{"id":11919,"date":"2018-09-12T11:00:54","date_gmt":"2018-09-12T15:00:54","guid":{"rendered":"https:\/\/lifeinsurance-orleans.ca\/Life-Insurance-Blog\/ontario-long-term-care-beds\/"},"modified":"2019-04-30T22:05:49","modified_gmt":"2019-05-01T02:05:49","slug":"where-should-ontarios-30000-new-long-term-beds-go","status":"publish","type":"post","link":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/2018\/09\/12\/where-should-ontarios-30000-new-long-term-beds-go\/","title":{"rendered":"Where should Ontario\u2019s 30,000 new long-term beds go?"},"content":{"rendered":"
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Sophia Marquez\u2019s* aunt Daisy is a retired social worker in her 70s who immigrated to Canada from the Philippines as a young woman. She lived in Toronto most of her life, never married, and enjoyed her independence, her friends and her family. About a year ago, Daisy started showing signs of dementia and all but stopped eating. She stopped taking her medications. She moved in with Marquez\u2019s parents, and soon began experiencing pain so severe that she couldn\u2019t sleep at night. This was extremely disruptive for Marquez\u2019s mother, who has Alzheimer\u2019s, and the situation escalated to the point that Marquez brought Daisy to the emergency department. Daisy was admitted to hospital, her pain was brought under control, and within a week, she was ready for discharge. But the family no longer felt they could safely care for her at home. Marquez, who is Daisy\u2019s decision maker, was given a list of nursing homes. She toured several homes and gave the care coordinator her top four choices, all of which had wait times of less than three months (some of the homes had wait times of two years). After being in hospital for several weeks, Daisy moved into Marquez\u2019s third choice.<\/p>\n

This family\u2019s story features two pressing concerns about Ontario\u2019s long-term care system: the increasing prevalence of dementia among seniors<\/a> and the housing of people in hospital<\/a> while they wait for long-term care beds, a phenomenon known as alternate level of care, or ALC (which is thought to contribute to a phenomenon the recently elected Ontario government has called \u201challway medicine\u201d). The concerns have led to calls for more LTC beds, and the government has committed to adding 30,000<\/a> by 2030.<\/p>\n

There is little debate about the need for more beds, but there are many questions about how best to go about adding them. There are also other concerns about long-term care homes, including the funding structure, how they are staffed, and whether some seniors would be better served in other types of settings.<\/p>\n

New beds: Where and what type? <\/strong><\/h2>\n

Of the roughly 78,000 LTC beds in the province, 30,000 are in homes that need to be redeveloped, says Candace Chartier, CEO of the Ontario Long Term Care Association, which represents nearly 70 percent of LTC homes in Ontario. These homes, many of which opened in the \u201970s and \u201980s, have licenses that will expire in 2025, and in order to acquire new licenses, one thing the homes need to do is eliminate any four-bed wards. This means these LTC homes must renovate existing facilities or build new ones\u2014either way, they will need new beds. The OLTCA wants these homes to be first in line for the first half of the promised beds which the Ministry has said will be added in the next five years.<\/p>\n

Lisa Levin, CEO of AdvantAGE, an association representing non-profit services for seniors in Ontario, including long-term care, housing and community services, says it\u2019s important that beds be allocated to all types of facilities, regardless of funding model: private, as well as community-based not-for-profit, charitable and municipal. The last time the province put out a call for proposals for new LTC beds, in April 2018, people had two weeks to put together their pitches. \u201cMunicipal homes weren\u2019t able to respond,\u201d says Levin. \u201cThey have unique circumstances and everything goes through council.\u201d Large chains, she says, have an easier time applying for beds, because they have proposal writers on staff and a quick internal approval process.<\/p>\n

Walter Wodchis, professor at the University of Toronto\u2019s Institute of Health Policy, Evaluation and Management, thinks perhaps only a third of the 30,000 beds that the system needs ought to actually be built anew. Another third might be freed up through better use of existing beds (through shorter lengths of stay), and the capacity of the last third could be provided through alternatives to institutional care such as supportive housing and assisted living, alternatives which allow people to live in their own (often subsidized) apartments with varying degrees of on-site, as-needed medical, personal and housekeeping support. Ideally, says Wodchis, these three options would be built near each other and work in tandem on \u201ccampuses of care,\u201d such as Schlegel Villages<\/a>, which has locations throughout southern Ontario, and Finlandia<\/a> in Sudbury. \u201cBy doing that, we can delay\u2014not avoid, but definitely delay\u2014admission to LTC,\u201d says Wodchis. He points to research out of Manitoba which showed that people who used assisted living had a shorter length of stay in LTC<\/a>. \u201cA shorter length of stay rapidly increases flow,\u201d he says. \u201cLet\u2019s say you reduce LOS by a third, that instantly creates 30 percent capacity. That\u2019s like adding 30 percent new beds.\u201d<\/p>\n

Samir Sinha, director of geriatrics at Sinai Health System and University Health Network, has challenged the plan<\/a> to build more beds. For one, he\u2019s concerned about a repeat of what happened in the early 2000s, when the addition of 20,000 new beds deepened gaps between well-bedded and poorly bedded communities. \u201cIt\u2019s easier to build beds in places where land is cheaper, and maybe in communities where developers exist,\u201d he says. \u201cLet\u2019s actually look at what the need is, and try and match new bed-building to areas that need the most.\u201d<\/p>\n

Sinha is also concerned that more appealing ways of caring for seniors\u2014which can be more cost-effective\u2014are being overlooked. In a provincial review<\/a> he led in 2012 as expert lead of Ontario\u2019s Seniors Strategy, he found that Ontario\u2019s least-bedded region, Mississauga Halton, also had the lowest demand for LTC. The LHIN in this area had heavily invested in supportive housing, a model that \u201ccosts one quarter of what it costs to provide care in an LTC home for people who were just as high-needs as many LTC residents,\u201d says Sinha.<\/p>\n

Similarly, models such as the U.S.-based PACE<\/a>\u2014a program for all-inclusive care for the elderly\u2014allow nursing-home-eligible people to live at home and access all manner of services, from primary care to dental care to lunch, through community-based agencies. \u201cIf we change nothing today, we would have to warehouse more people,\u201d says Sinha. \u201cIf we allow more creative care models and actually fund them\u2014fund even some existing programs better and allow them to have more flexibility\u2014I think we could care for far more nursing-home-eligible-patients in the community than we [are] able to today, with the current system.\u201d<\/p>\n

The OLTCA agrees that more creative models are needed for Ontario\u2019s seniors. \u201cRight now we just have acute care, home care and long-term care,\u201d says Chartier. A 2014 report from an expert panel commissioned by the OLTCA suggests that the system adopt several transitional options, such as short-stay beds in LTC homes for convalescent care, the incorporation of supportive housing in LTC facilities, and expanding the role of LTC in end-of-life care. \u201cWhat we\u2019re hearing more and more of is moving away from this standardized cookie-cutter approach and looking at the programs for specialized populations that may have a different type of need,\u201d says Chartier.<\/p>\n

Everyone seems to agree that the current system is overly homogenous. \u201cMaybe we need 30,000 long-term care spaces, but not to say that that means an institutional bed,\u201d says Wodchis.<\/p>\n

<\/div>\n","protected":false},"excerpt":{"rendered":"

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Most people agree Ontario needs more long-term care beds. But what’s the best way to add them? And how do we fix staffing and funding problems?<\/p>\n

The post Where should Ontario’s 30,000 new long-term beds go?<\/a> appeared first on Healthy Debate<\/a>.<\/p>\n<\/div>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[],"tags":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/11919"}],"collection":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/comments?post=11919"}],"version-history":[{"count":4,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/11919\/revisions"}],"predecessor-version":[{"id":14737,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/11919\/revisions\/14737"}],"wp:attachment":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/media?parent=11919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/categories?post=11919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/tags?post=11919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}