Aging in Place: The Canadian Experience

1
Aging in Place The Canadian Experience

• Gloria M. Gutman, PhD, OBC
• Gerontology Research Centre, Simon Fraser
  University, Vancouver, Canada
• Presented at the IAGG 19th World Congress,
  Paris, France July 5-9, 2009

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Demographics

• Currently 13 of Canadian population is aged 65
  or over proportion will increase to 20 by 2021
  when all of the Baby Boom generation are senior
  citizens.
• 93 of seniors live in private households 7 in
  institutional settings
• 2/3 in private households own their dwelling
  most, mortagage-free.

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Transitions

• As the years go by and people age, their needs
  tend to change their dwelling and neighborhood
  may change also.

4
Key Question

• To move or not to move?
• Do I remain in my familiar environment (i.e.
  age-in-place)?
• Do I move within my community, or move to another
  part of the province, a different province or a
  different country?
• Do I become a snow bird i.e. spend 6 months
  in a warm place like Florida, California or
  Mexico returning to Canada for the remaining 6
  months so as not to lose my Canadian health care
  coverage?

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Aging-in-Place

• May require change to ones existing housing
  (e.g. making home repairs, adding prosthetic
  design features, cleaning-up the grounds).
• This, in turn, costs money you may need to
  explore funding programs that provide grants,
  loans (e.g. CMHC ) or consider a reverse
  mortgage. Are you ready to do that?
•  
•  

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The challengeif I decide to move, what do I
move to?

• A wide array of housing alternatives for seniors
  exists in Canada (Gutman, Clarke-Scott
  Gnaedinger, 2001).
• They vary in scale (number of units), amenities,
  level of service, and amount of public subsidy.

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Options to Consider

• If people have children, they may think about a
  granny flat or auxiliary unit upstairs or
  downstairs

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A Granny Flat in Sackville, New Brunswick
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View of Granny Flat exterior
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View of living and dining areas
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View of bath/laundry room
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How about a unit in a seniors community?
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Jimmy Erasmus Senior Citizens Home, Rae Edzo, NWT
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Interior view of typical cabin
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Shared gazebo and courtyard
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Brinkworthy Place, Saltspring Island, BC
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Club House
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Main room in clubhouse
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Fenelon Falls Independent Living Centre, Fenelon
Falls, Ont.
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View from the street
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Garden Suites, New Glasgow N.S.view from street
with units hidden
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View of unit entries, parking at rear and walkways
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Outdoor swimming pool
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Gibsons Garden Inn, Gibsons, BC
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Indoor swimming pool
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Dining room
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Typical single room
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View of double room
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View of suite
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Motivating Factors

• Pull factors lifestyle, climate (amenity
  migration) wanting to be closer to family
  and/or roots (return migration)
• Push factors change in functional status and/or
  social support system (e.g. illness or death of
  spouse children moving away)

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The Shelter-Care Continuum

• self-contained units for independent seniors
• supportive housing (eg. Abbeyfield, small group
  homes, apartments with service options)
• assisted living for those needing more help with
  IADLs and ADLs
• care facilities for dependent seniors

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Challenges to finding appropriate seniors housing
support services in rural areas

• Small numbers increase the cost per person for
  construction or renovation
• Often there is a dearth of formal in-home support
  services and qualified personnel to provide
  service
• Low incomes of seniors in rural areas
• Attitudes and stereotypes

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Other Challenges

• Getting the Ratio of Housing Types Right!
• Oversight Accountability of new housing forms
• Standards
• Staff s Training
• (Re)allocation of Federal and Provincial Dollars
• Understanding the Relationship Between Housing
  and Health

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2001 British Columbia

• Residential Care
• Raised the bar for entry.
• 85 of residents have significant dementias and
  require at least 2.5 hours direct care per day.
• Assisted Living
• Implemented assisted living-middle option.
• Open over 4000 new publicly-funded assisted
  living units.
• Home Care

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Number of Assisted Living Units Across British
Columbia (McBain,2008)
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What is Provided in Assisted Living?

• Private, lockable unit either studio or 1
  bedroom
• Minimum two (2) meals per day 3rd optional
• Light housekeeping/laundry
• Emergency call system
• Personal care services

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Level of Personal Care

• Daily care hours range from .7 hours to 1.5 hours
  per day.
• Beyond 1.5 hours per day probably meansmovement
  to residential care-case by case.
• Care is provided under the leadership of an LPN
  and supported by Assisted Living workers.

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Criteria for Admission

• Provincial legislation and policy state
• Must be able to make decisions on their own
  behalf. (Sec. 26(3)) or have a spouse who can do
  it
• Must be able to communicate.
• Cannot be a risk to others.
• Assisted Living limited to 2 prescribed services
  Activities of Daily Living and Medication
  Management.

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• Must be assessed by Case Manager.
• Referral based on need, not on first come first
  serve basis.
• AL Case Manager Operator assess priority for
  entry.
• Suitability assessed on an ongoing basis.

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Cost

• Targeted to low and moderate income seniors
• Tenant pays up to a maximum 70 of after-tax
  income towards rent and hospitality
• Average Tenant contribution is 1,100 per month
• BC Housing provides monthly subsidy to operator
  (approx. 750 per month)
• Average care cost from Health Authority is 1,200
  per month1

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Client profile (McBain, 2008)
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Cognitive Function (McBain, 2008)
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Average Length of Stay (McBain, 2008)
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Discharged Residents (McBain, 2008)
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Policy Issues

• Weight that should be given to this housing form
  relative to others in the shelter-care continuum
• Efficacy of mechanisms currently in place for
  oversite and monitoring
• Not licensed unlike residential care
• Registrar appointed but it is a complaint driven
  process

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Policy Issues

• Entry and Exit criteria
• Tenants rights
• Cost-benefits to the state and to the client

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NORCs

• In contrast to Assisted Living projects which
  often are marketed as aging-in-place settings but
  where in fact LOSs are short, naturally
  occurring retirement communities (NORCs)
  represent unanticipated aging-in-place.
• The public policy issue here is who should
  provide needed services.
• There are some interesting examples of public
  private partnerships e.g. Cherryhill in London,
  ON (Kloseck, Crilly Misurak, 2003)

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References

• Gutman, G.M., Clarke Scott, M.A. Gnaedinger, N.
  (2001). Housing options for older Canadians User
  satisfaction studies. Vol. 1. Case Studies Vol. 2
  User Survey Results Vol. 3 Appendices. Ottawa
  Research Division, Canada Mortgage and Housing
  Corporation.
• Kloseck, M., Crilly, R.G. Misurak, L. (2002). A
  health care model for community seniors A
  community-systems approach. The Cherryhill
  Healthy Ageing Program Six-Year Outcomes. A
  report prepared for the Ontario Ministry of
  Health, Long-term Care Division.
• McBain, K. (2008). Policy and legislative change
  in long term care. Power point presentation for
  talk to Council of Forest Industries, Vancouver,
  BC, October 20.