Post COVID-19: reopening our cities means restructuring older adult care

The COVID-19 pandemic has affected aging populations in countries around the world, bringing to light many longstanding and severe challenges for older adult care sectors. Both home care providers and long-term care facilities have found themselves ill-equipped to respond to the current emergency, leading to tragic consequences. Familial and informal caregivers, who continue to supplement and support our fragmented care system, have been reduced to little more than "non-essential" and thus removed from the circle of care during a time when older adults may need these people most. It is clear that reform is desperately needed. As we begin to reopen our cities and consider transformations post-COVID-19, governments must restructure older adult care. Given the LTC system appears increasingly overburdened and we know many older adults would prefer to remain at home, why not look to existing innovations in the home care sector and try to improve coordination and balance between home and long-term care? By doing so, we could allow older adults and their families more autonomy in their care decisions, ultimately improving their quality-of-life and the delivery of older adult care. First, we have to come to terms with the unique care needs of older adults, as they represent an increasingly large proportion of the global population. In Ontario alone, the number of adults age 65 or older is expected to almost double from 2.4 million in 2018 to 4.6 million by 2046. Within Ontario, older adults have been among the most vulnerable to the COVID-19 pandemic, a truth supported by many disturbing statistics: 16 per cent of all of Ontario’s 33,000+ cases have been residents of long-term care facilities, a population that also accounts for 64 per cent of the province’s 2,600 deaths. All told, roughly 1 in every 50 residents in Ontario’s long-term care facilities have died of COVID-19. In Ontario 12,230 people aged 60 and over have tested positive for the virus, representing around 37 per cent of all cases. Compare that number to the around 12 per cent of all Ontarians that fit in this age group, and you can see the disproportion. The pandemic has also exposed challenges in delivering care to this population through long-term care facilities. The terrible conditions inside some of these care homes have been discussed in national and international media, and on May 19th, Ontario’s Minister of Long-Term Care Merrilee Fullerton announced that she would be launching an independent commission to investigate Ontario’s long-term care system in September. The focus on long-term care homes has opened up an opportunity for home care, where older adults continue to receive the support they need from informal caregivers and health care professionals while staying in their own home. The question of why home care hasn’t been given enough attention during this crisis is puzzling. Even for individuals who may not be good candidates to receive care at home, the question of what can be learned from home care delivery models is a valuable one and may illuminate how we can improve care in general for older adults. A recent study by a team of researchers at the University of Toronto’s Munk School of Global Affairs & Public Policy, in partnership with the Reach Alliance, explored an innovative model of care called “consumer-directed” or “self-directed care” that provides care recipients with more control over the care being provided to them. Self-direction refers to a growing trend in health care that provides people with more autonomy in deciding what care they need and how their needs should be met. The notion of self-direction highlights that it may be reasonable for a client to select a family member as one of their formal care providers and this family member should therefore be formally employed and compensated as such. Self-direction isn’t new to Ontario, it was introduced by the government in 2017 and dismantled soon thereafter by a coalition of for-profit and not-for-profit home care providers, citing concerns with increased bureaucratization, ultimately delaying care. Their concerns may have been valid, as older adults don’t need more hurdles to get through in order to access appropriate care, but it seems increasingly evident during this pandemic that familial and informal caregivers continue to be undervalued in our home and long-term care systems. We must learn to value the very important role they play in older adult care and begin to redesign our care systems to demonstrate this. Home care isn’t right for everyone, and there will be those whose needs are best met by institutions like long-term care homes. But the tragedies of the pandemic have made it increasingly evident that these two systems cannot function without familial caregivers supporting their loved ones both at home and in institutional settings. As the sector responds to the crisis, and the conditions in Ontario evolve, researchers and policymakers must think about what can be done to better support older adult care moving forward. The need for reform is evident, and as more research into the home care sector becomes available, there can be greater opportunities to learn from the strengths and weaknesses of the two delivery models. As cities reopen across Canada, let’s welcome the myriad of innovations developing in older adult care and ensure restructuring better values the important role of families and informal caregivers, for the benefit of all. Anna Cooper Reed is a social worker and PhD student at the Institute of Health Policy, Management and Evaluation at the University of Toronto. The Hill Times

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Post COVID-19: reopening our cities means restructuring older adult care

Home care and informal care givers must be utilized and better supported in any re-think of Canada's approach to caring for its oldest residents.

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