Many adult children in Canada find it daunting to secure the right arrangement for aging parents who can no longer live at home.Maskot/Getty Images
Canada’s population is rapidly aging. The Globe and Mail’s Aging Well series explores the country’s longevity economy, how people are living healthier and happier lives as they age and how to support older adults.
Step off the elevator at the Elliott Community in Guelph, Ont., and it’s clear things are changing in long-term care. Floor-to-ceiling, lifelike murals of neighbourhood houses greet visitors. Halls bear local street names and are painted vivid colours such as purple, mustard and orange – hues more common in daycares than retirement homes.
“You see lots of colour here because you lose that perspective as you age,” said Michelle Karker, Elliott’s CEO, while leading a tour. “What seems bright to us may not be that bright to people who live here.”
The painted walls serve a cognitive function, helping residents – many of whom have dementia – find their way. So do the random objects from everyday life affixed to the walls, from fake grass to golf clubs to kitchen utensils. This “stuff of life” as Karker calls it, provides the comfort of familiarity.
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What’s absent at the retirement and long-term care home? Staff uniforms, institutional lighting, rigid meal times and even nursing stations. One former station now holds a clothesline draped with shirts and pants, giving residents the chance to fold laundry if they wish – a small task that allows them to feel connected to the routines from their earlier lives. There are cooking activities, shopping trips and paraffin wax hand treatments. On a recent day, residents were invited to attend a 1950s party with an Elvis impersonator.
While such places as the Elliott Community illustrate how congregate living for older adults is evolving – becoming more homelike, personalized and centred on quality of life – many adult children in Canada still find it daunting to secure the right arrangement for aging parents who can no longer live at home. They are uncertain when to start planning, which options exist, what costs to expect and how to broach these difficult conversations with parents in the first place. With wait-lists growing and caregivers stretched thin, navigating this terrain can be a confusing and stressful reality for families.
Even Karker says moving her mother into a retirement home was emotionally draining. “Even though this is what I do, I work in the sector, it’s still challenging,” she admits. “It’s a huge transition for everyone.”
It’s a reality more families will face as Canada’s population of older adults is expected to grow – with those aged 85 and over among the fastest-growing age groups. Meanwhile, sandwiched caregivers, those supporting both children and adults, numbered 1.8 million in 2022.
Fortunately, experts say there are steps families can take to help make the transition easier.
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Start researching now
Bonnie Lashewicz, professor of community health sciences at the University of Calgary, says the best way to beat the initial overwhelm is to take the first step.
“Just start. You can quell some anxiousness by educating yourself and becoming acquainted with what services are out there,” she said.
Provincial health ministries websites, regional health authority websites, the Alzheimer Society and organizations specifically for caregivers provide resources and connections.
Another first step is to understand the four levels of congregate living for older adults, from settings with the least amount of care to those with the most:
1. Independent living: Typically offered by private operators to people aged 55 and up who want to live in an apartment independently. Think a condo with access to social activities and amenities such as chef-prepared meals, arts and crafts classes and exercise rooms. Some opt for independent living rather than staying at home because it guarantees a place in their chosen community, instead of risking a wait-list that can stretch up to two years.
2. Retirement or supportive living: Offers meals, housekeeping and nursing services as required. The goal is independence but with more support. This is an option often favoured by older adults who no longer want the burden of cooking, cleaning or home maintenance, but still value privacy and autonomy. It can also appeal to those seeking peace of mind, knowing that 24-hour staff help is close at hand if needed and that if health deteriorates, care can increase without the upheaval of moving to a new residence. Residents and family members cover the costs, usually through monthly rental fees, which vary by location and level of services provided.
3. Assisted living: Another private-pay option (although some communities are partially subsidized by government programs), assisted living is even more hands-on but still promotes some independence and autonomy. Experts say this can be useful for older adults with mobility issues, ongoing medical needs or early-stage dementia. Think help with daily tasks such as dressing or managing medications.
4. Long-term care: Partially publicly funded, long-term care provides support for nearly all activities of daily living, from eating to bathing, and round-the-clock nursing care. This is most often the setting for people living with advanced dementia, complex medical conditions or physical limitations that make it unsafe to live independently.
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Understand the costs
Long-term care homes are publicly funded through provincial ministries of health, although people are still expected to pay a provincially-set accommodation or copay fee. For instance, in Ontario, the basic room fee is about $68 per day, or a copay fee of $2,085 per month, with additional fees for a semi-private or private room. Meanwhile B.C. caps its long-term care accommodation fee at $4,073 per month. Provinces also typically provide rate reductions for those in low-income brackets.
The picture is far more complex for privately run homes offering independent, retirement and assisted living care, with fees varying widely for different suite sizes, location, care levels and amenities. And don’t forget add-ons such as transportation, private nursing or extra housekeeping. Those fees can pile up.
At Elliott, supportive living rates range from $3,810 to $5,164 per month, depending on the suite.
According to the Canadian Mortgage and Housing Corporation, in 2021 the average cost for senior housing in Canada for someone who requires less than 1.5 hours of care was $3,075 per month.
Planning ahead with your loved one or loved ones gives families a head start when it becomes time to make a decision about congregate living.kate_sept2004/Getty Images
Plan ahead together
Planning ahead is the No. 1 piece of advice from Amy Coupal, CEO of the Ontario Caregiver Organization, and primary caregiver to her father. After her mother died 15 years ago, she often checked in with him to see when he felt ready to make the move into a retirement home. A few years ago, he was. Fortunately, they’d already done their homework and figured out what was most important to them both. The home had to be convenient for Coupal’s visits, while also offering a thriving social community for her father.
“He wanted to be somewhere where he could eat meals with other people. That was a really important piece for him because he’d been living on his own for so long,” she said.
She admits she’s been lucky. Her father was willing to discuss moving and even welcomed the idea. They didn’t wait for a medical crisis or a dangerous cognitive decline to force their hand – a much more stressful situation for everyone.
“He was really the driver of that decision,” she said.
Make sure to visit in person
Googling “retirement living” is easy, but visiting in person is essential. How does it look and smell? How loud is it? What does the food taste like? (Yes, you can and should ask to try a meal, Karker says, because food quality has a huge impact on quality of life.)
Equally important, says Lashewicz, the community health sciences professor, is watching for small moments of kindness and caring from staff. Nursing is task-driven work, but it needs to be more than that. Do caregivers make eye contact? Do they linger long enough for a connection?
“Have your radar up for the kinds of connections you feel between caregivers and care recipients,” she said. Unhurried and unforced moments of care help preserve dignity.