I have a big idea for Canada. As our population ages, let’s rely less on long-term care and more on supportive housing:a cost-effective way for semi-independent seniors to live with dignity and independence.
Long-term care facilities, also known as nursing homes, have an important role to play, especially for seniors with complex health care needs (e.g., Advanced Parkinson’s, ALS, dementia). But the COVID-19 pandemic exposed the shortcomings of these facilities. Indeed, more than two-thirds of COVID-19 deaths in Canada occurred in long-term care homes.1 A lack of physical distancing options is a major reason for this, with long-term care facilities having as many as four residents to a room (not to mention shared bathrooms).
While long-term care facilities require reform (e.g., more physical distancing, more funding for staff, and less privatization), there remain many semi-independent seniors who are currently under-supported in their own homes. This is where seniors’ supportive housing can play a role for seniors who need 24/7 staff support in their building but not to the same extent as what is provided in long-term care facilities.
Seniors’ supportive housing typically involves the following components:
A financial subsidy to a non-profit housing provider to keep rents affordable for low- and moderate-income households.
The provision of various forms of staff support to the tenant.
Units that are typically not shared and which are physically accessible (where appropriate).
Permanent tenancy, with protection under provincial/territorial tenant protection legislation (the tenant signs a lease and has recourse to a housing tribunal if their rights are violated).
A recent University of Manitoba study found the annual operating cost for one unit of supportive housing was just one-third the cost of a long-term care bed.
Services provided in seniors’ supportive housing vary according to each tenant and can include assistance with bathing, going to the bathroom, getting into and out of bed, getting dressed, and assistance after a fall. They can also provide assistance with transportation, shopping, meal preparation, laundry, housekeeping, financial matters, and medication management. Supportive housing for seniors also involves social and recreational activities. These are similar to home care supports provided to semi-independent seniors in their own homes. In supportive housing, however, the services are offered in clusters to tenants living very close to one another. Sometimes such units make up only a portion of the units in a building. Other times, the services are offered in non-profit or public ‘seniors only’ housing. Supportive housing providers can be charities, non-profit agencies, cooperatives, or municipal or provincial social housing corporations.The same organization that owns and operates the building may provide the support services or they may be organized by a different organization.
There are cost savings to be realized with seniors’ supportive housing. A recent University of Manitoba study found the annual operating cost for one unit of supportive housing was just one-third the cost of a long-term care bed.2
Seniors’ supportive housing is especially important for low- and moderate-income seniors over the age of 75 who have health challenges and require assistance with daily activities. It’s important to keep in mind that about two-thirds of persons over 75 in Canada are women.3 In a well-designed system, some buildings—especially in larger cities—can cater to specific subpopulations, including Indigenous people, 2SLGBTQQIA+ tenants, and persons who speak a specific language or identify with a particular culture.
Unfortunately, there is not enough seniors’ supportive housing in Canada. Some communities have none at all, and there are typically wait lists in communities where it does exist. Many existing buildings providing supportive housing to seniors need capital upgrades. In other cases, buildings not currently providing seniors’ housing could be converted into seniors’ supportive housing.
Seniors are a designated priority group in Canada’s National Housing Strategy. Yet, the strategy contains no specific provisions for supportive housing for any age group. The strategy should therefore be enhanced with new annual capital funding for seniors’ supportive housing.4 A condition of this funding should be provincial and territorial support for additional funding to keep rents affordable and to pay for staff support. Another condition of federal capital funding should be that the operators of both the housing and support services be non-profit or public wherever possible.
Canada has learned important lessons from the COVID-19 pandemic, one of which pertains to the limitations of long-term care. Let’s right this wrong by creating more supportive housing for semi-independent seniors.
Notes
1 Ireton, J. (2021, March 30). Canada's nursing homes have the worst record for COVID-19 deaths among wealthy nations: report. CBC News. https://www.cbc.ca/
2 Doupe, M., Finlayson, G., Khan, S., Yogendran, M. S., Schultz, J., McDougall, C., & Kulbaba, C. (2016). Supportive Housing for Seniors: Reform Implications for Manitoba's Older Adult Continuum of Care. Winnipeg, MB, Canada: Manitoba Centre for Health Policy.
3 Semi-independent seniors with high incomes can afford to live in private retirement homes, which can cost a tenant more than $5,000 per month.
4 The National Housing Strategy should also provide capital funding for other types of supportive housing, including for persons experiencing long-term homelessness.
