One in nine newly admitted residents of long-term care facilities could have remained at home with proper supports, according to a new Canadian report.
The analysis by the Canadian Institute for Health Information, which is being released on Thursday, is based on data from several provinces for 2018-19, before the coronavirus pandemic.
“Most of us want to age in place. Most of us don’t really want to go to an institution,” said Tracy Johnson, a director of research and analysis at CIHI, the country’s health care statistics agency.
During the pandemic, advocates for the elderly have called for additional home-care funding to allow more older Canadians to avoid or delay moving into nursing homes. More than 80 per cent of Canada’s COVID-19 deaths have been linked to seniors’ homes.
The CIHI report also concluded that more than one-third of unpaid caregivers for people receiving home care services experienced feelings of distress, anger or depression. Ninety-six per cent of individuals on long-term home care had an unpaid caregiver.
Distressed caregivers spent an average of 38 hours a week providing care, twice the amount of time as those who did not report challenges. Distress rates were higher among those caring for individuals needing greater assistance and those who lived with the person they helped.
CIHI found that 11 per cent of newly admitted long-term care residents in 2018-19 could potentially have done well living at home while receiving continuing home care. This group needed limited assistance with activities such as eating, toileting and bathing. They also had little or no cognitive impairment, and had no history of recent falls, wandering away or challenging behaviours. There was no information available on whether these individuals had supports before moving into nursing homes.
The report found that those who could have stayed at home represented more than 5,000 long-term care spots in the eight provinces and territories that provided 2018-19 data.
“If we can free up the beds for the people who most need them, then you potentially … don’t have to build as many,” Ms. Johnson said.
The study found that new long-term care residents who could have remained at home with supports were more likely to be from rural areas and to live alone. The proportion varied by province, with rates nearly twice as high in Saskatchewan and Manitoba as they were in Alberta and Ontario.
Long-term care residents and their family members reported a range of barriers to staying at home, including difficulty navigating the health care system, out-of-pocket expenses when publicly funded home care didn’t meet all their needs, problems with reliability and flexibility with home care, and issues accessing special services, such as non-medical needs and emotional support.
Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, said even modest investments in the home care system would divert a substantial number of seniors from more expensive nursing home beds.
“The return on investment is obvious and profound when it comes to investing in home care and being able to avoid the need for long-term care,” he said.
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Jill Mahoney