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From cohousing to dementia villages: How Canadian communities are redesigning senior living

The long-term care system for the elderly needs a total overhaul. These programs are reimagining the system.

From cohousing to dementia villages: How Canadian communities are redesigning senior living
[Images: chromatika/Getty Images, masterzphotois/iStock/Getty Images Plus]

COVID-19 has amplified existing cracks in the long-term care (LTC) system in Canada. We need socially innovative solutions to help seniors age safely and with dignity.

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From cohousing to community paramedicine programs, and home-based primary care to publicly funded dementia villages, there is hope on the horizon.

As a social innovation designer, I study complex challenges with the aim to find the common approaches needed to solve these issues and not just manage the symptoms.

To better understand the challenges of the LTC system in Canada, I interviewed stakeholders involved in approaches attuned to individuals’ needs at different stages of aging—all of which are socially innovative.

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Here are some solutions that can help when it comes to redesigning the LTC system.

Senior cohousing

One of the goals outlined in the National Institute on Aging’s National Seniors Strategy is to help seniors stay active, engaged, and maintain their independence. But many seniors struggle to find suitable housing—especially affordable housing.

While retirement homes exist, for many, the costs are out of reach—so some are choosing cohousing.

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Louise Bardswich is a retired college dean who coowns a home in Port Perry, Ontario. She and three other women pulled their resources together to build a shared home.

This coowned home was designed to allow the housemates to share space, build community, and comfortably age in place. [Photo: Louise Bardswich/courtesy of the author]
Their home features design elements that will allow them to age in place—like wheelchair accessible bathrooms, a spacious kitchen, and a guest room that can be used for a live-in caretaker. The housemates pool their resources to cover costs, which Bardswich estimates are about CA$1,100 (or, $871) a month for herself.

While CA$1,100 is not affordable for everyone, it’s considerably cheaper than a LTC facility in Ontario—where the long-stay semiprivate option is CA$2,280.04 per month (or, $1,806).

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Cohousing can be difficult due to zoning bylaws, but legislation put forth in 2019 called the Golden Girls Act—named after Bardswich and her fellow coowners—aims to make it easier for seniors to create cohousing.

Community paramedicine programs

An integral part of supporting older adults to continue living safely in their homes is ensuring that they have access to the services they need. One innovative example is community paramedicine programs. These programs use existing, trained emergency medical personnel to provide primary healthcare to people who may have a difficult time leaving their home to see a doctor.

JC Gilbert is the deputy chief in charge of operations at the Simcoe County Paramedic Services. In the five years since the launch of its community paramedicine programs, Gilbert says there’s been a positive impact on patient’s overall well-being and reduced emergency calls. “We’re seeing people able to cope with their illness much better at home.”

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The Ontario Ministry of Health currently funds the development of community paramedicine programs across every region of Ontario.

Home-based primary care

House Calls is a primary healthcare practice for homebound seniors living in Toronto, led by Mark Nowaczynski and SPRINT Senior Care.

Dr. Nowaczynski explains that seeing people at home gives health practitioners the ability to gain a more holistic understanding of a patient’s health and well-being that is not possible during an office visit. The level of care he and his team provide can prevent hospitalizations and admissions to nursing homes.

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According to Dr. Nowaczynski, House Calls serves 450 seniors with an average age of 89. “We make it possible for our patients to live out their days at home and die at home,” he says.

Dr. Nowaczynski estimates that in Toronto there are 100,000 to 150,000 seniors who would benefit from home-based primary care. Between House Calls and other programs, “We’re probably meeting the needs of not even 2% of that population. So, we are barely scratching the surface, and the consequences are that there’s a large population of seniors who are receiving inadequate ongoing care.”

Making it possible for people to age at home has been shown to reduce the reliance on the healthcare system and be cost effective. Some countries have even shifted more of their healthcare budget to community- and home-based care. Denmark spends 36% of its LTC funding on care in designated buildings (like nursing homes), and the rest on home- and community-based care.

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In Canada, only 13% of its LTC budget goes to home- and community-based care.

Dementia villages

Dementia villages are communities of care designed to give their residents freedom and choice within a safe and supporting environment.

The first dementia village in the world opened in 2009 in the Netherlands. The Hogeweyk is an intentionally designed village with 23 houses for 152 seniors diagnosed with dementia. The village has a bar, restaurant, theatre, grocery store, streets, and gardens for residents to use and enjoy. It is publicly funded and runs on a budget comparable to conventional nursing homes.

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Providence Living in partnership with Island Health will open Canada’s first publicly funded dementia village care model in Comox, British Columbia. With construction starting this year, it will feature smaller households that support freedom of movement, access to nature, and connection with the community.

Candace Chartier, president and CEO of Providence Living, explains that this village concept is not just about the physical design but encompasses a shift in the model of care in which residents, staff, and family members work together to create a home environment in which residents can thrive.

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These examples show potential for the future of LTC in Canada—the challenge is to make them the new standard of care instead of a patchwork of services that result in wait lists, drive up healthcare costs, and create confusion for seniors and their caregivers.

Canada’s LTC can become a human-centered system that helps seniors get the care they need. But first we need to make humane, dignified care for seniors a top priority.

Sarah Tranum is an associate professor of social innovation design, faculty of design, at OCAD University. This article is republished from The Conversation under a Creative Commons license. Read the original article.

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