Aging at home is not an impossible dream

It’s no wonder that few people want to spend their golden years in a government-operated long-term-care facility.

Sterile rooms and impersonal care from overworked staff are not exactly things to look forward to. It’s far better to spend time with loved ones, in one’s own home.

When a pollster asked Quebecers, for instance, they found that over seven in 10 were hoping to remain in their homes past age 75. In contrast, less than one per cent favoured living in government-run long-term-care facilities.

Like elsewhere in Canada, unfortunately, long-term-care systems in Quebec lack the capacity to provide adequate levels of home care, as this has never been prioritized. Shifting the long-term-care system to focus more on home care services would help give seniors what they want — and “cash-for-care” models could be the key.

Common across Europe, these models offer seniors a choice between government-funded services or cash to spend as they see fit on their home care needs. This offers increased autonomy to seniors and a say in the care they will receive according to their needs, rather than standardized institutional procedures.

While the exact level of control over how the money is spent varies by country, when offered the option, seniors prefer these models which allow them to age with dignity and within their own homes.

But in Canada, one in nine institutionalized seniors could have remained in their homes had there been adequate support to do so.

This support could be made possible by cash-for-care models thanks to the compensation of informal caregivers, as is done in the Netherlands and Germany. This helps reduce the cost borne by relatives in caring for their loved ones, as much as it can help cover arrangements with home care workers.

Let’s not forget that about three-quarters of home care services for seniors in Canada are provided by family. There’s no doubt that such informal compensation arrangements would help relatives who want to provide care but can’t afford to do so.

Another key benefit of cash-for-care models is introducing competition into the long-term-care system. To be frank, government-run care institutions are practically nobody’s vision of a dignified way to care for seniors in the long-term. Unfortunately, for many they are the only option on the market.

This means that the country’s government-operated long-term-care facilities can expect to get financing, no matter whether they’re doing a great job or barely meeting the minimum standards set by ministries of health.

With a cash-for-care model, the funding follows the senior rather than the institution. This means that for government-run long-term-care homes to get funding, they need to be able to attract clients based on the quality of the services offered.

Cash-for-care is not a panacea. It needs to be accompanied by support measures such as training programs for informal caregivers and periodic home visits by licensed professionals, as is done in Germany. This helps address the gap in quality when care is provided by loved ones rather than trained professionals.

What cash-for-care models show, however, is that there is a way to make home-based care accessible to more seniors.

When given the choice, people prefer to live out their days in their homes, among their loved ones, rather than in impersonal government institutions with a set number of sponge baths per week.

Our country has the means to respect those preferences, and those who built the society we live in today deserve nothing less. Let’s give them our thanks by letting them age in their own homes, with dignity.

Krystle Wittevrongel est analyste senior en politiques publiques et leader du Projet Alberta à l’IEDM et Emmanuelle B. Faubert est économiste à l’IEDM. Elles sont les auteures de « Vieillir chez soi – Les modèles de prestations pour soins réduisent l’institutionnalisation » et signent ce texte à titre personnel.