Opinion

The good and the bad – retirement homes have stepped into the gap to provide long-term care

My parents (86 years old, married 61 years) have only rarely been separated in the last 20 years. They have dementia and osteoporosis and additional health concerns. Three years ago their problems became acute, Dad was on the verge of burn-out as caregiver and it became clear they couldn’t manage at home any longer. I held Power of Attorney for them and consulted their physician and local Community Care Access Centre (CCAC) to explore options, including retirement and Long-Term Care (LTC) homes (the table below shows some of the differences between retirement homes and LTC facilities, although some are starting to blur). Mom and Dad moved into their retirement home in 2009 with extensive help from our family and the CCAC. It was the right decision – they have been happy and they are at ‘home’ with many friends amongst residents and staff.

Differences between Retirement Homes and Long-term Care Homes 

Retirement homes

LTC Homes

Open

Eligibility

Eligibility and priority determined by application to the local CCAC and based on health need

Membership in a voluntary professional certification association

Accountability

Provincially regulated

Set by company, annual rent increases subject to provincial legislation, care rates vary widely

Rates

Rates set and subsidized by the Ontario government with assistance to low-income residents

Range from independent living → supportive housing and care → convalescent → complex long-term care

Services

Care and support for residents with complex long-term healthcare needs

This summer Dad was hospitalized due to a compression fracture in his spine. In five weeks he lost 17 pounds and his usual vibrant interest in life. His dementia kept him only minimally active in hospital routines. Without her partner, Mom’s dementia became more acute; she could no longer be left alone. The retirement home stepped in with advice and accommodated Mom on their high-care floor during the day when needed and I engaged a companion to help with nights. I was pleased when Dad moved into a ‘transition to home program’ at the hospital after two weeks, but stunned at the effort it required to get a formal recovery plan for him before discharge – it seemed self-evident that this was key to reducing Dad’s risk of another fall or hospitalization.

The top priority for my parents (and our family) has always been for them to stay together – and we are even more resolved given the severe disorientation caused by their recent separation. With CCAC morning and night care for Dad they remain in their retirement home together with friends and caregivers they know well, while on lengthy wait lists for beds in an LTC home – though not in the same queue. It also permits our family to provide support and stay regularly involved in their lives. A good ‘quality of life’ decision for the near term but a tough one financially.

Cost in a Retirement Home vs Long-term Care Home

Cost for Two in a Retirement Home*

Cost for Two in LTC**

$ 6000.00

Accommodation, basic care and meals

$ 4443.28

   1900.00

Extended Care

  included

   extra

Medications

  included

   extra

Daily supplies (pull-ups, etc.)

  included

   extra

Equipment(wheelchair, walker, monitors, etc)

  included

$ 7900.00

Total monthly base cost

$ 4443.28

 * In a good but not ‘high-end’ retirement home.

** Private rooms (basic rooms are ~ $1600 per month per person); MOHLTC August 2012

The cost to my parents rose by $2000 per month this year and will exceed $100,000 assuming no change in their needs. The equivalent cost in an LTC is less than $53,400 – no matter how their care needs escalate and all supplies, equipment and medications are included.

It is Time to Do Better

The number of retirement homes advertising increasingly complex long-term care has grown steadily but legislation and certification standards are not keeping pace.  Indeed, rent protection ceases to apply if you change rooms within the same facility. As many retirement homes concentrate higher-needs residents on floors with higher staff ratios and/or special equipment and space, residents already facing new health challenges requiring a higher level of care too often end up hit with a double whammy – increases for higher care and for their accommodation. Talk about being vulnerable!

It is time to consider regulating and subsidizing the care provided in retirement homes as it is in long-term care homes. This approach could lead to new win-win partnerships beyond managing impossible wait lists: reducing the number of new facilities needed, improving quality of life of residents (and their families) by allowing them to age in place with their spouse, familiar settings and caregiver relationships. It could also allow harmonization of accreditation standards so that best practices are more quickly adopted in areas such as human resources and facility design.

My parents’ situation isn’t especially unique although they are relatively privileged by income and active family support (which I am frequently told, is not typical). And that is one of my points: many seniors have no advocate to negotiate the maze on their behalf and even then, $100,000 annually is outside the range of most couples.

Retirement homes have stepped into the gap to address the lengthy wait lists for LTCs and provide parallel long-term care within their facilities. Now government needs to step into the gap to revise legislation and certification standards to provide a better framework for this care – we deserve better.

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11 Comments
  • Cindy Quesnelle says:

    I know this is an article from 7 years ago so may not get this comment. I work in a retirement home where all the extra services needed are put into nice Wellness minute packages. Problem. One caregiver…Doing meds, treatments, answering phones, laundry, daily garbage collection (yes this is true) as well as caring to the needs of 40-50 residents and dealing with any emergencies such as a fall. Then trying to give the extra care to the residents that are paying for extra service. Many now coming in with dementia issues. Exit seeking behaviors . One frontline staff is not enough. During our evening and night shift there is only one staff in the building. When these homes have their accreditations and inspections this is one area that needs to be recognized. Not only for the safety of our residents but the sanity of the staff. I have worked in this retirement home for 37 years. I have never seen such a sorry situation. This is because of the high needs of our residents now.

  • Jim says:

    Thank you for posting this article. How do you feel about Wynne’s plan, announced recently? This is part of our concerns at http://www.comfortlife.ca/.

  • Steve Fistell says:

    When I and my parents were younger, future systemic public health care concerns were an abstract notion. As time passed and my parents were becoming visibly older and frail, abstractions became very real. I began thinking about the inevitable outcome of the increasing burden of caring for my amazing parents. I was worried. Could I do it? I was mostly a single care sibling, my younger sister, living inconveniently far from our parents. It was mostly left to me. I can safely utter the cliche that it was hell.
    With my father diagnosed with onset dementia and my mother with pancreatic cancer, concrete reality took its place with sadness – and fear. Fear for their wellbeing. They have passed now, within seven months of each other, but the problem remains for others. The system in this vastly rich and plentiful country is broken. I don’t have to recount the horror stories of others. I’ll be brief now. If we have to finance compassion, then let’s do it. The population is getting older and the politicians who make life giving or life threatening decisions must take action. They’re not getting any younger either.

  • Elena K says:

    This is a great post, government should step up big time also in subsidizing seniors and their caregivers who wish to stay in their homes too. My dad lives with me and my husband, we became his caregivers after my mom passed and being full time working and trying so hard to keep him at home with us. We did not find adequate support at all, every time CCAC case manager’s visit, they promise so much and it never materialized in any feasible help, we are entitled to 7-8 hours of help and this is nothing, if we will be able to have government support and have more help in our home to care for him it would be best solution for my dad, us and not as big burden on the government also. Instead we need to start looking on LTC now. It will be expensive solution for everybody involved including government subsidies for his room. Needles to say very heartbreaking for my dad and us. It is well known fact that seniors happier and healthier living in their homes!

  • John G Abbott says:

    While not taking a position on your policy prescription, I appreciate you taking the time to outline a personal and compelling story of caring for your parents in today’s changing family and long-term care environments. The question remains as to how to get the best of all worlds for your parents and those who are or will face a similar situation. Quality, affordability and a parent’s preference have to factor into the policy solution. Best wishes to you and your parents for continued healthy living.

    • Linda Murphy says:

      I wrote this article to try to generate discussion to develop policy options for this issue. It is vastly disappointing to hear the almost resounding silence. Perhaps it is not as large an issue as I see it or most of HD’s audience is able to provide better care than I.

      In my view, the issues I raised are the tip of the iceberg as the level of care provided on secure floors in retirement homes continues to erode. For example, PSWs in my parents’ residence who should be providing direct care to residents are now also doing laundry, picking up, delivering and serving food to residents on their floor. With 2 PSWs and 20 residents on their floor, residents don’t get much one-on-one and the part-time recreation person resigned weeks ago!

      • mcel84 says:

        I myself work in a retirement home as a psw but am med certified and I truly believe that retirement homes need to be regulated. We have very high care needs in the area I work (assisted care floor) we are not staffed like a nursing home yet we except residents at a nursing home level. It is not fair for these residents to be paying the amount they pay. We try our best to give the best care we can but we just don’t have the staffing that we should. We currently have 8 residents on our floor that use a mechanical lift which requires 2 staff members at all times. Workers are starting to burn out and residents are frustrated with the wait times when calling for help . I’M really hoping the government will chose to regulate retirement homes.

    • Kathy McLaughlin says:

      Dear John
      Who’s paying your salary? Clearly not the seniors of this Province (at least not directly!). This is a perfect bureaucratic response and does absolutely nothing to assist the people in our Province who require the help. My father is 6 weeks post stroke (at 91 years of age and a DVA Vet) ; a meeting with the medical team 1 1/2 weeks ago indicated dad’s issues with no discharge date mentioned. Just now, we’ve received at the door of their retirement residence a wheelchair and a walker (with no locking capability) with the message that dad is coming home today. NOT! On Christmas day, we brought him home for the afternoon/dinner to celebrate and he requested to go back to the hospital after dinner as he felt he shouldn’t be out of hospital too long. Now he’s coming home? Excuse me – thanks for providing a totally broken health-care system that does nothing to take care of seniors. Gee John, best wishes back at you to you and your parents for continued healthy living – you’d better hope they stay that way. Oh, and by the way, DVA is unavailable until Jan 2 to assist this elderly Canadian hero with reintegration into his normal life. Another bureaucratic bollocks.

  • Neale MacMillan says:

    Thanks Linda for your clear comparison of the costs for retirement homes versus LTC facilities. I agree with your policy prescription — the retirement homes need to be regulated since they’ve become de facto temporary LTC facilities, and much more costly ones!

  • Irene Jansen says:

    Thank you for your post. My concern is that retirement homes are almost entirely for-profit, and in every province, they have been lobbying for subsidies and self-regulation. Corporations have happily “stepped into the gap” because they make a lot of money in this business. Government should step up by properly funding and regulating the full range of continuing care (long-term care, retirement homes and home/community care) and making sure all of it (over time) is delivered by public and non-profit organizations. Seniors need more graduated housing and care options that maximize independence, yes, and those retirement homes and assisted living facilities should be publicly funded and non-profit.

    See Part 4 of CUPE’s report on long-term care for evidence of the problems with for-profit seniors’ care, including this lesser-regulated area of retirement homes (pp 60-61):
    http://cupe.ca/long-term-care/our-vision

    See also Vol 10, No 4 (2011) issue of HealthcarePapers on residential long-term care. A number of the articles address these very issues.

    To read concerns about the Retirement Homes Act from seniors’ advocates and health care workers, see:

    Committee Transcripts: Standing Committee on Social Policy – May 10, 2010 – Bill 21, Retirement Homes Act, 2010

    http://www.ontla.on.ca/web/committee-proceedings/committee_transcripts_details.do?locale=en&Date=2010-05-10&ParlCommID=8875&BillID=2298&Business=&DocumentID=24906

    Sick seniors need better care
    Toronto Star, October 13, 2011
    http://www.thestar.com/news/article/1069581

  • Irfan Dhalla says:

    This is a great post. Thanks Linda. I agree with you that governments need to figure out how to regulate the retirement sector. There are many people who are no longer able to live independently, or who no longer wish to live independently, but who do not yet need nursing home care. As you point out, most of these people cannot afford to spend $50,000 or $100,000 per year on a retirement home. There are very few retirement homes for those with limited means. A well-functioning retirement home sector would hopefully free up nursing home beds for those who truly need that level of care. This would in turn allow hospitals to focus on patients who truly need hospital care.

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Linda Murphy

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