Seniors with disabilities should have the choice of living independently

Disability is a fact of life for seniors. About 40% of seniors in Canada have one or more disabilities. They need assistive devices and home care to remain living independent in their homes. In the first of a four part series we explore home care as an option for seniors with disabilities.

The lack of disability supports for seniors is forcing them into institutions. When they can no longer cope at home because they are too disabled, the system is geared to institutionalize them.  Warehousing seniors with disabilities is an old model of how to solve the problem.

A senior’s story

A retired man who recently moved into seniors housing reported it was depressing. “All the people are 20 years older than me and depressed,” he said. “I am used to being around children in my neighborhood and families. I liked to work in my workshop but here there is nothing but 4 walls.”

Despite living with a disability for most of his life, he raised a family, had a home and a job with the government. As he ages his disability made walking up and down stairs difficult. The only solution was seniors housing and he doesn’t like it at all. Why would anyone want to be warehoused and segregated from the community?

According to a US advocacy publication “The Mouth”, in 1995 1.9 million Americans with disabilities were housed at a cost of $40,000 per year each when they could be kept in their own homes for $10,000 per year.

“Numerous studies have shown that living at home, in a home or apartment, is better psychologically, more fulfilling, and cheaper than living in nursing homes.” Nothing About Us Without Us: Disability Oppression and Empowerment

Home care is the most efficient care

The New Brunswick Long-Term Care Strategy said, “the premise for the actions identified within this strategy is to focus efforts on keeping seniors out of the long-term care system for as long as possible …By providing enhanced supports at the community level it is hoped that the need for more costly forms of long-term care services, such as hospitals and moving to a special care home or a nursing home will be delayed for as long as possible.”

This is what families and seniors want. However, without assistive devices and other disability supports, seniors with disabilities will be forced into institutions.

A 2004 study by the New Brunswick Advisory Council on the Status of Women found that home care for seniors, who might otherwise be institutionalized, costs less.  Compared with hospital care, which is often used when seniors care units are not available, home care costs less than 50% of the per bed hospital cost.  Home care costs 40% to 75% of the cost of residential care, and even less when the senior is stable.

“• Home Care Costs Less Than Residential Care: Costs for home care clients, by level of care, were some 40 to 75 percent of the costs of facility care, with PC and IC1 at about 40 percent, IC2 and IC3 at about two-thirds and EC at about three-quarters of the costs of facility clients.

• Stable Home Care Clients Cost considerably Less: For home care clients who remain at the same level and type of care for six months or more, the costs are about one half, or less, of the overall costs for facility clients.

• Home Support Services Seem to Substitute for Acute Care Services: While the proportion of overall home care costs attributable to hospital care declined in the mid- 1990s, the proportion attributable to home support services increased. For Extended Care, the proportion of total health costs accounted for by home support and hospitals were 25% and 61%, respectively, for the 1987/88 cohort, while they were 54% and 33% for the 1996/97 cohort. The comparable figures for IC2 clients were 23% and 58% and 36% and 40%, respectively. Thus, home support may have served as a substitute for acute care services.” Centre on Aging, University of Victoria.

Too many seniors with disabilities in acute care hospital beds

In many jurisdictions, crowded nursing homes force seniors with disabilities into the most expensive form of housing, acute care beds in hospitals.

The Corpus Sanchez report (Jan 2010) found that patients in this category (known as alternate long term care or ALC) occupy 5,200 inpatient beds per day in Canada. “Many could be more appropriately served in the community  but have no supports to get them home safely and get the care they need there.

On Prince Edward Island, estimates are that more than 50% of the beds in the Queen Elizabeth Hospital may be occupied by patients amenable to ALC. Seniors with disabilities and no home supports would be the largest demographic in that group.

Next – what assistance do seniors with disabilities need?