Freelance Health Journalist
March 23rd, 2015
One in seven Canadians is over the age of 65, 77% have at least one chronic condition, and more than nine in ten want to remain in their own homes. For the children of these seniors, many of whom are working full-time and supporting their own families, the reality of this situation is wanting to support their parents’ independence while wanting to keep them as safe as possible – but often within the confines of limited time and money. The average retiree’s annual income is $42,000 and many are earning less – the cost of care can easily be upwards of this and will not include the additional expenses that will crop up.
For many adult children, there is a moment of realization when the phone call comes that their elderly parent fell in the bathroom and managed to call an ambulance, or when that parent goes from being a little forgetful to getting lost in the mall one time too many or to completely forgetting how to tell the time. This is the moment when a child realizes that their parent needs help – and that it’s going to cost money.
Lise Andreana, Certified Financial Planner and author of the book Financial Care for your Aging Parent emphasizes the importance of being prepared for this stage by looking out for clues about whether or not seniors living at home are able to cope by themselves.
“This is a very stressful time for both parent and child,” says Lise. “Once the adult child recognizes the need for action, they will sometimes rush in with a list of orders or try to ‘push’ their parents into accepting care the elder parent thinks they do not need. The best line of defense is to be prepared – begin the conversation early, long before you see a decline in your parents’ abilities to live on their own.”
$1,700 to $2,300+ per month
In Ontario, long-term care (LTC) facilities, which are government-funded and coordinated by the province’s 14 community-care access centres, provide 24-hour care with costs ranging from $1,708 to $2,362 per month. Ontario’s 630 LTC homes are over 97% occupied and the average wait time is 108 days, during which time families cover care costs. Waits in certain regions can be much longer than the average; for example, the wait time for a basic accommodation in central Toronto is 354 days.
In March 2013, there were 2300 patients ready to be discharged from Ontario acute-care hospital beds waiting for post-discharge arrangements, costing $1000 a day and taking up beds that were needed by other patients. Most of these patients are over the age of 75 and 37% have no more urgent or complex needs than those of people receiving care at home. The largest proportion of days spent waiting are by those awaiting LTC placements, often waiting close to 500 days, even with conditions like dementia – and fifteen percent die while waiting.
For these reasons, among others, the LTC option is becoming less feasible for most Ontarians. Luckily, there are many other options that children can explore for their parents (albeit likely out of their own pockets). These range from accommodations with the shiniest bells and whistles to home technology that may effectively do the job without breaking the bank.
$1,500 to $6,000+ per month
Retirement communities in Ontario range anywhere from $1,500 to $6,000 a month, with the average monthly cost coming in at $3,236, or $38,832 per year. The GTA has the highest average fees of any region in Ontario at $3,825 monthly or $45,900 a year, and Etobicoke has the highest average fees of any municipality at $4,534 per month or $54,408 for the year. This cost usually covers three daily meals, utilities and medical services on site, as well as a registered nurse. Many seniors also need help with activities of daily living such as dressing, bathing and toileting, which will come at an extra cost.
However, most seniors want to remain in their homes for as long as possible and the province of Ontario is increasingly on board with this option.
“Much of OHIP coverage is based on helping to keep the elderly in their homes as it is considered to be a less expensive option than facility care,” says Lise, who recommends calling in a community care access centre (CCAC) to carry out an assessment of a senior’s capacity to continue living at home and the additional care they may need to do so.
Career to Care Giver
$2,000 to $4,000+ per month
Some children may consider quitting their jobs to look after their parent in lieu of worrying about them all day at work and spending their salary on their care. The average annual salary in Ontario is $48,900. Depending on a person’s salary and the care options they feel comfortable with, it may make more financial sense to consider quitting work. However, becoming a full-time carer is no easy task and this is a big and very personal decision. According to the Government of Canada, the majority of caregivers (75%) are employed, regularly facing challenges such as conflicting hours, limited flexibility from employers for emergencies, and ultimately the need to reduce hours and/or take increased sick days.
Private Home Care
$500 to $7,500+ per month
A more practical alternative for many children whose parents don’t require 24-hour care might be to hire in-home care. Service providers charge $25-$35 per hour for such care, and over $100 an hour for trained medical staff, such as in-home nursing. In-home caregivers may help a senior with activities of daily living like mobility, feeding, bathing and cleaning, or changing their continence pads or colostomy bags, or even providing some regular company – although everyone is different and what is welcome company for one senior can feel like unwelcome hovering for another. According to a recent Statistics Canada survey, 15% of people receiving in-home care did not feel all of their needs were being met and those with unmet needs reported higher levels of stress and negative feelings, with 62% experiencing loneliness.
Nonetheless, in-home care costs a pretty penny, albeit not as costly as facility care. Around-the-clock care requires paying the full-time salary of between two and three caregivers, which can easily add up to more than $100 a day to well over $80,000 annually for 24/7 care through an insured private home care company. On the other hand, if a caregiver visits for a couple of hours once or twice a week, making in-home care a more affordable option, the senior will still be alone for the majority of the time. There is no way for children to know if their parent has slipped in the shower or that their power has gone out, leaving them without heat and food, which is what happened to so many of Ontario’s seniors last winter.
$75 to $120 per month
Still, today’s seniors want to stay at home and are using everything from live-in robots and virtual pets, to health-monitoring clothing and sensors placed around their homes to remain independent for longer. Some technologies can actually serve the purpose of unobtrusively remaining with seniors around the clock in their own homes at a fraction of the cost it would take to put them in a retirement facility or pay for regular home care.
The Close to Home smart-sensor system, which is being launched in Canada at the end of the month, starts at around $1000 a kit (including installation) plus a monthly cloud monitoring fee. Sensors can be placed around a senior’s home, anywhere from the bed, fridge, medicine cabinet, doors and windows, to a senior’s favourite chair where he reads the newspaper every morning. These sensors work together and are linked to a central online portal which unobtrusively collects data about the senior’s behaviours. It can then notify their children or a caregiver when something is amiss. If the power goes out in the senior’s home, he or she forgets to take their medication, or doesn’t get out of bed, children can be alerted via their phones or emails. They can also login to the online private portal at any time from wherever they are via their Smartphone or laptop to check that everything is okay.
Care facilities may also opt for this option, particularly in light of the data collection that can be used to provide more proactive patient-centred care. Mark Hanson, who is the Head of Technology for BeClose, which is the successful American version of Close to Home, says the technology is not only cost effective but also helps relieve caregiver burden and deliver positive patient outcomes.
“We’re starting to bend the cost curve of medicine by bringing care into the home,” says Mark. “Passive collection of data is really important – we make sense of that data, and boil it into things like, ‘are people sleeping, are they eating properly, are people ambulatory?’, and from that, we can derive analysis about their health.”
Lise Andreana, who advises and writes regularly about elder care, says that she had not considered technology as a means to help seniors stay in their homes for longer but that she can easily imagine how it will change caregiving of the future.
“[Home sensors] sound like an exciting new frontier of home care,” says Lise. “I would caution that even caregiving via technology will make demands on the time of the caregiver and may lead to exhaustion and stress but may provide a useful bridge between living at home independently and moving to a facility.”
According to Mark, however, the most effective way to use such technology is to combine it with the care of clinicians, “marrying touch with technology”. Whether an individual senior needs three sensors, or a care facility is looking for a hundred, they’ll only be bought once and the monthly fee is minimal comparatively speaking so this option may do the job for many families.
Making sense of it all
The Canadian population is aging and the demand for care of seniors is projected to double by 2031. More and more adult children with elderly parents will find themselves caught between trying to pay for their children’s education and their elderly parents’ care while trying to plan savings of their own. No matter which option a family chooses, there will also likely be unexpected additional costs like services for speech and language or dementia, as well as equipment like walkers, wheelchairs, ramps, scooters, shower safety bars and medication dispensers – so for many people, cost will be an important factor.
Some technologies, in particular, can offer a cheaper alternative to conventional care options. Modern-day technology is increasingly providing seniors with an increased quality of life and a means to remain at home for longer. The needs and preferences of each senior and their family, their budget and what government assistance they qualify for should help narrow down the options. But for seniors who want their independence, privacy and confidence, and whose children, near or far, want the reassurance that their parents are safe at an affordable cost – smart sensors could provide an answer.
For more information on Lise Andreana’s book, visit http://tinyurl.com/p726pyk
For more information on Close to Home Monitoring Technology, visit http://www.close-to-home.ca/
For more information on Personal Home Care in The GTA, contact Prudence at Closer to Home at: firstname.lastname@example.org
CBC News: Health care | Rising costs Click here
The Financial Post: The unexpected costs of caring for your elderly parents Click here
The Toronto Star: Canadians close their eyes to the staggering cost of elder care Click here
Moneysense: The toughest choice Click here
Interview with Lise Andreana, Certified Financial Planner, Niagara on the Lake, ON
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Canadians with unmet home care needs http://tinyurl.com/q8sck5j
Caring For Our Aging Population and Addressing Alternate Level of Care http://tinyurl.com/oavjm2a
Choosing a Long-Term Care Home http://tinyurl.com/nbs3uf8
Harper government launches the Canadian Employers for Caregivers Plan http://tinyurl.com/lm5k6tf
Home Care in Canada: From the Margins to the Mainstream. http://tinyurl.com/qjdjb7n
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Mark Hanson, Head of Technology and Product, BeClose @ Digital Health Summer Summit S.F. 2014 http://tinyurl.com/njjfv56
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