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By Matthias Hoben
and Carole Estabrooks

The most recent census, in 2016, showed that almost 17 per cent of Canadians are over age 65. In fact, those older than 85 have increased by almost 20 per cent since 2011, making it the fastest growing age group in Canada.

Matthias Hoben

Matthias Hoben

We’re an aging populace, there’s no getting around it.

As more Canadians live longer than ever, care in nursing homes – or long-term care facilities – is a necessary part of the aging journey for many.

When surveyed, most older adults say they want to stay in their homes for as long and as safely as possible.

But nursing homes fill a vital role in the continuum of housing for older adults who are unable to remain at home or in other supportive environments. As we age, we often develop complex medical issues that can only be safely monitored within a 24-hour nursing care setting.

Carole Estabrooks

Carole Estabrooks

But what are the social and economic costs of entering nursing home care too early or too late? What can we learn from provinces with differing policy approaches to aging in place?

Our recent study, published in the Journal of the American Medical Directors Association, shows that policies directed at aging in the community reduce the overall length of stay in nursing homes. But it also showed that such residents are entering nursing homes with more, and more complex, care needs. That reality is not yet reflected in nursing home care funding, training and staffing.

In our study, we used Translating Research in Elder Care (TREC) longitudinal data to assess the average length of stay for almost 8,000 residents across 18 nursing homes in three health jurisdictions in Alberta and Manitoba from 2008 to 2015. We found significant differences in how long the average resident stays in a nursing home, with regional policies likely being the key factor.

We found that in Alberta, where there has been a dedicated effort to keep older adults in the community longer, the length of stay in a nursing home is significantly shorter than in Manitoba.

Compared to all of Canada’s provinces, Manitoba has the highest proportion of nursing home admissions where care could be delivered elsewhere.

Alberta has made it a priority since 2000 to restrict admissions to nursing homes to those with complex conditions. To do this, Alberta has increased care services in the community and developed levels of supportive living according to need.

Manitoba, on the other hand, provides home care and only one level of supportive living.

So how does that affect the nursing homes and their residents and staff?

We found that while Alberta had lower lengths of stay in nursing homes overall, the residents in Alberta had significantly higher care needs than residents in Manitoba. More Alberta residents were found to have high physical dependency, severe cognitive impairments (e.g., dementia) or clinical instability. That makes sense if residents are entering long-term care at later stages of their care trajectories, when their care needs can no longer be met by community agencies.

Higher and more complex care needs can have implications for nursing home staffing and funding requirements. When care needs are high, staff may experience increased workloads, which can lead to burnout and a subsequent decrease in job satisfaction, with implications for physical and mental health. Other research demonstrates when nursing home staff are burned out, the quality of care that a resident receives can be affected.

Longer nursing home stays, as in Manitoba, on the other hand, can mean that residents are being transitioned to nursing homes too early – when they could still live safely in the community.

Nursing home care is costly to governments. In 2017, Canadian governments spent close to $19 billion on care provided in nursing homes and supportive living facilities. Individuals are also expected to contribute to their stay and spent more than $8 million in 2017.

Research shows that aging in place and keeping older adults comfortable in the community longer may offer a better quality of life and provide more efficient and cost-effective care.

But admitting residents into long-term care later in life, when their needs are higher, means we have to provide adequate funding and staffing for long-term care facilities to reflect the complex new realities.

Matthias Hoben is an assistant professor in the Faculty of Nursing at the University of Alberta and holds a professorship in Continuing Care Policy Research from this faculty. Dr. Carole A. Estabrooks is scientific director of the pan-Canadian Translating Research in Elder Care (TREC) and professor and Canada Research Chair in the Faculty of Nursing at the University of Alberta.

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