When it comes to where you live, culture matters. Growing media and public attention is shining a light on how long-term care (LTC) is structured and delivered right now in Ontario. And while there is a growing understanding about the need to reform Ontario’s LTC services there has been less discussion about how to ensure access and quality for Ontario’s diverse populations.
How we age in this province is an important determinant of health. Where we spend our twilight years is something we must plan for in such a way that is equitable and meets the needs of all Ontarians. The Ministry of Health and Long-Term Care issued a discussion paper in December to improve the connections between LTC and other health services and to promote equity in home and community–care access. This is a step in the right direction but there are some hurdles to be cleared to ensure equity is built into the new structures.
Currently, people who need residential LTC have two options: they can wait for a publicly-funded LTC home bed or they can pay out-of-pocket for private residences like retirement homes. The waitlist for a publicly-funded bed is long and low-income residents seeking a government subsidy can only choose dorm-style residences, not private rooms.
Looking at the Community Care Access Centres’ (CCACs) LTC waitlists across the GTA reveals that some people may wait few months or years longer than others according to their linguistic and cultural needs as well as their ability to pay higher accommodation fees. It’s a double whammy.
The top three facilities with the longest waitlists in the GTA are two Chinese homes and one Greek home in Scarborough. Current residents in these popular homes waited about seven or eight years to secure their bed in a shared room. According to the Toronto Central CCAC waitlist data, on average, nine out of ten basic-room residents waited 538 days and private-room residents waited 465 days for their bed in one of the eight ethno-specific homes, about six months longer than those who were placed in mainstream homes (for both basic and private rooms). In spite of the long waitlists, many immigrant seniors, especially those who speak little or no English, are waiting for a placement at an ethno-specific home offering support by staff speaking their mother tongue, traditional cuisines, and cultural activities.
Further, we found a large gap in waiting times between basic rooms (i.e., two to four beds per room) and private rooms, indicating income-related inequities in LTC access. According to the Toronto Central CCAC waitlist, nine out of ten basic-room residents waited about three months longer than private-room residents for their bed (397 versus 311 days). The monthly accommodation rates, set by the MOHLTC and paid by residents, are currently $1,774.81 for basic rooms and $2,535.23 for private rooms. Low-income residents can apply for government support, but only for the basic room. Consequently, those who can afford to pay more may get placed faster in private rooms, regardless of the level of their care needs. This creates an obvious inequity in who gets care first, and in some cases who gets better care.
Cultural accommodation is so important for the health, well-being, and quality of life of residents in LTC homes. Among others, proper food is the top requirement when children from ethno-cultural communities check out homes for their parents. Chinese seniors, for example, would prefer congee rather than toast and cereal for breakfast and rice rather than pasta for supper. Some seniors may not eat rather than having something so different from what they usually eat at home. Research shows that culturally-appropriate meals can promote residents’ food and liquid intake, which in turn can reduce the risk of malnutrition and unintended weight loss, prevalent concerns for LTC residents. Also important is culturally-sensitive care offered by residents’ own language. It has been reported that linguistic and ethno-specific care services have positive impacts on residents’ physical and mental health such as reduced social isolation, lower rates of depression, and fewer falls and hospitalizations.
Finding a bed in an ethno-specific LTC home has been extremely challenging for many because demand is much greater than supply across the GTA. For low-income seniors, it can be even more difficult to secure a bed at a preferred home that meets their own financial and cultural needs.
As our population ages and becomes more diverse, the demand for LTC in general and for culturally-sensitive LTC services in particular will continue to grow. To serve our seniors better, we need to understand more fully about the inequities in accessing LTC across a wide range of services including home and community-based care. Our preliminary findings from the CCAC waitlist analysis offer limited, but important data which can spark discussions about the needs to improve cultural accommodation across LTC homes and to reduce financial barriers. We need to continue this discussion about the existing inequities in LTC access and to think about the ways to improve equitable access to LTC services for our marginalized senior populations. With this issue high on the provincial agenda, we have an important opportunity to build equity into how we provide LTC in Ontario.