By Michael Kary

Statistics Canada census figures for 2016 revealed the country saw its greatest increase in the proportion of older adults. There are now 5.9 million seniors in Canada, compared to 5.8 million children 14 and under.

As the latest Statistics Canada data suggests, if current trends continue, demand for residential care will only increase significantly in the future because the proportion of seniors living in care homes increases with age, and the number of elderly seniors will grow as the aging of the population accelerates.

The latest census data shows over 770,000 Canadians were aged 85 or older in 2016, with this cohort growing almost four times as fast as the overall population between 2011 and 2016. One per cent of people between the age of 65 and 69 live in residential care homes in Canada, while the largest age group living in care homes is 85 and older at 29.6%.

In a 2015 report, entitled Future Care for Canadian Seniors: A Status Quo Forecast, the Conference Board of Canada estimated that by 2026 over 2.4 million Canadians age 65 and over will require continuing care support — up 71 per cent from 2011. By 2046, this number will reach nearly 3.3 million.

According to the report, “total spending on continuing care supports for seniors in Canada is projected to increase from $28.3 billion in 2011 to $177.3 billion in 2046. With nearly two-thirds of this spending likely to continue to be provided by governments, spending growth will significantly exceed the pace of revenue growth in most provinces.”

The same report also highlights that the number of seniors living in retirement homes, supportive housing, or long-term care homes will grow to over 610,000, and that Canada will need an additional 131,000 spaces for Canadian seniors, growing to an additional 240,000 spaces by 2046.

It is for these reasons, particularly with demand growing more rapidly than supply, that the Conference Board of Canada report advocates significant public and private sector investment in building the infrastructure that is necessary.

With this increasing demand, as well as governments and stakeholders advocating for moving resources away from acute to home and community care (HCC) to reduce costs and improve quality care, it is somewhat troublesome to see other reports recommending that the role of the private sector in the delivery of senior care be significantly diminished or reduced.

This, for example, is seen most recently in a report released in March 2017 by the Canadian Centre for Policy Alternatives (CCPA) titled Privatization and Declining Access to BC Seniors Care.

While the BC Care Providers Association (BCCPA) is in general agreement with two of the three recommendations from this report, particularly relating to improving access to publicly funded HCC and developing a framework and action plan to improve access and service integration, the recommendation to significantly reduce the role of the private sector in HCC is entirely misguided.

In making this recommendation, the CCPA report argues that the quality of care provided in private care homes is largely inferior to that provided by non-profit and government run care homes. It also notes that staffing levels, including direct care hours (DCH), are lower—as highlighted in a recent report from the BC Office of the Seniors Advocate (OSA).

While the DCH levels may be lower in some private care homes, this assertion is somewhat disingenuous without also noting the DCH levels, whether private, non-profit or government run, are determined by the regional Health Authority, which provides funding for different DCH levels to care homes. The number of daily care hours provided to seniors is mandated and closely monitored through a contractual agreement between the care provider and the health authority.

Likewise, along with failing to mention different DCH funding levels, the CCPA report also does not mention that all care providers, whether public, private or non-profit, are held to high-quality standards and regulations. There is little evidence in the B.C. health system to show that private care homes provide inferior quality of care.

In fact, a recent report from Alberta which highlights results of a 2014/2015 Long Term Care Family Experience Survey largely debunks this notion indicating that in general, no one model type (government, private or non-profit) was better or worse than the others across all key measures of family experience measured.

Like the Alberta study, the OSA is currently undertaking a comprehensive survey of residential care homes across BC to get a better understanding on the overall resident experience, so only then may it be clearer whether significant differences do indeed exist.

Not only is the CCPA report’s recommendation to diminish the role of the private sector in HCC misguided if it were adopted, it would have a very detrimental effect on access to seniors’ care across the province. This would be particularly problematic as private sector investment is critical to meet the needs of a rapidly growing and aging population.

In summary, the private sector has and continues to play a crucial and important role in the delivery of senior care. Removing these private providers out of our mix of care options is not only impractical, it would be costly and counterproductive.

Rather than pushing out private operators, the responsible position would be to embrace and encourage the types of innovation they have introduced into the system while upholding high standards for quality care. Such innovations include, for example, the introduction of new technologies but also development of large campuses of care which include a variety of amenities such as daycare centres or restaurants.

The BCCPA hopes to continue to discuss and highlight the important role the private sector plays in the delivery of seniors’ care, particularly as a leader in innovation and improving choice in all areas of the continuing care sector.

The BCCPA also continues to support and uphold appropriate oversight and regulations so that care providers, regardless of ownership type, are held to the highest possible standards when it comes to caring for the elderly. Along with communicating this to government and other stakeholders, the BCCPA hopes to have further dialogue on the role of the private sector in seniors’ care including possibly as a future topic area at one of our regular Care to Chat events.

Michael Kary is Director of Policy & Research at the BC Care Providers Association.