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Needs Based Planning for Long Term Care Verses Political Imperative

December 03, 2019  · 3 min read

Long-term care must be designed to facilitate the dignity, autonomy and personal wishes of older people while keeping them connected to their community and social networks. A recent study featured by CBC News shows that there is an increasing trend in declining wage, staff shortage and job dissatisfaction among Ontario, Canada’s personal support workers (PSW). "We want to make sure we're treating our elderly people with care, as human beings, and not as parts on an assembly line," said Brian Dijkema, co-author of the study.



Not all countries currently have fully integrated systems to support long-term care – far from the truth.  The level of economic development or the proportion of care-dependent older people within their populations can be a limiting factor in achieving an integrated system to support long-term care.  Without integration there is less emphasis on the planning and development of services to support older people in their location and residence of choice.


Promoting new ways of thinking about long-term care, including shifting to a central objective of optimizing functional ability should be the priority for all long-term care systems.  All countries need a fully integrated system of long-term care.  This may imply the development of a national plan and at a minimum, the plan should outline the services to be provided, who will provide them and how these services will be financed.  Serious consideration must be given to, how universal access will be facilitated, how quality will be ensured, and how the system will be coordinated to ensure the provision of integrated and comprehensive long-term care.


Comprehensive planning based on population demographics must be adopted if services are to be situated in communities where they are most needed. No longer can needs be based on electoral aspirations of politicians such as exist in countries like Canada for example.


IFA believes that governments must develop integrated systems that support long-term care provision based on need, with defined planning ratio benchmarks that ensure both, the allocation of residential and community care places.  Care provision and quality must be measurable across all service settings.


Furthermore, long-term care provision must include the development of programs and services specific to the needs of informal/unpaid caregivers.  Research shows that 83% of long-term care provided to older adults coming from family members or other unpaid helpers, and they need help.



To ensure services are developed and implemented where they are needed, governments must adopt needs-based planning ratios across defined electoral regions that identify where older people live.  Such ratios should be developed based on a regions’ population aged 70 years and over.  Long-term care provision must include formal residential care facilities and direct care services into the homes or places of residence for our older citizens.


Those with special needs should be defined as people from Indigenous communities; people from non-English speaking backgrounds; people who live in rural and remote areas; those with special needs such dementia; and people who are financially or socially disadvantaged.  When considering planning ratios for indigenous communities, consideration must be given to life expectancy of the population.


Recommended planning ratio provision in developed countries is 125 places per 1,000 people over the age of 70 with 55 of these places being allocated to community packages of care delivered to an older person’s place of residence and 70 places for the provision of residential and/or nursing home care.


Adopting such a model would greatly enhance service provision when you consider that in Canada the average daily subsidy paid by government is approximately $150.00 per day in a nursing home care setting.  Extending subsidies to the provision of home-based package care at the same level could support 2-3 older people at home.  This would not only improve service provision to a greater number of individuals but minimize the number of inappropriate admissions to nursing homes.


“Many older people in nursing homes in Canada could actually live in the community with a specially designed package of services rather than be inappropriately placed in a setting that does not help maintain and improve their functional ability” said Mr. GregShaw, Director International and Corporate Relations at IFA.


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