Gaps exist now, and cities and countries around the globe should be paying attention.
Last month I wrote about the importance for our Manitoba seniors of being able to “age in place”. But there comes a time when it is no longer safe or possible to continue living independently in one’s own home. Places for the elderly to live can be scarce for people who need a higher level of care.
The first option many choose, partly because they no longer want the demands of yard work, is a condo or life lease without any care provided or a rental apartment. This is considered independent living. Some condos are easier to find than others, but many of the life lease options are scarce, with waiting lists of three to five years.
Assistance at a price
The next step for most people is an apartment where you pay a monthly rent that includes some or all meals, recreation programming and often a shuttle service for groceries and appointments. This type of housing is often referred to as assisted living. The waiting time to get into one of these units is not as long, but the housing is expensive. People on a limited income cannot afford the $2,500 to $3,500 monthly cost for these units.
Between this level of housing and a personal care home there are a few alternatives with varying levels of care; all include meals and some type of supportive housing. Supportive housing combines community living in a secure apartment setting with personal support services. The resident pays for rent and a service package (meals, laundry and housekeeping). Personal care is funded through the regional health authority at no cost to the tenant.
Supportive housing has different client fees than personal care homes, and its affordability may affect how extensively it is used. This difference must be taken into account to ensure that supportive housing strategies produce a cost effective alternative to nursing home use. The Manitoba Centre for Health Policy is conducting a study which will compare the costs of supportive housing versus nursing homes in Winnipeg so it can be ensured that supportive housing actually exists as a viable financial alternative to nursing home care. (See: http://umanitoba.ca/faculties/health_sciences/medicine/units/community_health_sciences/departmental_units/mchp/)
Do we provide enough housing options to meet client needs in the period before they require placement in a personal care home? We do know that when such placement is required, people sometimes can wait over a year, living sometimes in unsafe conditions in the community, waiting in hospital beds or requiring home care at levels of service that become challenging. It would be hard to make the case even today that the housing needs of our older populations are being met.
According to the American Association of Retired Persons in the United States, over four million women aged 50-plus live in households with at least two females, due to the number of low-income women needing housing – and some grassroots solutions are being established by women themselves in co-housing called the “Golden Girls Housing Network” where several women will share a house and expenses. (See goldengirlsnetwork.com.)
Some feel we are currently on the verge of a crisis in terms of housing our elderly and frail population. It is always valuable to look at best practices in other provinces or countries.
In France they use a system of “seniors villages” – some are intergenerational models – that are linked by halls where elderly and younger persons co-reside and agree formally on how they will assist one another. In the United Kingdom residential care homes are dwindling in popularity, giving way to models that offer a greater level of independence. This offering of flexible care straddles the divide between general purpose housing and residential care and is flourishing across Britain.
New model has promise
In the U.S., there is a model called “Green House Homes”, a radically new approach to long-term care where nursing homes are torn down and replaced with small, home-like environments, in which six to 10 persons can live a full and interactive life.
They have their own room and bathroom, an open kitchen and communal dining table, a living room with a fireplace, and the same care they would receive in a traditional nursing care setting. As you might expect, independent research has revealed numerous benefits compared to traditional nursing homes, including fewer bedsores and less readmission to the hospital, lower staff turnover and a dramatic shift in family involvement and number of visitors. (See: thegreenhouseproject.org.)
Housing is a critical long term issue that needs to be addressed by countries and cities around the globe. As needs change over time, we must be able to provide options that allow seniors to gradually increase the support and assistance they receive while at the same time maintaining as much independence as possible.
Myrna Driedger is MLA for Charleswood.