INVESTMENT IN SENIOR CARE - THE ECONOMIC IMPACT OF THE SILVER TSUNAMI (2023)

Issue

Challenges associated with senior care are impacting the business community. The limited availability of appropriate senior care, challenge navigating the options, and the uncertain quality and reliability of some senior care support means that productive employees in our B.C. economy need to leave the workforce to help support and care for their aging parent.

Background

Numerous studies over the last few decades have been warning us about this silver tsunami and its impact on the workforce, and yet here we are. Over the next 20 years, Canada’s senior population is expected to grow by 68%.

The last several years has been proven to be the most challenging ever for seniors and their adult children in B.C. It has put the lack of resources for seniors and healthcare workers in the spotlight from not only a social issue but an economic one. Many employees are already faced with the reality of balancing their careers with significant family obligations – caring for children, aging parents, or both.

In 2017, the federal government changed the employment insurance (EI) to provide a family caregiver benefit of up to 15 weeks to care for an adult family member whose life is at risk and who has experienced a significant change in their baseline state of health. These were welcome changes in the law that underlined three important realities that will demand a greater role of family members in providing direct care to seniors approaching their final years: financial, demographic, and moral. 

Canada will need to nearly double its long-term care by 2035 as baby boomers continue to age and B.C. will need to prepare for that increased demand for aged care services or more citizens will be forced to exit the workplace to care for aging parents. It is understandable that these adult children providing care to aging parents report considerable caregiver stress and poor perceived mental health and ultimately leave the workforce, whether it’s a leave of absence, early retirement or simply a termination to focus on the full-time care giving. Almost one-third of family caregivers are in distress; this has increased 3.4% in the last five years. On average, 82% of clients of distressed caregivers receive less than two hours of service per day.

Longevity, technology, and family shifts mean that more people are surviving into lengthy periods of disability, and care is concentrated on fewer people, many of whom must maintain employment and face significant work, health, and financial consequences in order to sustain caregiving[1].

“Over two-thirds of all seniors’ care in the province is delivered by non-government providers – which includes both private and not-for-profit providers. Many nongovernment providers are funded directly by the regional health authorities to deliver seniors’ care services across the province.” – B.C. CARE POLICY 2021

Increase Availability of Senior Care

The last provincial review of seniors’ care was conducted in the late 1990s. From 2001 to 2016, access to publicly funded long-term care beds has declined by more than 30 per cent. At the same time, the provincial government introduced an alternative to long-term care, a new housing model called assisted living, called the Community Care and Assisted Living Act. While many seniors welcomed this more home-like model of seniors’ residential services, it is important to note that the funding level for this new assisted living model was approximately half of what it was for long-term care.

Low to moderate-income residents and their families, who can barely afford the cost of the basic service package have no better alternative. A recent study highlights significant unmet care and personal needs for these residents—not by choice, but because they can’t afford the fee structure in private-pay assisted living residences, where seniors pay more for each additional service provided.

This points to the importance of improved funding and better planning of seniors’ services to ensure that there are enough subsidized non-profit assisted living residences and long-term care facilities to meet the needs of B.C.’s aging population. (footnote 104 Longhurst, 2020.)

There is a shortage of the well-trained healthcare workforce capable of caring for a much larger population of older adults. There is also a critical shortage in health care workers and professionals. There are also not enough trained staff to meet the sector’s needs, either now or in the foreseeable future when Canada will have many more “older” adults.

There is a need to create more government and private sector long-term care homes in our communities across B.C. In particular, smaller communities across B.C. are impacted. Investment is required to add more senior care homes and expedite approval of construction and development to meet the current and future demand for all B.C.’s seniors.

Stay-at-Home & Long-Term Care

Lack of care options has huge ripple effects on Canada’s economic productivity, as people increasingly leave the workforce to support an aging parent. We need more care facilities for seniors who do not find “stay at home” an option that meets their health, safety, family support and financial interests.

Over the past five years, the senior population has grown 22% but the number of home support clients has only increased by 15%. The current B.C. ‘Better at Home’ initiative supports those who prefer or can live and be supported at home, but unfortunately, due to the lack of public beds it’s a waitlist for a vulnerable senior until a bed comes available. Sadly, when affordable long-term care is required, it is simply not available.

Stay at Home Challenges

Home health care: Home care and home support options enable seniors to get the help they need at home. Services range from publicly subsidized care, which is delivered through the person’s health authority, to customized private-pay options, which can include medical care, transportation, companionship, and home making.

The “We Must Do Better: Home Support Services for B.C. Seniors” report by the B.C. Seniors Advocate, finds the province’s home support services need fundamental restructuring, as follows:

• Overall, 34% of family caregivers in B.C. are in distress and this rises to 57% when looking at clients who are receiving less than an hour per day of home support.
• Most provinces do not charge for home support services. B.C. does charge and is the most expensive.
• 61% of seniors moving into a long-term care facility had no home support 90 days prior to admission (similar to five years ago).
• B.C.’s rate of newly admitted long-term care residents with low care needs is twice as high as Alberta and Ontario who do not charge for home support and is 34% higher than the national average.

Recruitment and retention of home support is one the greatest challenges. 75% of the health care workforce is part-time or casual. This needs to change if we are to attract the workforce needed to meet demand.

Also, public home support is unaffordable to most seniors. For example, through the regulated daily rate co-payment, a senior with an income of $28,000 is required to pay $8,800 a year for daily home support. British Columbia is one of the few provinces to charge a fee for home support, and among those provinces that do have a fee, B.C. has the highest rate.

Long-term Care Challenges:

Long-term care: Long-term care homes are an option for seniors who need 24-hour professional support and care because of their physical needs, or because they have advanced Alzheimer’s disease or another dementia. For many seniors, this is the best option when the person can no longer be cared for in their own home or in an assisted living home.

The demand for long-term care and assisting living is a major challenge and is predicted to grow in the face of the aging demographic. There will be 44% increase of Canadian seniors in care in 2030, compared to 450,000 today, and this does not include the majority who will receive care at home. According to the BC Care Providers Association, it’s estimated that a minimum of 5,000 to 7,000 long-term care spaces are needed by the end decade to accommodate demand in our Province.

It is a sad reality that seniors face long waitlists for public care options if they cannot afford private care homes. A historical lack of in-home care support has had a ripple-down effect in B.C. People who could live at home are instead taking up desperately needed beds in residential facilities, where the waiting lists to get in are long. In certain cases, in-home care not only keeps seniors in their homes, but are cheaper for government than building more residential facilities.

IMPACTS: Lack of senior living home & home-care options.

Lack of senior living home & home-care options have an impact on the care givers (often people employable in the workforce) and seniors. The impacts are as follows:

Impacts on Family Caregivers

• Taking employees out of the workforce to help care for an aging parent. Facts prior to the pandemic: There are about one million "informal" caregivers in the province, according to Statistics Canada. They are predominantly family members caring for their mothers, fathers, spouses, or adult children.
• It compounds the gender in-equality issues within the workforce with the burden largely being caried by women. Not only are most informal caregivers female, but women are more often the primary caregiver (67 percent vs. 59 percent of men caregivers), meaning they are the sole caregiver or provide the majority of care along with other unpaid caregivers.
• it has longer-term financial impacts on this group in their retirement, career advancement, and current ability to meet their own financial obligations, let alone their parents.
• According to Carers Canada there are over a million caregivers in British Columbia and in Canada, 25 per cent fill this role. Half of these family caregivers are between the ages of 45 and 65 in their peak earning years.

Impacts on Seniors

• Health: isolation, mental, physical, and spiritual - their overall well-being
• A population of seniors with capital wealth (home ownership) but in many cases not sufficient monthly income to:
  • eat well (leading to malnutrition).
  • get enough personal and medical care at home.
  • adapt their houses appropriately as needed to be safe leading to hospitalizations from falls.
  • afford transportation alternatives to get regular medical check-ups from specialists again leading to further hospitalizations and use of ambulances.
• Family members having to bridge this gap in financing the required care and putting themselves and their families at financial risk.

     Results of staying at home in many regions:

• Seniors may be exploited - seniors who don’t have sufficient income enter higher interest reverse mortgages rather than spending on their own care
• housing/property shortage for development of multi-purpose senior communities, affordable family townhomes etc. Disproportionate number of large single dwelling homes on large properties owned by seniors (often only one person).

Need for Private In-Home Care Regulation

The most common misconception about the private home care industry in British Columbia is that the industry is government regulated and licensed. There is the assumption private agencies are licensed, must abide by strict hiring policies and carry comprehensive liability insurance coverage.

In fact, the B.C. private home care industry is not government regulated. There are no licensing requirements to operate a private home care agency. Care aides are not required to be certified or criminal background checked. There are no liability insurance requirements.

Any individual, company or franchise can operate a home care agency. It is legal to hire unqualified and uncertified care aides with no criminal background checks required. Unqualified care aides are permitted into private homes to legally administer all forms of critical care. Liability insurance is discretionary. A care aide is often assumed to be an accredited professional.

A care aide is a generic term for one who assists with the care of another individual – it is not a certification. A care aide may or may not be certified.

Service Provider Funding

All service providers, including non-profit, public, and private sectors all play a role in services needs. But the funding model for the important work that non-profits contribute is inefficient and needs improvement.

Non-profits providers spend significant time seeking grants and the funding provided is very often short term. This results in Non-profits provider uncertainty, staff turnover and loss of momentum. It also results in frequent and confusing program changes, and significant administrative time to write grant proposals to seek continuation of the service or program being delivered. It is a problem that is growing and so should be long-term commitments and growth should be consistent with the growth of this population group.

Access & Navigation

Navigating the seniors living and care continuum is challenging. B.C. Senior care options are difficult to navigate; users and seniors find it difficult to learn what care options and support is available, and at what price.

In 2019, EngAge BC, an operating arm of the BC Care Providers Association, launched Route 65. Route 65 is a free, online tool that helps connect seniors and their family members with the services offered by B.C.’s leading operators of independent living, assisted living, long-term care, and home health care.

It could be better advertised or embraced by the health authorities as they assist families in navigating a complicated system of private and public options. Create a platform that provides a “One Stop Shop” to navigate all public/private options for senior care and progressive support. The platform needs to address the sudden nature of the need for support and service - including Crisis Capability to respond to immediate needs of seniors and their families in crisis.

Canadians are living longer, and our healthcare system is reeling under the pressure of too many seniors occupying hospital beds due to the lack of care options in their community. It means their family members and loved ones are facing agonizing choices on how to support an aging parent, companion or spouse.

If we do not prepare for the anticipated doubling and tripling of demand for aged care services, our healthcare system could buckle due to overwhelming demand. By investing in recruitment and training to strengthen the healthcare workforce, and ensuring that our infrastructure is the best available, a more positive picture emerges for British Columbia’s families.

THE CHAMBER RECOMMENDS

That the Provincial Government:

1. Increase availability of senior care to all who need it, where they need it.
   • Expedited approval of construction and development of more private and public senior care facilities across all communities in B.C.
   • Expand options for care facilities for seniors where “stay at home” is not an option that meets their health, safety, family support and financial interests.
   • Extend the terms of yearly or multi-year funding/grant models to provide better planning and stability for non-profit organizations providing senior care.
2. Support senior care labour force supply, training, and in-home care standards.
3. Improve access to and navigation of Senior Care Service options.
   • Study and financially support gaps in service for a clear, equitable service and care pathway for all seniors, of all needs and ability to pay.
   • Create an integrated, supportive platform that provides a “One Stop Shop” to navigate all public/private options for senior care and progressive support. The platform should be kept current and include Crisis Capability to respond to immediate needs of seniors in crisis.