By Louise Crandall, Manager, Public Affairs and Communication, VON Canada
So, you’ve been putting off ‘the talk’ with your elderly parent for ages and all of a sudden it’s a crisis – a health emergency happens and he or she needs immediate care that family members can’t provide. You’re never prepared – either emotionally or with all the facts.
This just happened to me. Two full days of phone calls were necessary to find out how the system worked in my home province (Ontario) and to make arrangements for my father, who lived a six hour drive away, to be admitted to assisted living residence a couple of hours closer. I needed to call a dozen retirement residences to see if they had assisted living facilities and, more importantly, a room. I had to call doctors to have files transferred. I had to call the local Community Care Access Centre, which arranges support services in Ontario. I had to call lawyers and I had to arrange extra help for my father from a personal support worker (PSW).
There are a number of questions you need to ask – either yourself, your parents, a doctor or a case worker – when helping someone made the transition from independence to receiving care at home or in a facility. But do this before it becomes a crisis.
What level of care is needed? Are they fairly independent but just want someone to provide meals and housekeeping? Or do they need substantial nursing care or help with the activities of daily living such as showering or dressing? Can they live in a facility with open doors or do they need a secure (locked) floor to prevent wandering? Or could they remain in their own home with some support services?
The answers to these questions will determine whether a retirement residence will be fine or whether your parent should move into a nursing home (also known as a long-term care residence). Some retirement residences offer assisted living, which means help with meals, medication, recreational activities, dressing, etc.
What can we afford? Retirement residences offer services that can range from a chauffeured limo, a theatre, to help with showering. But they are not provincially regulated and can cost thousands of dollars a month, depending on the facility and services offered. And the key thing to know is that usually no government subsidies are available–the resident has to bear the cost.
Long-term care residences (nursing homes) are provincially regulated and must meet specified standards. They generally cost less than retirement residences and in many provinces subsidies or co-payment can be arranged depending on the financial circumstances. (In Ontario, the cost can range from $1,600/month for a shared room to $2,160 for a private room. In BC, the cost ranges from $900 to $2,930/month.)
How does admission work? You are on your own to find a suitable retirement residence. Admission into long-term care facilities, however, is managed by specific groups working within each province’s health ministry. While the responsible body is different in each province, the process is fairly similar. You first need to contact the right agency, open a file and request an assessment. But here is the key thing you need to know–admission to a nursing home can take months to arrange. (In Ontario. the average wait is 106 days.) The preliminary assessment by a case worker (usually a nurse or social worker) might itself take weeks to schedule. Even finding a ‘crisis bed’ in a nursing home might take weeks (which is when retirement residence respite beds and home support come in useful).
What about timing? Timing is critical but is something you usually can’t control. Just because you’ve chosen a suitable, affordable retirement residence doesn’t mean a bed will be available when it’s needed. Many have waiting lists that are months or even years long. And what if you tour the local nursing homes and choose one you like in the anticipation that your parent will have to be admitted at some point? In Ontario, you submit three nursing home choices to your CCAC case worker but if the call comes that a bed is available and you turn it down because mother or father is managing okay right now, the file is closed for six months.
What should you look for in a retirement/assisted living residence? This depends on what services and amenities the person needs and can afford. These facilities can range from basic to luxurious, and are priced accordingly. Find out what recreational programs and meal plans are available if that is important. Ask what health services are provided. Is there 24 hour registered/trained staff available? Is there supervision with medication? Are there charges for the additional services? What happens if the resident’s health deteriorates?
What should you look for in a nursing home/long-term care residence? Since they are provincially regulated, these facilities must meet specific standards. But quality and service still vary. Make sure the residence meets the accreditation standards established by Accreditation Canada. Check whether registered nursing staff is available 24 hours/day. Look at the general appearance of the residents and the facility. Is there a secure environment? Are staff are trained to meet any special or unusual needs? What is the quality of meals? How are concerns, questions or special situations handled?
What about home and community care services? This can be a good option either in the short-term until a nursing home bed becomes available, or as a way to keep seniors in their own homes as long as possible. There are two types of home care services. Home support services include assistance with daily activities (e.g. bathing, dressing, grooming, getting up or into bed); assistance with medications; respite care to give a caregiver some time off; and help with light housekeeping, laundry, and meal preparation. These services are generally provided by trained personal support workers. Home nursing care on the other hand offers a range of professional services including health assessment, dialysis, wound care, intravenous care, medication management, therapies, teaching of self-care, and more.
How can we access home care?
Home care services can be provided by either government (e.g. in Alberta), private sector companies or not-for-profit organizations, often under contract to the responsible provincial ministry. But you should know that available home care services depend on where you live, and small or rural communities may have few offerings. If you live in Ontario and Nova Scotia, the services might be funded by the provincial government, user-pay and insurance plans, or provided by a volunteer (or a mix of all four). In most other provinces, home nursing is delivered by government staff while home support is generally provided by both for-profit and non- profit agencies.
But once again, a provincial agency is responsible for assessing the need, determining what services will be provided and/or paid for, and who will deliver these services. As with admission to a nursing home, this requires first opening a file and having an assessment by a case worker, which might take weeks to schedule. After the assessment, it is quite possible that the person is assigned a low priority for publicly-funded home support services. If you have insurance or are willing to pay for extra help, home-based care services can be arranged from an agency or individual.
The need for senior care could happen gradually or over a day, as in my parent’s case. So, don’t postpone that talk with elderly parents about where they want to live when the time comes, and what they can afford. And if the time seems near–however difficult it might be–tour the retirement residences or nursing homes in your area to see what is available. Maybe put your name on a waiting list. And make that call to the Community Care Access Centre or your provincial equivalent.