Publications, opinions, and speeches
Reconstructing care for seniors
Published on 16/04/2020
It may be too soon to examine the lessons from the COVID-19 crisis and consider what should have been done differently. It may also be too early for foresight when that future is far from certain.
It is first essential to put out the fire before planting new trees. But it is not too soon to start planting the seeds of new ideas.
In order to stabilize the economy and get things back to “normal” (whatever that “new normal” will be), there may be a rush to re-establish structures and procedures as they were before the pandemic. The health care system will have little time to heal. The economy will need to get back up and running. Supply chains will have to be re-established. The galloping inflation that likely will result from massive (but vital) injections of cash into the economy will have to be tamed. The struggling voluntary sector will need to help those struggling.
But there are risks to simply rushing into the rebuilding process. The current emergency has shown us that the status quo may not have been, in many cases, the best option.
Some of the systems that were in place prior to COVID-19 were not exactly working well. The shortages and weaknesses in health care, particularly around emergency preparedness, are now well documented. Hard lessons are emerging, including the need for made-in-Canada medical supplies and pharmaceuticals.
Employment Insurance (EI) is an example of big gaps in the income security system. While not perfect by any means, this country has a relatively good system of seniors benefits and assistance for families through the Canada Child Benefit. The weakness has always been the availability of “adult benefits” for Canadians of working age. The long-identified shortcomings of EI became starkly clear during the frantic rush to create a new emergency benefit to assist huge numbers of people with no EI coverage.
Perhaps the most glaring lesson learned is the care of seniors. Nursing homes throughout the globe have emerged as the ground zero in this gut-wrenching saga. In the period of rebuilding that follows the pandemic’s peak, we will need more than just tighter restrictions for infection control and safe care. Long-term care in nursing homes will still be necessary. But they will not be sufficient. We will need more than just nursing homes.
There are many examples throughout the world of how to provide alternate forms of care for elderly citizens. These were never seriously embraced in Canada. In fact, in many cases, there are barriers preventing their establishment. Unfortunately, it took a terrifying pandemic to provide a badly-needed wake-up call.
Most seniors have few housing options between living alone or in an institutional setting. While many older adults want to avoid later-stage congregate care, they acknowledge that for social, health, and safety reasons, it is preferable not to live alone.
Co-housing is one model that has emerged elsewhere as a way of responding to social isolation and the provision of care. Small groups of friends and neighbours are creating housing arrangements in which they choose to live together. While each individual has a separate bedroom and private area, residents share common space, such as kitchen and living room.
Co-housing involves the sharing of costs and responsibilities. Residents agree to look after each other if someone is ill or needs practical assistance, such as grocery shopping. This informal care set-up comes closest to the family arrangements to which most people have been accustomed throughout their lives.
While this innovative solution provides affordable housing, care, and social support, it is not easy to establish. There are few affordable options in major urban centres. Most homes typically are not built to accessibility standards. Municipal bylaw restrictions often discourage and even prevent this kind of co-habitation. The proposed Golden Girls Act in Ontario, for example, challenged this prohibition.
Other models proven successful elsewhere include intergenerational housing. Older adults are matched with students who get free rent in exchange for free care. Dementia villages provide secure care environments that enable residents to avoid institutions and move safely within the village.
Given the recent war analogies of the current pandemic, we can learn some important lessons from wartime years. In the aftermath of World War II, Canada saw a reconstruction period that involved thoughtful rebuilding around new opportunities and improved delivery systems for both goods and services. While it may be too early to begin that careful deliberative process, it is not too soon to contemplate how and when that reshaping should take shape.