4.1 Description of current programs

In his appearance before the Committee, the Honourable Jean-Yves Duclos, identified the four policy goals of the government’s current seniors’ agenda: “(a) improving seniors' access to affordable housing, (b) improving the income security of seniors, (c) promoting healthy aging and improving access to health care, and (d) fostering the social inclusion and engagement of seniors.”[175] The previous chapter focussed on income security and affordable housing, health and homecare services. This chapter will focus on the priority areas related to social inclusion, healthy aging and engagement.

Testimony before the Committee indicated that housing is central, not only to income security, but also to aging in place; which in turn relies on access to home- and community-based health and social services, age-friendly communities, and informal caregiving. These are the themes described in greater detail in this chapter. Many of these themes are the responsibility of provincial and territorial governments, or are shared between federal and provincial/territorial and sometimes municipal governments. However, the federal government has primary responsibility for funding and programming for seniors who are also Indigenous, veterans, or Canadians incarcerated in federal prisons.

A. Federal initiatives

1. For veterans

In addition to income support programs, Veterans Affairs Canada provides program funding for health and wellness initiatives. As described by Elizabeth Douglas, Director General of Service Delivery and Program Management with the Department, provincial or regional health authorities assess veterans to determine whether they are able to “age in place” in their homes, or whether they require residential long-term care.[176]

For those able to remain in their homes, the Veterans Independence Program (VIP) acts to “complement existing [federal, provincial or municipal] programs,” with the intention to help veterans “remain independent and self-sufficient” at home and in the larger community.[177] Qualified veterans may receive financial assistance to obtain services such as: “grounds maintenance; housekeeping; personal care; access to nutrition; as well as health and support services provided by a health professional.”[178]

The program aims at providing an alternative to institutional care, supporting the independence of older veterans and allowing them to “age in place” in their own homes.[179]

The early intervention and support provided through the [VIP] program provide the benefits of improved long-term health and socio-economic conditions, increased independence and self-sufficiency through delayed or avoided institutionalization, and improved quality of life for both the veteran and their families.[180]

For qualified veterans in need of residential care, the Department provides financial support in two long-term care settings: those that give priority to veterans, and those that are available to all, including veterans.[181] Eligibility for this program is based on several factors, including health care need, service-related disability, income, and military service.[182]

2. For Indigenous peoples

Indigenous Services Canada administers the Assisted Living Program, which provides funds to identified service providers to help provide non-medical social support services to people living on-reserve. Its two components are: In-Home Care and Institutional Care. Both components support low-income seniors, adults of any age who have chronic illness and children and adults with mental and physical disabilities depending on their level of needs.[183] In‑Home care is designed to help individuals in these groups “maintain functional independence while remaining in their homes and their communities,” while Institutional Care provides services to individuals in those groups who are “unable to live independently and who must be cared for in an institutional setting, such as a nursing home or personal care home.”[184]

The Director General of the Community Infrastructure Branch in the Department of Indigenous and Northern Affairs told the Committee that the Department “provides an average of $146 million annually, directly to First Nations, for housing support. This funding can be used at their discretion to meet a range of housing needs, including adapting the homes of their members.…”[185] She also described initiatives “to improve the wellness of Indigenous peoples by addressing the socio-economic challenges they face,” and a commitment to “continuing the collaboration with Indigenous leaders and communities, provinces and territories, and other key partners, on improving socio-economic conditions for vulnerable Indigenous seniors in Canada.”[186]

3. For federal prisoners

Correctional Service Canada (CSC) is responsible for “administering court-imposed sentences of two years or more, including conditional release supervision of offenders in the community.”[187] The Commissioner of CSC, Don Head, told the Committee that “22% of federal offenders are between the ages of 50 and 64 years, and approximately 7% of the federal offenders are aged 65 years and older.”[188] Rather than chronological age, however, the Commissioner explained to the Committee, “It is the combination of age and functional impairment, often related to the presence of multiple chronic diseases, that determine the unique needs of the older offender.”[189]

Offenders’ health needs are assessed upon admission and regularly thereafter according to the Commissioner, and those in need are treated in CSC health centres, or by community services where necessary for “specialized care.”[190] Palliative care[191] is provided in an institution, supported by “volunteers, clergy and palliative care specialists” or within a CSC hospital.[192]

In 2010, the Office of the Correctional Investigator recommended that CSC “prepare a national older offender strategy for 2011-12 that includes a geriatric release component as well as enhanced post-release supports.”[193] This recommendation was repeated in the Investigator’s most recent report.[194] The Commissioner told the Committee that CSC was working to “develop [an older offender] strategy.”[195] The strategy is scheduled to be completed by 30 March 2018.[196]

4. New Horizons for Seniors

The New Horizons for Seniors Program was described by Minister Duclos at the first meeting of this study as having a “specific objective of help for seniors by seniors.”[197] This view was echoed by Nancy Milroy Swainson, Director General, Seniors and Pensions Policy Secretariat, within the Department of Employment and Social Development,[198] who listed the specific objectives of this program as follows:

[O]ne, to promote volunteerism among seniors; two, to foster mentoring by seniors; three, to expand awareness of all forms of elder abuse; four, to support the social participation and inclusion of seniors; and five, to provide capital assistance for community programs and projects for seniors.[199]

She added that more than $40 million is provided to “small community-based projects that are led or inspired by seniors, and to large pan-Canadian projects that address issues such as elder abuse and social isolation.[200] The Financial Literacy Leader from the Financial Consumer Agency of Canada told the Committee that this program “has helped to fund many programs in communities to help with the issue of financial abuse and fraud among seniors.”[201]

5. National Seniors Council

As noted in the introduction to this report, the motion that triggered this study called on the Committee to consider the role of the National Seniors Council with a view to broadening its mandate from its current role (i.e. to provide advice to the Government of Canada on current and emerging issues and opportunities related to the health, well-being and quality of life of seniors).[202] Minister Duclos informed the Committee that the Council reports to both him and the Minister of Health “on the challenges and opportunities related to the well-being and quality of life of seniors,” adding that the Council’s strength “lies in the expertise and experience of its members.”[203] He also said that final decisions with respect to the “future structure and mandate of the Council” had not been made but that the Committee’s study was the perfect context to provide input on this issue.[204] The Council’s membership, including new appointments and reappointments, is current as of June 2017.[205]

B. Joint federal/provincial/territorial initiatives

In addition to federal programs described above, federal collaboration with, and federal transfers to provincial, territorial and even municipal governments support the social inclusion of older Canadians. The National Housing Strategy and the Canada Health and Social Transfers are described below.

1. National Housing Strategy

While the National Housing Strategy was launched after the Committee’s hearings had ended, government officials made reference to the strategy as it was being developed, assuring the Committee that seniors’ housing would be reflected in it. Minister Duclos indicated that the purpose of the National Housing Strategy is “to re-establish federal leadership in housing, especially as it relates to the very important issue of housing for seniors.”[206]

The National Housing Strategy was released by Minister Duclos on 22 November 2017. It identifies seniors as a particularly vulnerable group and includes several measures targeted to this population. The co-investment fund component of the strategy, which will be cost-shared with provincial and territorial governments, municipalities, non-profits and the private sector, is expected to result in 12,000 new affordable units for seniors. According to the Strategy, this component will also “support partnerships with services to allow for seniors to age in place.”[207]

In addition, the Canada Housing Benefit, to be co-designed with provincial and territorial governments, will provide direct support to individuals and families in core housing need, and is expected to “reduce housing need for seniors by providing rental support.”[208] This benefit is expected to be launched in 2020–2021.[209]

2. Canada Health and Social Transfers

The Canada Health Transfer (CHT) and the Canada Social Transfer (CST) are the major means for providing the federal share of social programs administered by the provinces. The CHT is the largest major transfer to provinces and territories. It provides long-term predictable funding for health care, and supports the principles of the Canada Health Act which are: universality; comprehensiveness; portability; accessibility; and public administration. Starting in 2017-2018, the total CHT amount will grow in line with a three-year moving average of nominal Gross Domestic Product, with funding guaranteed to increase by at least 3% per year. In 2017-2018 the CHT is estimated to exceed $37 billion.[210]

Minister Duclos told the Committee that the Minister of Health “leads our government’s efforts with respect to healthy aging and access to health care,” adding that “the Government of Canada has advanced a number of initiatives benefiting seniors, ranging from new funding for provinces and territories, to investing in home care,[211] to advancing the implementation of age-friendly communities in Canada,[212] to working with partners to address dementia.”[213] In addition, the federal government has been signing bilateral “accords” with provincial governments, which include additional funds to be dedicated to home care and mental health care.[214]

The CST is a federal block transfer to provinces and territories in support of post-secondary education, social assistance and social services. In 2017-2018, the CST is estimated to exceed $13.5 billion.[215]

4.2 WHAT THE COMMITTEE HEARD

A. Social isolation harms seniors, while active participation benefits them and those around them

Witness testimony highlighted the negative impacts of social isolation on health and inclusion while others described the important contributions made by seniors to the overall quality of life in Canada. Several roles were identified, including volunteering, employment, and involvement in decisions that affect them.

1. Social isolation leads to negative outcomes

A submission by AGE-WELL, a federally funded technology and aging network, described the pervasiveness of social isolation among seniors and its negative impacts. “Research indicates that as many as 43% of older adults living in the community feel socially isolated. The negative effects are well documented: depression, stress, functional decline, and death.”[216]

In addition, work by the National Seniors Council (in its studies on elder abuse, active aging, and low income among seniors) found that social isolation was “consistently identified as a problem, risk factor, barrier, or consequence experienced by many seniors.”[217] Its subsequent study on social isolation focussed on nine groups of vulnerable seniors: “Aboriginal seniors, seniors who are caregivers, immigrant seniors, LGBTQ2 seniors, seniors living alone, seniors living in remote or rural areas, low-income seniors and those living in poverty, seniors with mental health issues (including Alzheimer’s and other dementias), and seniors with health challenges or disabilities.”[218]

Testimony provided to the Committee echoed some of these themes, and identified additional factors contributing to social isolation: vision loss;[219] poverty;[220] racism;[221] being of advanced years and without access to transportation[222] (addressed in greater detail below); cultural minority status;[223] living in a rural environment;[224] and barriers created by the built environment.[225]

The solutions identified are also numerous. In addition to paid employment, volunteering, and participation in decision-making, virtually all testimony highlighted the importance of aging in place in reducing social isolation.

2. Paid employment can reduce social isolation

Testimony during this study highlighted the importance of paid employment not only for economic security for seniors, but also as a mechanism to sustain social networks. The Seniors Advocate for British Columbia stressed that sometimes there is no better way to address social isolation and engagement than through paid employment.[226]

On a related note, one research centre highlighted the challenges associated with withdrawal from the paid workforce, particularly for older men, “[F]or older men, the transition from paid work to retirement can be especially difficult and can impact negatively on their mental well-being.… They construct meaning and identity around paid work, and often feel a deep sense of loss on retirement.”[227]

3. Volunteering creates and nourishes social connections

As described in a 2013 publication from Volunteer Canada, social inclusion is among many benefits experienced by older volunteers. “Volunteering provides health benefits to older adults. It offers them significant physical, emotional and cognitive or brain health benefits. It also enhances social support, social inclusion and civic engagement.”[228] Recent Statistics Canada data show that the largest number of volunteer hours is contributed by “younger seniors,” aged 65 to 74, at an average of 231 hours per year.[229]

Testimony to the Committee identified the involvement of volunteers as a contributor to social inclusion, including through Indigenous Friendship Centres. “This inclusion of Elders[230] in all aspects of the Friendship Centres helps reduce social isolation, while also recognizing and valuing the important contribution Elders and seniors make to Canadian society through volunteerism.”[231] In addition, many of the organizations appearing before the Committee and submitting briefs identified the crucial role of older volunteers in delivering the programs they offer to other seniors.[232]

There was widespread recognition of the positive contribution of the New Horizons for Seniors funding program in supporting volunteering by seniors,[233] with calls for a longer-term funding commitment for approved projects.[234]

4. Decision-making processes need to be inclusive

Several witnesses identified the importance of involving seniors not only socially,[235] but also in matters that affect them, both to improve the programs and to engage seniors in their communities.[236] As described by a representative of the National Initiative for the Care of the Elderly, “it is crucial that decisions are made with older adults and not for older adults.”[237] Another witness, a gerontologist and educator, described the situation in the Netherlands related to the development of curriculum on the study of geriatrics and gerontology, “they do include older adults in all the decisions they make at the university and college level.”[238]

B. Canadians want to age in place

While estimates vary, a 2013 publication by Canada Mortgage and Housing Corporation (CMHC) reported that, “Approximately 85% of older Canadians would prefer to age in place,”[239] adding that “many seniors want and expect to age in place, and do not seriously consider alternative options until circumstances force them to do so.”[240] A wide range of policies and programs can support seniors in this preference, though testimony before the Committee focussed on four themes: housing, age-friendly communities, home-care services, and caregiving by families and friends. Each is addressed in greater detail in subsequent sections of this report.

1. Housing needs to be affordable, adaptable, and accessible

The Committee heard about housing needs across the country, from the need for increased rental housing for seniors in Cape Breton,[241] to issues with zoning in Vancouver and around Toronto that permits only single-family housing,[242] and to calls to ensure the continuing affordability of existing subsidized housing units.[243] Testimony by witnesses and in written submissions also considered affordability of housing as a critical factor in supporting seniors to stay in their homes and to “age in place”.

This message was also something the Committee heard in its recent study Breaking the Cycle: A Study on Poverty Reduction.[244] It was noted that affordable housing was an especially acute problem for First Nations seniors, recent immigrants, and seniors living in the metropolitan areas of Vancouver and Toronto.

Yet, in the intense focus on affordability, it can be easy to lose sight of important issues related to suitability. Accessibility and adaptability can be related to affordability but merit further scrutiny in their own right. They also play important roles in creating suitable housing which can delay and smooth transitions from completely independent living to more supported environments.[245]

According to CMHC, “[a]daptable housing design allows homes to be easily modified to meet changing needs over time, while reducing future renovation costs.”[246] As noted in the first section of this chapter, several federal initiatives fund such adaptation for particular populations. However, not all housing was designed in anticipation of such changes being required, and federal funding is not provided directly to homeowners or landlords to cover associated costs. Testimony described how older housing, for example, may not be sufficiently adaptable to allow someone with decreased mobility to stay in their home.[247] Research results from a study of seniors’ rental housing in Cape Breton were presented to the Committee, which also identified “design-related barriers to aging in place.”[248]

The Committee heard from the Canadian Association of Occupational Therapists, who identified several low-cost approaches to eliminating barriers that prevent people from living in their own homes, explaining that, “[o]ccupational therapists have a unique understanding of how individuals function in their living environment, and collaborate with home modification professionals to ensure that seniors’ needs and preferences are met.”[249] Testimony calling for the removal of physical barriers in the home was echoed by the Vecova Centre for Disability Services and Research.[250] Minister Duclos even noted that seniors often “require adaptation to their housing in order for them to stay at home and to live well.” The Minister went on to tell the Committee that the forthcoming federal accessibility legislation would address this issue.

Finally, numerous witnesses suggested that accessibility should be encouraged[251] or even required in new construction,[252] as has been done in the United Kingdom and Japan.[253] Other testimony called for the implementation of “universal accessibility standards for all new construction financed with public funds,”[254] or for making it a criterion “for awarding funds for new infrastructure or renovations to existing infrastructure.”[255]

a. Accessible housing can support transitions across a continuum of care needs

Health professionals refer to a “continuum of care” for Canadians as follows:

The continuum of care may be defined as the array of health services that spans the range over the life course from primary care (including prevention and health promotion) through institutionally based secondary and tertiary care to community and home-based services that promote health maintenance, rehabilitation and palliation at the end of life.[256]

To meet these health needs and more generally support the social inclusion of seniors, a range of housing transitions are possible and, for many seniors, likely: from private home ownership (and home care as required), to institutional assisted or supported living, to longer term care, and finally perhaps to a palliative care facility.[257] As posed by Leighton McDonald, representing the Canadian Home Care Association before the Committee, “If you have well seniors on this side, and seniors needing palliative care on that side, what are all the services required across the board, and how do we make sure we have that infrastructure in place?”[258]

With broad agreement among witnesses and across written submissions that acute care facilities should rarely and only briefly house seniors in this transition,[259] the focus was largely on “aging at home”, (home care is discussed in greater detail below). However, some testimony pointed out that other options are sometimes necessary. “Aging in place” is not a “silver bullet,” as described by the Chief Executive Officer of Langley Lodge, pointing out that maintaining independence is particularly challenging for older seniors who live alone.[260]

Even with home care and caregiving by friends and family (discussed in greater detail below), testimony to the Committee noted that some needs cannot be met in an individual’s home. Pat Armstrong, representing the Canadian Centre for Policy Alternatives before the Committee said, “The aging-in-place solution … ignores the fact that many people require skilled care that cannot easily be provided by partners and friends, who are themselves getting older, and it ignores the fact that many people live in places unsuitable for those with very heavy care needs.”[261]

Her testimony continued, with a focus on working conditions for staff providing services in home care and in long-term and other residential care facilities:

For those who can be cared for at home, we need to provide enough paid staff with appropriate skills, and create working conditions that ensure quality of life for those who provide, as well as for those who need, care… [In residential care,] we need to understand the importance of not only having enough staff but also having enough staff with appropriate education and conditions that ensure continuity in staff.[262]

A Conference Board report commissioned by the Canadian Medical Association and mentioned in testimony,[263] anticipated the shift from long-term care to home care, and still concluded that by 2035, an additional 199,000 new long-term care beds will be needed to accommodate new demand.[264] Other testimony flagged the increasing need for long-term care, highlighting the need for renovation and construction of such facilities.[265]

The Committee also heard testimony related specifically to palliative care for seniors, whether in their homes, in residential care, or in acute care facilities. The Committee learned that the supply and demand for palliative care are not matched. “It is estimated that 90% of Canadians will require care and support at the end of life, yet currently less than a third of Canadians are estimated to have access to high-quality palliative care services.”[266] Other testimony reported that, “only 16% to 30% of Canadians who die have access to or receive hospice palliative or end- of-life care.”[267] Some testimony proposed increased funding to meet the growing demand for end-of-life care.[268]

In particular, testimony with respect to hospice facilities offering palliative care emphasized the support for both the person facing end of life and the family members, who are often seniors themselves.[269]

b. Innovative housing models can support aging in place

Marika Albert, the executive director of the Community Social Planning Council of Victoria, described co-housing “as a model to support accessibility, affordability, and aging in place.”[270] She defined it, in the British Columbia context, as “a neighbourhood design that combines the independence of private homes—condo-sized units—with the advantages of shared amenities similar to co-operatives, and a village-style support system,” which she also described as a “co-care model.”[271] While co-housing is based on a private ownership model, Ms. Albert suggested that the co-care element could be adapted to co-operative housing.[272] This model was supported by other testimony as promising, possibly providing “friendship and community feeling”.[273] A proposal from CARP encouraged funding and removing barriers in order to support innovative housing arrangements such as co-housing.[274]

The Chief Executive Officer of Réseau FADOQ told the Committee that intergenerational housing developments contribute to “inclusion [and] keeping people active.”[275] The Coalition for Healthy Aging Manitoba and the Manitoba Seniors Coalition both called for federal funding for innovative housing approaches, including intergenerational housing.[276]

C. More focus is needed on the community

In her testimony before the Committee, the representative from the Public Health Agency of Canada told the Committee of the Agency’s work with provincial and territorial governments and other stakeholders “to help communities become more age friendly,” with focus on “multiple aspects of community life, including transportation, housing, social participation, and inclusion.”[277] Her testimony continued, “An age-friendly community recognizes that seniors have a wide range of skills and abilities, respects their decisions and lifestyle choices, and supports seniors who are vulnerable.”[278]

Many witnesses talked about the contributions that age-friendly communities make to social inclusion and the quality of life for seniors. Other testimony, however, described some of the challenges in implementing the age-friendly vision. For example, Glenn Miller, of the Canadian Urban Institute, told the Committee that of the 25 largest cities in Ontario that have committed to becoming age-friendly, “none of these cities has yet acknowledged their commitment to become age-friendly in their land-use plans.” It is noted, however, that “the City of Toronto recently agreed to acknowledge age-friendly design and development in the city's official plan when the process of updating the plan begins next year.”[279] Glen Miller proposed that CMHC be funded to “undertake innovative research in areas such as age‑friendly development.”[280] Other testimony proposed similar initiatives, including the “adoption of Age Friendly Community targeted funding to help promote age-friendly communities in our provinces and municipalities.”[281]

1. Accessible public transit is a necessary component of age-friendly communities

Public transit was identified as a necessary component to any age-friendly community, with several witnesses noting that a lack of access to transportation was a major contributor to social isolation.[282] A requirement for age-friendly communities frequently identified in testimony was accessible transportation, for medical appointments and for social interaction and civic participation. Federal leadership and/or support for such services was proposed as one solution.[283] As described by a submission from CARP:

Public transit is essential for the social participation of seniors. In Canada, 5% of senior men and 14% of senior women require transportation assistance, and this increases to 28% and 54% for the oldest age group (90+). Among women aged 85+, approximately 25% have identified transportation as a barrier to participating in more activities.[284]

Transportation for seniors was identified as particularly problematic in rural communities,[285] where solutions often required reliance on volunteers to do the driving[286] or partnerships between senior-serving organizations and private-sector transit providers.[287]

2. A broad range of health and social services need to be available for all seniors

Testimony from a wide range of individual and organizations focussed on the need for services to be accessible to those who need them, from specific health services (e.g. speech-language pathology and audiology services)[288] to social and cultural activities.[289]

Testimony also identified language as a barrier to services for seniors who were newcomers to Canada,[290] recommending that culturally appropriate services in minority languages were important as a means to remove that barrier to services and social inclusion.[291]

D. Home care, home care, home care

Central to aging in place is the availability, affordability and quality of home care supports which include a wide range of supports and services, well beyond the traditional health care provision. According to Jean-Guy Soulière from the National Association of Federal Retirees, “Home care is not limited to just health care, but also includes access to non‑medical support services, like housekeeping, meal preparation, transportation to appointments and social activities, as well as snow removal.”[292] Testimony indicated that the inconsistency in the availability and affordability of home care supports varies not only between urban and rural environments,[293] but especially among provinces and territories.[294] To address unequal access to home care, proposed approaches varied from a general call for pan-Canadian standards[295] through to amendments to the Canada Health Act.[296]

Many witnesses and submissions commented that home care is less costly than acute or long-term care.[297] Specifically, the president of the Canadian Medical Association told the Committee that acute care costs on average $842 per day, while home care costs $45 a day.[298] A CARP representative also pointed out that “from a business point of view it makes so much more sense for us to keep people home where they want to be, where it's cheaper for them to be, and where they will have better outcomes than for them to be prematurely moved to long‑term care hospitalization.”[299]

Witness testimony proposed the use of multi-disciplinary teams in delivering home care supports.[300] Others noted that home care could be improved by the use of health professionals, but not necessarily physicians, in the management and delivery of health-related home care services. The role of nurses was highlighted,[301] and the Committee also heard of the added value (and savings) that would be gained by including occupational therapists in assessing home care needs.[302]

1. Technology has the potential to make significant improvements to home based care

Technology-enabled home care focuses on prevention, independence, and quality of life. “For frail seniors with complex care needs, deployment of innovative technology-enabled home care solutions can mean the difference between being an active participant in their community or living their remaining years isolated or in institutional care.”[303] The ways in which technological developments can support home care were described for the Committee by Melissa De Boer, a nursing student at Trinity Western:

better control of chronic illness through remote patient monitoring; improved safety in the home due to the ability for technology to alert caregivers and health care professionals of early signs of deterioration in health; enhanced self-care and person-centred care through the provision of education and active patient engagement; improved safety and medication management for people in their home… and increased access to appropriate care in rural, remote, and hard-to-service areas.[304]

The Committee heard that the digital revolution is already supporting “aging in place” by monitoring health conditions of seniors in their homes,[305] while other testimony highlighted the great promise in existing and emerging technologies in supporting home care and aging in place.[306] Several witnesses suggested greater financial support for research and application of such technologies to home-based care for seniors.[307]

While most testimony was supportive of using new technologies to support seniors in their homes, cautions were also raised.[308] In their written submission, the Little Brothers Organization described such concerns:

These [technological] solutions may be appropriate for young seniors or active seniors. They may prefer to go to the automatic teller rather than wait in line at the counter and make their purchases or manage the services they use online rather than make time-consuming in-person appointments. Older seniors who left the labour market before computers, the Internet and email were introduced may not be comfortable with or even able to use these technologies.[309]

2. The present structure and funding of health care hinders establishing a system of home-based care that is needed to age in place

A major thrust in Committee testimony related to how Canada’s health care system is funded and structured, and the critical importance of changes to both. As described by the president of the Canadian Medical Association, “It is critical for us to decentralize health care services from hospitals towards communities and home care.…”[310]

In his testimony, he added, “[T]he health care system is not designed to treat elderly people suffering from multiple chronic illnesses who do not want to spend their final days in a hospital bed, or in an emergency room with strangers or people who are not part of their circle. They want to be treated at home.”[311] The Committee heard that provincial governments spend, on average, less than 5% of their health care budgets on home care,[312] and that a shift from “hospital-centric care”[313] to home care is “essential” and “urgent.”[314]

3. There is a critical shortage of trained home care providers

Testimony emphasized the growing demand for home care supports, some of which will be provided by paid providers; other testimony questioned whether there will be enough workers to fill the need.

[W]e are putting personal care workers into homes, with professional staff to supervise, oversee, and provide some additional help. Are we, however, going to be able to find the human resources to hire? That's one of our big questions. I think our advanced education system can ramp up a bit to create the programs, but can we fill the seats? Can we train the people so that they're there to hire? We also need leaders. You can have people in the trenches, but you need leaders who have the skills.[315]

As described by Birgit Pianosi, who teaches gerontology, the need can be met with :

A strategy that provides the right education and training opportunities’ to ensure [and that will] ensure that Ontario and Canada gain an informed workforce that will have the necessary knowledge, skills, and confidence to identify issues of need amongst older adults while delivering them the right care, in the right place, at the right time.[316]

Several witnesses echoed the importance of training individuals to meet the need for providing appropriate care for seniors, especially in their homes.[317]

4. Informal caregivers need more support

Family and friends were identified as “a vital part of the home care and health care system,”[318] providing approximately 70% of all care provided to Canadians, most of them seniors.[319] As described by British Columbia’s Seniors Advocate, “Informal care or family caregivers … is … not to be underestimated as a solution to caring for our aging society in a way that is potentially more cost-effective, although not always, and it is certainly more centred on the needs of the seniors themselves.”[320] The combination of savings and social benefits was identified by other witnesses[321] as reason to provide as much support as possible to these family members, friends and other volunteers.

As noted by one witness, most paid and unpaid caregiving of seniors is provided by women.[322] Data also show that women spend more time on senior care than men: of the women providing senior care, 49% spent more than 10 hours per week on the activity, compared with 25% of the men who provided senior care.[323]

Financial support for informal caregivers in the form of various tax measures has been identified in Chapter 3 of this report, along with proposals for improvement to these and other benefits provided by all levels of government. However, witnesses and submissions identified other important dimensions of support: providing respite care, professional support, and support from employers.[324] Several witnesses identified respite care as an important support for informal caregivers[325] who are also employed but also for those who are not in the paid workforce.[326] One submission highlighted the importance of this not only for sustaining employment, but also for helping “maintain networks and social relationships.”[327]

Minister Duclos recognized the balancing act between employment and caring for a loved one that informal caregivers carry out.[328] This concern was echoed by other testimony as well.[329] As described by Irene Sheppard, executive director of Fraser Health,” [w]e know that families are willing to care, but they do need workplaces that support them to do so.”[330] Witnesses proposed education and other initiatives to increase employer understanding and accommodation of informal caregiving responsibilities.[331]