Piecing together private and public senior care resources

Last week I wrote about one of the most common challenges that family caregivers face - overcoming resistance. This week's article is on another big challenge that caregivers experience - information fragmentation. I get asked a lot about the differences between the public healthcare system and private-pay services and housing for seniors. "I don't know what I don't know" is a common phrase I hear. Navigating the maze of public and private-pay services can be confusing and overwhelming for anyone, let alone for someone who is trying to juggle kids at home and a full time career at the same time. Let's see if I can make things a bit clearer.

Home Care

In the normal course of aging, a senior (or their family caregiver) likely will have to consider at some point getting in-home help or moving into a seniors residence. In either case, one has options. Most seniors in the normal course of aging will start with some in-home help. One can obtain home support services from the public health authority or from private-pay sources but the method of access, the scope and delivery of these services vary greatly depending on the path you choose. Home support from the public health authority is initiated by contacting the local health unit and asking for an assessment for home and community care. Following this assessment, a determination is made regarding eligibility and the tasks that the senior requires help with. These approved tasks are generally centered around personal care (getting dressed, showered, etc.) and medication management. Public community care workers will not come to your parent's home to clean, take them to appointments, drop off groceries, or go for a walk. They will come, perform just the approved tasks and then leave. Typical visits are anywhere from 15 minutes to 1 hour, and multiple visits in one day are possible.

Private-pay home care services can be obtained through a number of sources - home care agencies, placement platforms, and word of mouth just to name some examples. With private-pay services, you can set the requirements and the scope to be whatever you'd like, and can include things like companionship, cooking, cleaning, personal care, medication reminders, and accompaniment to appointments. Typical visits are 3 hours and up, all the way to full time or live-in care.

So what are some of the pro's and con's of each option? With subsidized home care services, one of the most common complaints I hear from clients is that it's not the same person coming each day, and they don't always come at the time they're supposed to. Having different care workers coming randomly is very disruptive and hinders continuity and consistency of care. However, for most seniors the amount they pay for subsidized home care is a fraction of what they would have to pay for private home care services. For seniors where their care needs are minimal, subsidized home care might be appropriate. With private-pay home care services, the extra flexibility and control you get over the scope and timing of services comes with a much higher price tag. However, most seniors will need at some point help with house chores, meal preparation and errands, all of which are not covered by the public healthcare system. Private-pay services are more easily customized to each person's needs, and more conducive to satisfying the whole range of needs. There is no issue with having both public and private-pay home care services, and many people in fact do.

Seniors Housing

As care needs escalate, one may need to consider moving to an assisted living residence or care home, both of which are available through the public health authority or through the private-pay sector. Assisted living generally involves scheduled care such as help with the morning routine, showering, other hygiene tasks, medications, and nighttime routine. Residents who live in an assisted living residence are typically cognitively high functioning and still have mental capacity. Care homes on the other hand offer more round-the-clock care. As an example, a care home would be appropriate for those who have incontinence issues, need for dementia care, or require transfer assistance to get in and out of a wheelchair.

The method of access, costs and environment differ quite a bit between a public vs private seniors residence. Some residences are 100% private pay, some are 100% publicly subsidized and some residences have a mix of both. To access a subsidized residence, one would contact the local health authority and request an assessment for placement. Following the assessment, a determination is made as to the level of care required and then the waitlist process starts (and can be quite long). There are some nuances around selecting preferences. I won't go into them here but I would advise doing research and touring some of the residences. After a spot is found and taken, the fee payable is assessed as a percentage of the senior's income up to a certain maximum.

With private-pay residences, one would approach the residence to apply directly (pro tip: go for a tour late morning and ask to stay for lunch so you can test out the food!). You have complete control over the choice of residence, timing of move, and selection of suite and floor plan. Costs are much higher than the subsidized option, and there are waitlists for many private-pay residences as well. Again, I recommend doing research and going on some tours. I would also highly recommend sitting down with a financial planner to plan out a budget so you know what you can spend each month. Private-pay residences generally have a wider range of in-house services, recreation, food choices, floor plans, and amenities. With each new residence being built, boundaries are being pushed. Gone are the days where a care home has to feel institutional or depressing. Some of the newer residences being built by companies such as Sunrise Senior Living and Amica Senior Lifestyles are re-defining what senior care can look and feel like.

In closing, my best advice to families is to be pro-active and start the conversation and research well before any decisions have to be made. Each person is unique and these decisions are extremely subjective and personal. There are a lot of nuances I haven't covered here such as emergency placements and transitioning from private-pay to subsidized residences. Feel free to reach out directly if you have any questions specific to your family's situation. I hope this has been helpful!