Solving the Puzzle: The Changing Landscape of Nursing Homes

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Today’s options in nursing homes and senior living abound — and they’re only expanding. Here, a basic primer for navigating the ever-changing landscape of retirement living residences in Canada.

It used to be fairly straightforward. Granny reached her 80s, got shaky on her feet or started leaving the stove on, and consequently moved into an old-age home where she could be looked after properly.

“Outside of employees coming and going, there was not much of a community dynamic,” says Michael Keating, executive director and association counsel of the New Brunswick Association of Nursing Homes. “That was the late 20th century, when government had stepped in to play a bigger role in long-term care.”

Today, senior living looks a lot more varied, and the options are only expanding. One reason for this is the surge in new residences that cater to seniors who pay out of their own pockets. “There’s been an evolution of the private system that is a complement to our traditional government-subsidized system in Canada. It allows consumers more flexibility and choices,” says Trina Carey, general manager of Canada for A Place for Mom, a company that helps seniors find retirement-home spaces.

She adds: “Within the next 10 years, when a higher proportion of our population is looking for senior living, it will be a really interesting time.”

That flexibility and choice have to do, in part, with the type or amount of care provided. While government-funded facilities are provided to people who have met the criteria and may require 24-hour supervision or care, retirement homes are increasingly offering multiple levels of care, often in the same building.

This allows residents to age in place rather than be forced to leave as they become less independent, says Adam Fineman. He’s the director of sales and marketing at Signature Retirement Living, which operates eight properties, with more on the way. “You can go into a seniors apartment in a serviceless environment,” he says, “and if your care need escalates, then you can transition onto the enhanced-care floor.”

Other variable features have to do with the living environment itself—the size of your suite, for instance, or the range of amenities on offer.

“The competitive landscape is very real,” says Fineman.

Next: The waiting game

The waiting game
Choice can also mean something as fundamental as staying in the same neighbourhood as your kids or avoiding a lengthy wait time. Notes Carey: “A person’s ability to pay gives them options, and sometimes that means there may be sooner availability.”

Publicly funded homes can often take years to get into.

In Toronto, Barbara Williams was approved for long-term care but lingered on a waiting list for 11 months. She was warned it could take much longer. While she waited, Williams, who is 78 and has Parkinson’s disease, paid to live in a private retirement home and hired the personal care assistance she needed.

Although she did recently move, she said at the time: “I’m finding it difficult not knowing when they’re going to call to let me know I’m going to this place, whether it’s going to be next week or three months or three years,” she says. “I’m beginning to strategize about the logistics of the move and prepare for it.”

Wait times elsewhere in Canada appear no better, as the long-term care system struggles to catch up with the growing demand.

“In New Brunswick, we’re trying to get ready for the onslaught – the really huge demographic shift that’s going to happen,” Keating says. “Doctors are referring people into the hospital environment to fast-track them into the nursing homes. That’s a huge problem. It’s creating a bottleneck, and people are living without proper exercise and social interaction.”

Next: The price tag

The price tag

Every province manages and regulates its own nursing home industry. All properties, whether public or private, must comply with government regulations if they provide a certain level of care to seniors. (Care needs, too, are labelled differently, as each province has its own classifications.)

As for fees, they’re literally all over the map. When a long-term care facility is government-funded, the cost for personal care is covered. But non-health services, such as accommodation and meals, must be paid for by residents. If you can’t afford the full cost, you can apply for a rate reduction or subsidy. But, again, the eligibility criteria—and whether these subsidies apply to private or only public homes—depend on where you live.

Fees also vary hugely according to the level of care you need, the services and amenities you receive and whether you’re in a spacious private suite or you share a publicly funded room with other residents. The bottom line? Monthly rates can be as low as $1,400 (or less, if you’re eligible for a government subsidy) or as much as $6,000 or more for heavy care or upscale amenities. There are properties in Canada offering beauty spas, infinity pools, bowling alleys, theatres, Red Seal chefs, dog groomers, Bentley car service and trips to wineries.

Next: Thinking outside the rocking chair

Thinking outside the rocking chair
Not all innovations have a price tag. Some progressive retirement homes are partnering with child daycare centres, which promote heartfelt opportunities for synergy. “Residents are interacting on a multigenerational level,” says Carey. “To have these little kids running around these seniors, it’s just awesome!” Other retirement buildings and long-term care residences offer restaurants that are open to the public.

“That’s absolutely where we’re headed, being able to facilitate those interactions in some very simple ways,” says Jodi Hall, the New Brunswick Association of Nursing Homes’ director of operations. “Our residents aren’t isolated or excluded from community members. We see it as a win-win-win for everyone.”

Hall, Keating and other stakeholders in New Brunswick are exploring sustainable solutions to ease the pressure on the senior long-term care system. Sometimes, all it takes for a senior to stay in her own home and in good health are regular social calls, or a hot meal, or transportation to a senior centre for a day visit. “What we’re trying to embrace for the future, bringing government alongside with us, is that nursing homes are a community-based infrastructure and that we’re able to provide resources to seniors in the community, as much as in our homes,” says Hall.

Next: Making your selection

Making your selection
As the private sector continues to compete for a share of the senior living market, people who can afford these retirement options are faced with some comparison shopping.

“The industry has come a long way over the last 15 to 20 years,” says Fineman. “Today, the customer has choice, and the customer is very informed about what the options are. The notion of customer service has definitely been escalated.”

Williams did her homework from her computer. “I did research online about the various homes and living conditions. That helped enormously,” she says. She logged onto the websites of individual nursing and retirement homes and checked online reviews.

You can also request guided tours. “If you’re looking at multiple properties, ask questions of the residents who live there,” says Fineman. “They’ll tell you about the good and the bad.” This is your chance to peek behind the luxurious drapes of an architecturally beautiful building and pay attention to the details. Maybe the facility is understaffed or the food isn’t up to par or the people aren’t friendly. “You want to see if the property has a warm and engaging atmosphere,” Fineman says.

Among publicly funded homes, which might be operated by a government agency, a non-profit organization or a private company under contract, there may also be differences. Alarmingly, a recent study in Ontario found that privately run public facilities have a significantly higher rate of death and hospitalizations compared to not-for-profit operations.

Williams’ private retirement residence, about average in cost, was located in an attractive, convenient neighbourhood, a big plus for her and something she dearly missed after she finally moved to a publicly funded home. She also participated in the recreational programs and exercise classes, where she interacted with other residents.

She says, “It’s reassuring to see other people in similar circumstances. “I can tell you, truthfully, that a lot of our residents are pleasantly surprised by how much they enjoy the experience,” says Fineman. “They’re more active. They’re eating fabulous food. And they’re reinvigorating their social life.”

Say what?
When it comes to categorizing senior living, there is no universal terminology. But here’s a basic primer.

  • Independent living
    Also known as retirement residence, seniors building
    Geared to senior living, with programming and recreation facilities. Care is minimal or provided on a fee-for-service basis, but residents might have an emergency call button or the option to pay extra for a daily meal in the dining room or weekly housekeeping.
  • Assisted living
    Also known as independent supportive living, supportive living, enhanced care
    Personal care, like bathing, dressing and toilet assistance, is provided to varying degrees for seniors who require it. There may be a nurse on staff. Meals are provided in the dining room.
  • Memory care
    Also known as dementia care, Alzheimer’s care. Offers enhanced security, care and specialized programming for seniors with dementia.
  • Long-term care
    Also known as nursing home, long-term care facility, auxiliary hospital. The traditional old-age home. Offers 24-hour supervision and personal care with on-staff nurses.


A version of this article appeared in the October 2016 issue with the headline, “Solving the Puzzle,” p. 56-59.