more seniors out of long-term care facilities, which are expensive both to build and run.  

COVID-19 put spotlight on home care

The benefit of increased home-care investment in Canada is getting long-overdue attention, now that COVID-19 has torn through long-term care homes, killing thousands of residents and exposing lethal weaknesses in the system, said Dr. Samir Sinha, head of geriatrics at Mount Sinai and University Health Network hospitals in Toronto.

“Long-term care is at a crossroads,” said Sinha, who is also the director of health policy research for the National Institute on Ageing.

“People are thinking about their futures more than ever before and saying, ‘When I age, you know, am I going to be able to age with independence? Will I have to go into one of these homes? You know, how do I actually stay in my home for as long as possible?'”

WATCH | Laura Fernandez’s mother volunteered in a long-term care home:

Laura Fernandez describes the difference it makes for her mother, who has advanced Alzheimer’s disease, to receive the care that allows her to stay at home. 1:15

Not only do most seniors want to live at home for as long as possible, more of them actually could, according to a report released by the Canadian Institute for Health Information (CIHI) in August 2020.

After reviewing the health status of people admitted in long-term care facilities in several provinces over the course of a year, CIHI concluded that across Canada, about one in nine new admissions “could potentially have been cared for at home, provided they had access to ongoing home-care services and supports.”

In Ontario, where people admitted to long-term care facilities are often quite frail or suffer serious cognitive impairment, including dementia, CIHI estimated that one in 12 new admissions could still potentially have remained at home if sufficient care were provided.

“One of the greatest reasons why people end up in nursing homes in Canada is because we don’t have enough publicly funded home care and supports … available,” Sinha said.

Although the Ontario government (under both Liberal and Conservative leadership) has increased its investment in home care and community services over the last decade, those investments haven’t kept pace with the needs of an aging population, according to the Ontario Community Support Association, which represents more than 200 not-for-profit organizations that provide home care and community support.

While long-term care homes have been struggling during the pandemic, the home-care sector could have helped lessen their load if it were funded appropriately, said Deborah Simon, the association’s CEO.

Devastating COVID-19 outbreaks in nursing homes have exposed enormous weaknesses that the Ontario government has pledged to fix, but many seniors’ experts say expanded home care should be a cornerstone of the solution. (Evan Mitsui/CBC)

Home care has also proven to be a safer option during COVID-19, Simon said, because seniors could more easily isolate in their own homes than in the congregate living setting of a long-term care facility. In addition, home-care workers use “the full gamut” of personal protective equipment.

“Care can be safely provided to people in the community who have COVID, using those very, very stringent practices around infection control,” Simon said. 

Put home care first, advocates urge

The COVID-19 crisis prompted the Quebec government to announce an additional $100 million investment in home care on top of the $1.7 billion it had already budgeted for this year.

“Home care is what people want, and they want it even more because of the pandemic,” Health Minister Christian Dubé said at a news conference in Montreal in November.

In a statement, Ontario’s Ministry of Health said it provided about $2.88 billion in funding to home care in the 2019-20 fiscal year. No estimate was given for the 2020-21 fiscal year.

Both the National Institute on Ageing and the Ontario Community Support Association say government funding should be prioritized so that home care is the end goal, rather than just an interim solution until seniors get a space in long-term care. (David Donnelly/CBC)

On Tuesday evening, a ministry spokesperson told CBC News in an email that “the government continues to make investments in our home-care sector for 2021-22,” citing an “additional” $111 million for the High Intensity Supports at Home program to help people with high needs — including Lucy Fernandez — transition out of hospital to home.

The spokesperson also cited last October’s announcement of a $461 million “temporary wage increase” for personal support workers in both home-care and long-term care settings during COVID-19.

In a separate statement, a spokesperson for the Ministry of Long-Term Care said it was investing up to $20 million for a community paramedicine program to provide services to seniors in their homes while they wait for a bed in long-term care.

But both the National Institute on Ageing and the Ontario Community Support Association say government funding should be prioritized so that home care is the end goal, rather than just an interim solution until seniors get a space in long-term care.

The Ontario Community Support Association has submitted a pre-budget consultation report to the provincial government, advocating for an investment of $595 million in the 2021 budget to make that happen.

The National Institute on Ageing has also submitted a proposal, co-authored by Sinha, to prioritize home care.

WATCH | Doctor says most Canadians want to age at home for as long as possible:

Geriatrics specialist Dr. Samir Sinha says boosting the level of home care and sending fewer people to long-term care facilities is both cost-effective and the right thing to do. 0:33

Both reports estimate the cost of home care to be significantly less expensive than long-term care. They also point to the Ontario government’s own estimate that about 38,000 people are currently on the waiting list for a long-term care bed.

To address that, the Ontario government has pledged to build 15,000 new long-term care beds and update 15,000 more.

That will cost billions of dollars that could be better invested — at a lower cost — in building a robust home-care system, Sinha said.

“By finding that better balance with those future investments we’re looking to make, I think we’re actually going to allow more people to age in the places of their choice,  which frankly allows everybody — the taxpayers and individuals and governments — to win.”

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