The Old Normal
The evidence is accumulating. Our seniors’ care system is not keeping up with the growing diversity of Canada. It has failed to provide equitable access to care that is culturally and linguistically appropriate. Many long-term care (LTC) homes that cater to specific cultural or religious groups have extremely long waitlists across the Greater Toronto Area (GTA). Worsening health outcomes have been reported by family caregivers whose loved ones were placed in LTC homes without options for familiar food or people who understand their culture and language. Immigrant seniors in the GTA have reported that they were less likely to receive publicly-funded home care than non-immigrant seniors, while experiencing higher unmet needs for care. In focus groups and interviews conducted by Wellesley Institute, family caregivers of immigrant seniors shared how limited access to culturally and linguistically appropriate care could exacerbate stress.
Inadequate access to seniors’ care negatively impacts the health and well-being of seniors and their informal caregivers. As those with unmet needs ultimately end up requiring more health care resources, inadequate access to seniors’ care also has significant cost implications on our health care system. A recent report by Canadian Institute for Health Information found that about one in nine newly admitted residents in LTC homes could have potentially been cared for at home with adequate home care services. About 15 per cent of hospitalized Canadians are designated as Alternate Level of Care (ALC) patients, which means that they are ready to be discharged from hospitals but do not have other appropriate settings immediately available for them to move in, such as home or LTC settings. In Ontario, home care on average costs about $103 per day for a high-needs person, compared to $182 for a LTC bed, and $730 for an acute care bed. The Canadian Medical Association estimated that by freeing the ALC beds Canada would save $2.3 billion annually that could be better spent elsewhere by providing more appropriate levels of care to seniors.
The Pandemic Impact
Seniors have been taking the brunt of the pandemic impact and certain groups have been affected more than others. We do not fully know how COVID-19 has impacted seniors’ access to care, or the health outcomes of diverse senior populations and their family caregivers because of limited socio-demographic data. But we do know from Canadian and international evidence that racialized populations in general are experiencing disproportionately higher rates of COVID-19 infections and related deaths. Studies in the US found that nursing homes with higher shares of Black or Hispanic residents were more severely affected by COVID-19, than those with mostly white residents. Using the concept of “double jeopardy,” international research described the COVID-19 experiences of Black seniors in the U.S. – facing higher risks for infections and poorer health outcomes – as shaped by long-standing race- and age-based inequities and social vulnerabilities.
The pandemic may have intensified existing disparities in access to LTC and home care for racialized groups. Ontario’s LTC COVID-19 Commission heard that being cut off from families during the pandemic left LTC residents, especially those whose mother tongue is not English, more isolated without the support of their family members to bridge the language gap.
A New Normal for Seniors’ Care
Existing research and decades-old advocacy for better seniors’ care demands a call for strengthening home and community care supports so that people can age in place safely and with dignity, and comfort for as long as possible. For those needing residential care, amidst the COVID-19 pandemic, we have seen a growing consensus on the need for reforming LTC into more person-centred, home-like environments.
The 2021 Federal Budget clearly made commitments to strengthening seniors’ care through supporting seniors to age in place with enhanced home and community care, as well as establishing new national standards for LTC. Ontario’s LTC COVID-19 Commission’s final report urged leaders at every level to reimagine seniors’ care and move towards a person-centred model, focusing on supporting diversity in the services provided in LTC. To prioritize health equity, this is an opportune time to fulfill and promote the Residents’ Bill of Rights under provincial legislations like Ontario’s Long-Term Care Homes Acts, 2007, which requires homes to be operated so residents “may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.” In fact, a LTC home should be “primarily the home of its residents” – the fundamental principle of the LTC Homes Act.
As we rebuild seniors’ care in Canada, we must ensure that our new normal reflects the growing diversity in planning and delivering care across a continuum of seniors’ care – whether improving home care or promoting home-like residential LTC. Cultural and linguistic accommodation must be recognized as a critical element of care that helps create such home-like environments.
What It Would Mean
With enhanced access to care that reflects an individual’s culture and language at home or in their community, seniors will have better chances to age in place with safety, dignity, and comfort as long as possible. When individual needs require more intensive care, seniors could then move into home-like residential care settings where they would receive quality care that is culturally and linguistically appropriate and feel safe, included, and respected by staff and peer residents.
This approach would significantly reduce the extremely long wait times for certain cultural or religious LTC homes, while reducing ALC days and alleviating pressure on the health system. Overall, this would eventually mean improved health and well-being outcomes for all seniors and their family caregivers.
How We Get There
To strengthen the system’s capacity to provide culturally and linguistically appropriate care that reflects the local population needs, Wellesley Institute’s Policy Brief proposed three specific recommendations: i) providing on-going, targeted funding that accommodates the needs of underserved populations from diverse ethnocultural communities and informing seniors and family caregivers from these communities about available programs and services; ii) providing a coordinated interpretation system that is accessible by all clients and service providers; and iii) developing and implementing a mandatory standardized cultural competency training program for all staff supporting seniors.
To do this effectively, Canada’s seniors’ care system requires an accurate understanding of the ethno-cultural and linguistic needs of senior populations. Enhanced collection and utilization of socio-demographic data can be an effective tool to achieve this goal and build an equitable and fair care system for all seniors.
Finally, federal and provincial governments must commit to developing and meeting targets for health outcomes for seniors requiring care. Those outcomes must include equity commitments and must be achieved equitably. Funding, training, and laws, regulations, and policies all have an important role to play, but our system must be measured against a vision and metrics that meet what is needed for health equity and what is morally just.
With reforming seniors’ care high on the federal and provincial agenda, we have an important opportunity to embed diversity into how we provide care for seniors across Canada – a significant step forward to achieving health equity.