Coordination of Care Often the Biggest Issue for Seniors in Their Homes

[This piece was originally prepared for a writing contest with SeniorsZen]

As my grandparents get older, my family, like many in Canada, are starting to have those conversations that are most often called the “tough” ones. Though to a certain degree we tend to believe that our own loved ones will be the lucky exception, the reality is that with an aging population and a Baby Boomer cohort often squeezed between professional and family responsibilities, decisions about elder care are almost universal. The problem is that, because both our elders and our selves like to avoid thinking about these decisions before they are inevitable, when those conversations do start happening, they are most often hectic and rushed. Having worked herself as a long-term care nurse before her retirement, one would think that my grandmother would be most aware of the struggles that families who do not have a prior plan go through and would dean to have one herself. When her need for personal support in her home first became apparent to my family, indeed, we all couldn’t help but remarking upon the irony that a woman who had given much of her life to caring for those in need had done so little to plan for her own. In a way, this made the situation a double-frustrating one, as along with the normal problems of waiting lists and the paucity of reliable resources on care quality, there was a feeling that our family, and my grandmother most of all, “should have known better” when it came to the decisions surrounding elder care. What I’ve discovered, though, is both that it is rarely so simple a distinction between preparedness and lack thereof and that even in the best circumstances, the time of life my older relatives are moving into tends to be a trying one.

With that said, I do not think there is cause for undue negativity. One of the most positive things about the new realities of housing options for older Canadians is the choices involved. As opposed to the purely-institutional model that prevailed when my grandmother herself worked in the sector, it seems now that we have a bevy of options that are more designed to fit both life stages and individual needs. For instance, in my home town, there are several retirement residences which have graduated “stages” of care, moving from supportive apartment-type arrangements all the way to what would traditionally be termed “nursing home” levels of assistance. As my father works for one of these homes as a contract manager, I’ve been able to get a bit of a “behind the scenes” look at the functions of such institutions, which can unfortunately often feel opaque to the average potential resident and their family. Increasing transparency around some of these functions would be ideal, but I often wonder if so much of the continued silence on these issues (though it has certainly improved over time) is that, as a society, we simply do not like to think about aging that much. Indeed, even in my own family, with members dealing with elder care in a professional capacity, the conversation was closed off until it became too late to put off discussing. Luckily, we had the connections to community resources and the knowledge base such that the negative side-effects were not drastic. That said, my father every day sees the consequences of individuals and families not taking these eventualities into account. Though certainly more investments are needed at both a government and business level in the provision of services for seniors, more openness on the effects of aging as a society would help to mitigate As a family, we have had a discussion and agreed upon conditions with my grandmother about when it would not be appropriate for her to continue living in her house with caring assistance and would need to be in a residential facility. At the same time, this new reality, and the one that my grandmother has the ability to access through such mechanisms as self-managed care dollars and funds for home renovation, is one which creates its own challenges. Chief amongst these is coordinating care, from both the formal and informal sectors, from medical and non-medical realms.

In the end, it is well-known that Canadian seniors, by and large, would like to be able to stay in their own homes as long as possible after retirement. The reasons for this are obvious, both psychologically in the sense of independence and accomplishment it gives them, and practically in that it is often better from a health, well-being and family connection perspective. Though residential care facilities and other senior-targeted living arrangements will continue to be relevant for those with particular needs into the future, it seems from both my own experiences and the general public conversation that these institutions are often left in a position of compensating for a lack of prior planning. People who could have stayed in their homes, as likely would have been their preference, if they and their families had had these discussions earlier, end up in inappropriate care arrangements simply because they are the ones available at the time. Providers do need to make more of an effort in terms of connecting with the public and publicizing what services are available to individuals, but, at the same time, families need to be more willing to address these topics before the issues become imminent. In my family`s case, it has been fortunate that the consequences were only some minor confusion and frustration. In this new environment of senior living options, it is the ability to have those conversations that needs to catch up to the options available, such that care can be better coordinated and more timely and appropriate.