retirement homes Archives - Your Health Matters

No Need to Sell the House When Searching for a Nursing Home

Lisa Priest — Mon, 21 Jan 2013 15:28:00 +0000

The Question: My mother is searching for long-term care home for my father and because of the expense involved, she will probably end up selling her house and looking for a new place for herself to rent. I can’t imagine that this is the best way to go – it just seems like we are extending my father’s hospital stay somewhere else at our expense and now my mother is going to be out of her home. At least at the hospital, my parents are not draining their resources paying for my father’s care.

The Answer: It can be daunting to search for a long-term care facility at the last minute when returning home is no longer possible for your father. You also face the sad reality that your parents, after being together for years, may not be able to live together any longer.

Though it seems like a nursing home is costly compared to the hospital, the monthly payment is only for the “living portion” – room and board – of the facility as the medical care is still funded by the provincial health plan. The fees for these homes – there are about 630 in Ontario – include among other things, meals, bed linens, having medication administered, and assistance with the essential activities of daily living. There are additional costs with cable television and hairdressing.

According to Donna Rubin, chief executive officer of the Ontario Association of Non-Profit Homes and Services for Seniors, a spouse will not be forced out of their home to afford long term care.

“There is certainly no need to sell a house,” Ms. Rubin said in a telephone interview. “If you can’t afford it, the government steps in and provides the long term care home with a subsidy on your behalf, so there really is no need to sell the family home. In fact, if the spouse is still living in at home, a ‘special circumstances’ application may be made to reduce the resident accommodation charges even further.”

The fees for nursing homes are regulated, costing in Ontario per month $1,674.14 for a basic room: $1,947.89 for a semi-private room and $2,274.86 for a private room. The short-stay or temporary stay at a home costs $1,083.75 per month, according to 2012 figures from the health ministry, the latest available.

Retirement homes – where about 40,000 Ontario seniors reside – can also be an option, though their residents generally tend to be healthier. The cost of these homes ranges from $1,200 a month to $6,000 a month.

In some cases, it can be worth exploring the cost of hiring help inside the home, such as a personal support worker – especially if it will keep the couple together for longer, according to Betty Matheson, patient care manager at Sunnybrook Health Sciences Centre, who manages specialized geriatric services.

“The costs do vary for care at home, depending on the services you require,” said Ms. Matheson. “The family should weigh the affordability of care in the home, compared to the costs of a nursing home. That way, your parents can spend their days happily in their own setting.”

That hired help would almost always be in addition to any funded help you may receive, such as that through the community care access center.

“I would really explore all those options and see what’s the best for you and your family,” said Ms. Matheson.

However, she pointed out that not all people are candidates for staying at home with hired help.

“If dad is in such a state that behaviorally he is not safe at home – he wanders or becomes aggressive,” she says “Sometimes there is no option except a nursing home for the safety of everybody involved.”

Ms. Rubin, whose provincial association represents not-for-profit long term care homes, seniors’ housing and community service agencies, offered several tips on what to look for. She suggested you ask about the ratio of staff to residents and how many residents are under one personal support worker – the ratio for the latter typically ranges from 1 to 10 to 1 in 13.

She recommends that you go to one of the homes you are interested in and spend time observing staff. Is it a welcoming atmosphere? Do staff members know the names of the residents? Is the facility clean and in good repair? Is the call bell within easy reach? Does the food look appetizing? What kind of volunteer support does it have for any number of activities, including feeding? She also suggested that you try to determine how committed the home is to maintaining the independence of its residents: incontinence programs and other programs to regain function – such as eating and walking – would be ones to seek out.

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Stuck in Hospital: When Patients are Waiting for Another Care Setting

Lisa Priest — Mon, 01 Oct 2012 16:57:00 +0000

The Question: My mother is an elderly woman with Alzheimer’s admitted to Sunnybrook a few weeks ago and she is now ready to leave. None of the retirement homes I have visited so far seem to be suitable for her but I’m actively looking for one. What will happen to my mom in the meantime?

The Answer: Each day, there are 70 to 75 patients at Sunnybrook like your mother: with her acute problem treated in hospital, she is now awaiting placement elsewhere – be it a rehabilitation facility, long-term care home, complex continuing care, palliative care – or her own home with extra help. In your mother’s case, it’s a retirement home equipped to care for patients with dementia.

Her circumstance is faced by thousands of patients every day. An estimated 7,500 hospital beds, representing 14 per cent of all acute care beds in Canada, have patients in them, awaiting care elsewhere, according to a Canadian Health Services Research Foundation report.

When patients are in beds, waiting for alternate care, it has a domino effect on the system. Operations are postponed, there are long delays in emergency and some patients can’t even get into Sunnybrook – and are sent to other hospitals in the province or even to the United States – because the hospital is literally full and beyond. There are days in this hospital when it is operating at 110 per cent occupancy.

“We need to have a system when the person needs rehabilitation, long term care or home with all the supports, they immediately have access to the right type of care at the right time in the right place. The system is presently being improved upon, but it isn’t 100 per cent yet,” said Lois Fillion, operations director of Sunnybrook Health Sciences Centre. “There are still delays in the system which results in all being caught in a juggernaut.”

When an alternate level of care [ALC] patient, such as your mother, is identified, Ms. Fillion is able to track her in real time, including the health care facilities she has applied to and whether those institutions have accepted the referral or not, and whether that has been done within five days of the patient’s request.

“These are real people with real needs and when you hear their stories, you want to cry,” said Ms. Fillion, poring over a thick binder of hospital statistics in her office. “How can we work together to meet the needs? I think it means the system has to look at every case, we have to customize the service to meet the needs.”

Patients, in particular, are caught in a terrible spot: knowing the hospital is not the ideal place to convalesce, they stay, waiting for placement. On a late August day, one patient had been waiting 268 days at one of our other sites, the Holland Orthopaedic & Arthritic Centre; two others had been waiting 274 and 262 days respectively at the Sunnybrook site.

While there is no one fix, the Home First program has been able to help patients such as your mother through a specialized team led by a community care access coordinator, who supports and assesses care needs of the patient and family within one to two days of discharge from hospital. That coordinator has access to health care professionals and community support services to support your mother, while you search for acceptable accommodation. Since its inception in fall 2009, it has helped reduce emergency room visits and numbers of those on long-term care wait lists.

While at Sunnybrook, your mother will get physiotherapy to keep her mobile but hospitals are not great places to be, unless you absolutely have to be there. That is especially the case for patients with dementia, who may be bothered by the bright lights, continual changing of staff and unfamiliar surroundings.

“In the case of some patients who arrive at Sunnybrook, their family members may be in crisis themselves and burned out from the responsibility of caring for their loved one 24 hours a day,” says Noreen Dawe, professional leader for social work at Sunnybrook. “The health care team works with families to support and inform them about available resources that may allow them to continue caring for their loved one at home for as long as possible.”

For more information on HomeFirst, please visit:

http://www.torontocentrallhin.on.ca/Page.aspx?id=5796

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