Developing New Strategies to Support Future Caregivers of the Aged in Canada: Projections of Need and their Policy Implications

Projections of future need for Canadian continuing care services typically uses current utilization patterns and population aging. Accurately assessing this need is much more complex since disability patterns among the elderly are changing and availability of caregivers is affected by changes in family structure. This paper projects annual growth rates between 2001-2031 in the need for informal and formal support among elderly Canadians and discusses the policy implications of the increasing demand for informal caregivers. Using Statistics Canada's LifePaths micro-simulation model, these projections incorporate disability rates and the potential availability of informal caregivers. The authors conclude that continued focus on family to meet the needs of elderly Canadians without increased support is not sustainable in the long term. New strategies to support Canadian caregivers are proposed and their economic feasibility in the public and private markets are evaluated.population aging, caregiving, disability, informal and formal support

The Becoming Subject of Dementia

In this paper we analyse the becoming subject of dementia, as it is made to appear within the contexts of nation-building and everyday life. Insights yielded from this analysis suggest the importance of time to recognition of normalcy, and to the meaning of being a person

Policy Brief No. 19 - Caregiver Assessment: An Essential Component of Continuing Care Policy

Family and friend caregivers are the backbone of Canada’s health and social care systems. The support they provide is indispensable in enabling individuals with long-term health issues to remain in their communities. Caregivers take on a challenging role—one that can impact their physical and mental health, social activities, personal finances, employment and relationships (Health Council of Canada, 2012; Keefe, 2011). Caregivers’ health and wellbeing has repercussions for the care recipient, their family, their communities and the health care system. To support this critical role, caregivers need to be understood as partners in care, but also as potential individual clients of health and social care systems in and of themselves. Caregiver assessments are a key tool to identify and provide such understanding. Such assessments are used by health care practitioners to evaluate the degree and urgency of risk to the health and wellbeing of caregivers or to the deterioration of the caregiving situation. Through assessments, practitioners can more efficiently and appropriately target interventions and supports such as psycho-social counseling and prepare for changes in care. This Policy Brief makes the case for the integration of caregiver assessment in home and long term care services and provides research-based evidence from the literature and studies using the Caregivers’ Aspirations, Realities, and Expectations Tool (C.A.R.E. Tool). Home and long term care policy can no longer afford to remain solely focused on persons needing care. Recognizing caregivers as partners and clients is crucial to supporting the care situation. In this, assessment tools have a critical role to play

How Residents’ Quality of Life are Represented in Long-Term Care Policy: A Novel Method to Support Policy Analysis

Context: In one’s final years, quality of life (QoL) is a fundamental desire. In Canada, a publicly-funded long-term care (LTC) system is governed provincially through multiple policies about housing and care provision. A pan-Canadian research team investigated federal and provincial policies’ influence on the QoL of older people living in residential LTC in four provinces: British Columbia, Alberta, Ontario, and Nova Scotia. Objective(s): This paper describes a novel method of policy analysis developed by the authors to analyse the inclusion of QoL domains within these LTC policies, and assess implications for residents, their families, and staff. Method(s): Within the novel method mentioned there were four stages in the method that consisted of an iterative and collaborative approach to understanding the relationships between LTC regulations and resident QoL domains through four perspectives (resident, staff, family, volunteer). At first, inclusion/exclusion criteria were applied to select appropriate policies, and secondly, policy texts were to coded according to Kane’s (2001) QoL domains. The third stage involved assigning a level of regulatory power, with the final stage interrogating the policy categorisation data from four perspectives: residents, families, volunteers and workers. Findings: The outcome revealed a dominant discourse of safety, security, and order over other domains such as dignity, privacy, and spirituality. Limitations: Policies dictate regulatory and guiding principles, and are only one part of the story. How these policies are implemented is beyond the scope of our research, but we recognize that understanding these implementation practices are essential to fully capture the experiences of residents, their families, and staff. Implications: This novel method is useful in exploring how QoL is supported across a high number of complex cross-jurisdictional policies. We conclude that our approach to policy analysis enables a re-examination of policies affecting LTC and assesses whether these policies reflect the values of the residents and society at large

Projecting Family Support Needed to Assist Older Canadian Living in the Community, 2006-2031

Canadian policy makers are increasingly interested in planning for the inevitable increase in home care services that will be fuelled by population aging and community care policy. Our goal is to advance understanding of the patterns and predictors of disability and support among the population aged 65+ and use this information to project future health human resources. Using the 2002 General Social Survey, logistic regressions estimated the probability of an individual with specific characteristics of having a specific level of disability and those with a long term health problems using one of three types of support networks (formal, informal, or mixed). These parameters were applied at five-year intervals in Statistics Canada LifePaths microsimulation model to project future demand. When looking at the population needing assistance, results from the micro-simulations show an increase from 630,000 to over 1.3 millions between 2006-2031. Results also show an increase in the proportion of elderly having to rely exclusively on the formal network (40% in 2006 to 44% in 2031. By applying the median amount of assistance per week by age and sex (GSS 2002) to the projected population who will receive assistance, the number of hours per week received is projected to double from 2006 to 2031. This trend is most pronounced among the 85+ in that the amount of assistance is projected to almost triple from 2006-2031. Despite recognition of the steady increase in demand for home care, Canada has made little headway in developing consensus on policy directions. A discussion of the policy implications of these findings will highlight the need for greater recognition, better working conditions and career paths for front-line home support workers who provide the majority of care among paid home care providers. Yann Décarie is a Ph.D student in Demography at L’Institut National de la Recherche Scientifique (INRS) under the supervision of Alain Bélanger. Yann received a degree in Statistics from the Université de Sherbrooke and an undergraduate degree in Actuarial Science from the Université de Montréal. Since 2006, Yann has been working with Professor Jacques Légaré and Professor Janice Keefe as a research assistant on a project related to the projection of disabled people and home care needs. Yann’s research interests are on ageing, projection methods, microsimulation and population health

Research Brief No. 3 - Disability and Support Networks of Older Canadians

The percentage of older Canadians requiring assistance with health-related tasks due to a long-term health condition increases sharply with age (Chen & Wilkins, 1998). As the first of the Boomers reach age 65 in 2011, it is of great interest to identify trends in disability and support network usage, to better predict future needs and resources within community care. This project used data from five national datasets to investigate the global disability rate and examine socio-demographic characteristics associated with disability and the use of informal and formal support networks to assist older adults with a health problem in performing everyday activities. No significant trend in levels of disability was identified for the period 1994/95-2000/01 when controlling for socio-demographic variables (age, sex, education, marital status, region of residence, and country of origin), suggesting stability in disability rates over time. Analysis of support network utilization revealed socio-demographic characteristics associated with need and receipt of formal and informal support; strong correlations were found for age and disability level

Le soutien aux personnes �g�es en perte d'autonomie: jusqu'o� les baby-boomers pourront-ils compter sur leur famille pour r�pondre � leurs besoins ?

Projection of future needs for home care services typically uses current utilisation patterns and population ageing. Accurately assessing this need is much more complex since disability patterns among the elderly are changing and availability of caregivers is affected by changes in family structure. This paper projects annual growth rates between 2001-2031 in the need for informal and formal support among elderly in Quebec and discusses the policy implications of the increasing demand for informal caregivers. Using Statistics Canada Life Paths micro-simulation model, these projections incorporate disability rates and the upcoming availability of informal caregivers. The authors conclude that continued focus on family to meet the needs of elderly without increased formal support is not sustainable in the long term.Population aging, caregiving, disability, informal and formal support, Quebec

End of One Way

Describes the role of three South Minneapolis community-based organizations. Demonstrates how the organizations form partnerships and share leadership with their communities. Explores a set of themes derived from each example of community engagement

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

Background: Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. Objectives: To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. Methods: A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. Results: A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. Conclusion: This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform