By Dawn Harsch, John Yip and Samir Sinha
It’s time to stop warehousing our elders in Canada and think creatively about long-term care. For decades, older Canadians have been telling us that they want to age in place, in their own homes and communities, and now nearly 100 per cent want to avoid institutional-style nursing homes in light of what they witnessed during the pandemic.
As we take stock of the lessons learned, there is a strong public and political appetite for new models that support better and sustainable aging and care experiences.
Small care homes are not a new concept. They have been used for decades in Japan, Scandinavia and across the United States to meet the challenge of caring for an aging population, while enabling people to retain personal dignity, autonomy and fulfilment. Small care homes are purpose-built residences for up to 12 persons that can be easily incorporated into any new or existing community — from suburban subdivisions to highrise condos, and even small towns and rural communities.
They have many of the design features you would expect in a modern nursing home — wide doorways, supportive handrails, private rooms with ensuite washrooms and accessible showers, elevator access, commercial sprinkler systems and much more. But unlike institutional LTC homes, these buildings are designed to look and feel like a regular home. Small care homes are nestled within neighbourhoods — close to services, schools, parks and social activities — offering the type of housing, living and care experiences that most Canadians overwhelmingly prefer.
Meals are homecooked by staff, based on resident needs and preferences, and shared family-style around a large dining room table. Everyone is invited to participate in daily social activities and household tasks, such as preparing meals, washing dishes and doing laundry.
The limited number of residents creates a more intimate level of familiarity for both the people who live and work there. At a time when the LTC sector is struggling to retain staff and must recruit tens of thousands more to meet current and future demands, we need to be thoughtful about care settings that support not only healthier work environments, but also personal and professional fulfilment. The staffing model within small care homes can be adapted to support a range of needs, including advanced dementia and complex care through to palliative and end-of-life care.
Studies show that small care homes can offer both economic and social benefits to our health-care system. These models are quicker and easier to build, offering a more immediate solution to our burgeoning LTC bed capacity crisis. Small care homes can ultimately generate savings for the health-care system, as residents in these settings tend to have better care outcomes that result in fewer emergency department visits and hospitalizations, and have seen significantly fewer cases and deaths related to COVID-19 since the pandemic began. Unsurprisingly, small care homes have been correlated with an improved quality of life, happiness and sense of freedom among residents, as well as family satisfaction and overall satisfaction with care.
So, Canada, what are we waiting for? Faced with long wait lists, overburdened health systems and rising costs, governments are investing billions in fixing LTC. Let’s ensure that money supports the type of housing and care models that aging Canadians both want and need when they can no longer live and receive care in their own homes.
While Nova Scotia and Quebec have started to advance this model and Alberta has pledged to do the same, we need every jurisdiction to support this system that can better enable aging in the right place.
Indeed, small care homes are an idea whose time has come.
Dawn Harsch is the president of Exquisicare, a small care home provider based in Edmonton. John Yip is president and CEO of SE Health. Dr. Samir Sinha is director of health policy research at Toronto Metropolitan University’s National Institute on Ageing.