Getting a foot in the health care door

A weekly column by Graham Hookey who writes about education, parenting and eldercare

One of the most important decisions people can make, as they age, is what to do about living accommodations.

For most, indecision will lead to panic decision-making and the outcome can be disappointing for the elderly and frustrating for the family.

For most elderly, the most common decision regarding housing is to simply stay put.

The desire to maintain independence and to be surrounded by familiar places and people are pretty strong influences in that non-decision.

For many, that decision might be the right one and it’s certainly easy for families to support it for as long as their parents can support themselves.

The challenge comes when circumstances change.

In the management of eldercare facilities by the government, the elderly are rated on a scale that determines the kind of care they will need.

Every province has different terminology, but essentially the ratings go from completely independent to requiring full-time assistance for everything (acute care or severe Alzheimer’s).

A couple of decades ago, most of the people in the long-term health care facilities were in the middle of this range, and staffing needs were established based on that.

Now, virtually 100 per cent of the residents of long-term health care facilities are at the dependent end of the scale, yet the staffing formulae have changed little.

More than residences, these facilities have really become mini-hospitals without the attendant equipment or staffing to fully support the complex health needs of those living there.

There has been a greater emphasis on building or licensing private facilities, as public facilities have developed long waiting lists and higher levels of dependent patients. But most of the private facilities have opted to stay at the less dependent end of the spectrum, where staffing levels are lower, or at least the level of care needed from staff creates less risk for them and the residents.

What can often happen in a time of crisis is that a family can find themselves scrambling, while under duress, to find suitable accommodations when independent living is no longer possible.

It can be a lack of available resources at certain care levels or a lack of financial resources to pay for those that are available that can lead to frustration and disappointment.

With an aging population, the problem of accommodation for the elderly at all levels is only going to become greater and the importance of having a plan that much more critical.

The government, in my opinion, is not going to be able to respond quickly and compassionately to every sudden need and those who have few established options are going to find themselves dealing with a full-blown family crisis of doing the right thing for their family members.

It appeals to me that everyone, the elders and their adult children, need to understand the system, and the various options, before it is needed.

In this way, entry into the health care system at an earlier stage might benefit them when or if a sudden change of health necessitates greater support.

Already being associated with a health care facility that has varying levels of care can make the transition from one level to the other that much more simple, and less chaotic, than trying to butt into the system when a crisis occurs.

I have to confess that when my very independent mother decided to go into a retirement home, rather than live in her own house for part of the year and with me part of the year, I was not happy.  I felt guilty that she did not feel we could support her.

But she had seen what had happened to others and she was determined to have her foot in the health care system, for her sake, and ours, when the time came that she needed it.

Graham Hookey writes about education, parenting and eldercare . Email him at

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