The long-promised surge of baby boomers in massively increased numbers into their truly senior years is about to happen. Will they have the homes, the care and services they need? It seems unlikely – unless Manitoba gets serious now about putting the necessary supports in place.
It has been dubbed the “Silver Tsunami’– the large wave of baby boomers that will start hitting age 75 in 2021, just seven years from now. This is when the demand for housing and care options for the elderly will start to rise dramatically. By 2036 our province is expected to need between 5,100 to 6,300 more personal care home beds according to a recent study by the Manitoba Centre for Health Policy.
The situation is already disturbing. Emergency rooms are crowded, with long wait times the norm. Hospital beds are filled with elderly, who are employing these acute care facilities for non-acute care at extreme cost to the taxpayer. Why? Because the overwhelming need for care/housing options is not being met.
Places for the elderly to go are few and far between. According to a recent Winnipeg Regional Health Authority memo – Dec. 31, 2013 – there were 109 people in hospitals and 286 people in the community waiting for placement in personal care homes. Many of these homes have a one- to two-year waiting list for admission.
System backed up
This non-acute use of hospital beds is a concern for two main reasons. For patients it means that they are not in the most appropriate place for the type of care they need. For hospitals, it means that beds are not available, causing back-ups in the system, such as longer wait times for elective surgeries or admissions from emergency departments. The latter backup, of course, reduces space in the emergency rooms for others to access in cases of trauma or extreme illness. Something needs to change soon.
There are those who think the obvious answer is to build more personal care homes. However, this is a costly venture. PCHs accept residents who need the greatest care, but they’re also the most expensive to build and maintain. The WRHA estimates the cost of building a PCH these days at approx $275,000 per bed.
Since 2006, the government has instituted an “aging in place” policy that emphasizes keeping seniors who have less serious cognitive or physical issues in their homes, or the community, as long as possible. It has encouraged the construction of assisted living facilities and created supportive housing units. There are over 50 of these two types of facilities in Winnipeg, built to provide alternatives to PCH placement.
Currently the government subsidizes three housing “models” for long term care – supportive housing (WRHA spends about $42 per client per day), personal care homes and chronic care facilities (the latter two models cost about $120 per client per day). The new continuum of long–term care for seniors is seen as beginning with homecare (workers providing assistance in one’s home), then on to a supportive housing facility, then to a personal care home. The government generally sees supportive housing as a substitute for PCH care, for those residents with relatively lower care requirements.
Primarily designed for the elderly with dementia, supportive housing facilities provide 24-hour supervision/support in a secured environment to those who need some assistance managing with physical limitations, or have ongoing health conditions. SH guidelines have distinct entrance/exit criteria for their residents, and depend greatly on family members, or advocates to address health concerns.
However, what happens to those who require more care than that offered in a supportive housing facility, or who don’t meet the eligibility requirements for one in the first place – but are not yet eligible for PCH placement?
Often these seniors must remain in their homes with hours and hours of homecare services to assist them. And because homecare was never meant to be a guaranteed service, involvement is expected of family members, to pull up the slack at a moment’s notice when workers are unavailable through illness, holidays or short-staffing.
But what happens to those who have little or no family support? Or those who already have the maximum hours homecare is able to provide – and are still not coping? Or families who have caregiver burnout resulting from their efforts to supplement homecare services? What happens is that the level of safety, quality of care and quality of life goes down and some seniors, sadly, fall between the cracks. Emergency rooms see an overwhelming number of seniors repeatedly, the victims of anxiety or even just the stress of being alone.
The long personal care housing waiting lists are causing substantial stress; even supportive housing facilities are feeling the strain. At one time the only homecare staff mandated to assist in these facilities were visiting nurses. Now, it seems that the Winnipeg Regional Health Authority has no choice but to call on homecare workers to supplement staff at the SH facility, while the resident waits for a bed to open up at a PCH.
It must be very costly for the WRHA to do this. Essentially, they are subsidizing twice – paying $42 a day to SH for staffing, and then paying for the homecare worker visits. Part of the problem is that the supportive housing staff, or “tenant companions” are limited as to how much assistance they can, under WRHA guidelines, provide their residents. Recent discussions with the WRHA long term care decision makers have revealed that they do not want SH facilities to be “health care” facilities.
In February 2011, a University of Manitoba Centre for Aging research study concluded that “in making plans for [elderly care], long-term planners will need to either 1) change the current philosophy of supportive housing to accept sicker people and expand the program or 2) build more PCH beds”.
Other provinces have an answer
Other Canadian provinces have an offering that, ideally, would help solve the PCH/hospital dilemma: a fourth recognized “model” of care, an alternative type of long-term health care facility that could provide medium and lighter care than a personal care home (somewhere between a PCH and assisted living facility). It would be an option for those who do not meet the eligibility requirements for SH or PCH, yet are unable to cope in their current living situation. This model of care would offer 24-hour health care and support to their residents by on-site staff.
The model would help reduce the strain on home care workers in the community and greatly reduce family caregiver stress by offering a homey and non-institutional care/living option for the elderly. Within this safe environment seniors would be provided with nutritious meals, 24-hour attention to health care needs, housekeeping and laundry, and recreational activities to increase social stimulation. Such a setting might even prevent premature placement – or help eliminate placement – into a PCH.
This type of facility already exists in Winnipeg. The Thorvaldson Care Center, located in Osborne Village, is Manitoba’s only “intermediate” care facility for seniors. Established in 1959, this operation has been owned and run by my family for the past 55 years. Originally located at 5 and 7 Mayfair Place in Fort Rouge, we operated as a “nursing home” (as it was called back then) with 38 residents; in the late seventies we transferred to a lighter level of care in a new location. My father, Herman, purchased four older homes on Stradbrook Ave., one of them being the childhood home of Premier Duff Roblin.
At that time, our homes (with 44 residents) were licensed by the provincial government (Manitoba Health) as a residential care facility for the “aged and infirmed”. During the 1980s there were about 10 to 12 other smaller residential care homes around Winnipeg also catering to the elderly, all of which have since closed.
In 1992, my family decided to start the process of tearing down the old homes in favour of constructing a newer, more modern facility, still government licensed (Department of Family Services). This new building, designed by my father, allowed us to become bigger (now licensed for 70 residents) and provide better, more comprehensive services to our residents.
What sets us apart from other Winnipeg facilities is the level of health care we are able to offer. With an on-site registered nurse and health care aides, we provide prompt, consistent attention to our residents 24 hours a day. Medications, eye drops, inhalers, dermal patches are administered and charted. Assistance with personal hygiene, dressing and grooming is attended to, along with overnight monitoring and checking. The RN monitors the health of each resident and is in frequent communication with their medical practitioners and family members.
Blood pressure/blood sugar levels can be monitored; prescription refills and changes are attended to; medical appointments transportation can be arranged. In-house blood-work labs visit weekly and portable x-ray services can be ordered.
Each resident has a private, comfortable bed-sitting room. Cozy dining rooms are located on both floors.
With the exceptional, comprehensive level of care provided our residents, we strongly believe that our care centre is that missing fourth model of care that the elderly in our province desperately need.
Trial run proposed
But unfortunately the provincial government and WRHA do not seem to see it that way at this time. We are told that we do not “fit” into any of their long- term care categories – therefore are ineligible for any funding. Unlike some other facilities, all our capital and operating costs are paid from the residents’ rent.
We have offered our many years of knowledge and expertise to the WRHA, inviting them to use our facility as a pilot project – a moderately sized intermediate care facility to fill the void for the hundreds of elderly in that grey area of inadequately met care needs.
This model of care is efficient and would be invaluable to our health care delivery system. It would reduce the present excessive costs of care for the elderly in hospitals and help ease the congestion. PCH beds currently used for lighter care could be freed up to accommodate patients with higher need levels. With a nurse on staff to monitor health and watchful for problems, emergency room visits would be reduced.
For over five decades my family has been privileged to be of service in caring for seniors. We have worked earnestly to maintain integrity in the attention and services provided. We have helped those at a particularly vulnerable time in their lives. Over the many years, we have cared for and made a difference in the lives of over 5,000 elderly – one day at a time.
Herman Thorvaldson and daughters Jocelyn and Karen have been the heart, the spirit and the hands-on operators of the Thorvaldson Care Center for over half a century.