Future Long Term Care Environments Redesigning the Continuing Care System for the Babyboomers

Future Environments

The Canadian population is aging. Currently, 13% of Canadians are over 65 years and this will increase and peak at 24% in the year 2031. This demographic shift is generally referred to as the “aging of the babyboomers” or the “grey wave”. Babyboomers are a vocal group of consumers. Their aging will definitely affect the way we do business in future years; including the delivery of retail, recreational, financial, health and social services.

Many trend studies were conducted on the preferences of babyboomers, regarding their lifestyle preferences as they age. They are generally portrayed as a generation that is healthier, more educated and they have higher expectations for services. Choice and independence are important to this group. Income level will rise for this group, although there will be a greater disparity between rich and poor. Based on responses to surveys, this group has indicated a desire to stay at home or in the community as they age. Nursing homes will not be their first preference for receiving services.

The Current Continuing Care System in Canada

Currently, all provinces have a continuing care system to provide services to individuals who require services at home or in institutions on a long term basis. This generally includes long term care facilities (nursing homes), home care services, and other community services such as day programs. Most provinces have a Single Entry System that assesses and refers individuals to these services.

During the last few years, most provinces have attempted to improve and enhance their continuing care services. However, under the current system, the public perceives that there are insufficient home care services provided in the community. In addition, the supports that individuals require to assist them to stay in community are not available. This includes community services that assist them to perform daily activities such as housing services that assist individuals to “age in place” and transportation services that meet the needs of a frail population that may require walkers, wheelchairs and other assisted devices.

Re-Designing the Continuing Care System for the Future

Based on analyses of the preferences and needs of a new generation of elderly, the current continuing care system must be re-designed to meet these changing needs. Perhaps, the most important theme for this re-design is to understand what should be done to enable “babyboomers” to age in the community and in the environments they are comfortable with. The future system must be client focussed. The necessary supports will have to transcend beyond the traditional boundaries and “turf” of health, social services and housing sectors. This is not only a “health system” change. The general public and all levels of government (federal, provincial, territorial, municipal), professional organizations and stakeholders must be involved in the re-design and implementation of continuing care services.

New Themes for the Redesign

Following are a number of concepts that must be accepted to move the system forward to meet the future needs of the babyboomers.

Evolving from the concept of providing “bundled services” in buildings, to the concept of “unbundled services” to be provided in a variety sites

Currently, elderly that are frail and cannot stay at home without supports are admitted to nursing homes. Nursing homes provide a variety of health and support services located in nursing home buildings.

A new focus should “bring services to people, instead of bring people to services.” A new way has to be found to “unbundle services” that are traditionally provided in nursing homes and deliver them to clients in a varity of settings such as assisted living, supportive housing sites, seniors’ apartments, condominiums and peoples’ homes. With the new technology, as well as assisted devices, there are large numbers of persons that are traditionally served in nursing homes that can be served in supportive housing sites and home environments.

Creating supportive living environments to assist individuals to “age in place” in the community

As individuals age, they require assistance in daily living activities as well as supervision to prevent falls and other behaviours and chronic conditions relating to the aging process. However, such assistance can be provided at home, or at supportive living housing sites, where meals and some supervision are available. Babyboomers have indicated that when they age, they prefer to stay in the community. It is important that planners and service deliverers study this need and develop new models of supportive housing and living environments to enable this new generation to age in the community. This could include re-designing communities, zoning by laws, building codes and others to assist these individuals to age in the community.

Building a system of community care and supports services

Home care is a service valued by Canadians and it will need to be enhanced to support the future needs of babyboomers. However, to support aging in the community, home care services need to evolve to a broader system of community care and supports services. This could include services such as meals on wheels, transportation services, companion services, self-help groups, wellness centers and others. Supports by informal caregivers such as families, friends and relatives are important and thus strategies have to be developed to support informal caregivers. To create this social support system, stakeholder groups need to be involved and a collective goal and vision have to be developed. With this change, a greater majority of Canadians will be able to remain in the community as they age.

The nursing home system will remain as an important and integral part of the continuing care system in future. However, its role should be changed to target at the client group with high and complex health needs. It could also be the future sites for specialized programs as such palliative care and sub-acute units.

Creating “co-ordinated access” to services to meet service and information needs

Babyboomers are a generation of individuals with higher education, training, and selfdetermined attitudes regarding the kind of lives they prefer to live as they age. The first group is now entering their early fifties. Information on retirement planning, as well as housing and aging lifestyle choices will be in demand. They will be reviewing and visiting care/housing option sites. Housing, health and social service providers need to work together to provide streamlined and organized information to assist these individuals to make their choices. Web sites and internets will be suitable mechanisms for transfer of information. Coordinated access to a system of community care and support services is necessary to embrace this new concept of “aging in place” in the community.

Summary

The current continuing care system has served us well, but its features need to be redesigned to meet the changing needs of the babyboomers. The next ten years will be the most important years to shift and build this new system to prepare for future needs of the aging population. Many provinces have conducted long term care reviews to assess strategies necessary for the future. We must collectively seize this opportunity for improvement and change.

Comments made in this article are based on research conducted by the Long Term Care Review Project in Alberta. Reports published by the Long Term Care Review include the followings: Summary of Consultations with Public, November 1998 to March 1999, Summary of Consultations with Experts, January to March 1999, Future Scenarios: Continuing Care Service Needs in Alberta, November 1999, Healthy Aging: New Directions for Care, Part I, II, III, Novermber 1999, Strategic Directions and Future Actions: Healthy Aging and Continuing Care in Alberta, April 2000.

These reports are available from Communications Branch, Alberta Health and Wellness, 22nd floor, 10025 Jasper Avenue, Edmonton, Alberta T5J 2N3.

Summaries are available from Internet site at: http://health.gov.ab.ca.