The Council on Aging of Ottawa (COA) is pleased to participate in the pre-budget consultations. The past three years have been extremely challenging for all of us, particularly for older adults. As pointed out in our 2022 submission, the pandemic has revealed the weaknesses inherent to the long-term care system, including understaffing, the need to improve wages and working conditions for staff, as well as the need to increase capacity and improve the quality of care for residents and families. Notwithstanding a series of announcements by the Ontario government over the past 12 months, those challenges remain high on the priority list and additional and ongoing leadership and investment are necessary.
There is an absolute need to increase investment in older adult health care and support services as a consequence of this rapidly growing segment of our Ontario population. COA wants to partner with the Ontario Government in developing innovative and practical programs promoting independent living, as much as possible, away from institutional settings. In-home support and community care need increased emphasis as a hallmark for older adult wellbeing and the best use of limited taxpayer funds.
In Ontario, the number of seniors aged 65 and over is projected to almost double from 2.6 million, or 17.6 per cent of the population in 2020 to 4.5 million, or 22.2 per cent, by 2046. The growth in the share and number of seniors accelerates over the 2020–2031 period as the last cohorts of baby boomers turn. age 65. Given that the older adult demographic is projected to almost double, the COA believes that the government needs to substantially increase current investments now to meet the challenges of a rapidly growing aging population which will require an increasing level of support and services beyond the pandemic. Such investments must be sustained and occur within the context of a vision of an age-friendly Ontario, addressing the urgent needs of older adults in the areas of public health, home and community care, housing, accessibility, and transportation. Let’s hope the lessons learned from the pandemic are not in vain. Now is the time to invest and develop a comprehensive Older Adult Strategy to meet the multi-dimensional needs of our aging society.
As a bilingual Council, the COA believes that provincial funds must be managed in such a way as to serve the Francophone population of Ontario, by ensuring that older Francophone adults have access to the same services in French and the hiring of Francophone staff, if not bilingual, where required. Similarly, consideration must also be given to addressing the diverse needs of older adults across the province; low income, language, ethnicity, sexual orientation, gender identity, disability, and health status should not be barriers to timely access to supports and services.
Below, you will find more specific comments relating to the areas of long-term care (Section 1), home and community care (Section 2), and age-friendly housing (Section 3).
Section 1 | Long-Term Care
The public confidence in LTC is significantly and severely eroded. Too many LTC residents and those waiting for LTC in the community currently live in high-risk situations and neglect, and urgent action must be taken to ensure LTC residents and those waiting do not have to live this way.
The issues within Ontario’s long-term care (LTC) sector are long-standing and well-known: chronic understaffing, poor conditions of work, a shortage of space/beds with long waits for admission, inadequate building standards, reliance on institutional/medical models of care rather than person-centred care, a weak inspection regime, a lack of public accountability for the quality of care being delivered and increasing reliance on family caregivers to provide basic care in LTC.
While the Government has committed to addressing some of the long-standing issues, the COA believes there remains room for improvement to address these issues sustainably.
Increase staffing and improve working conditions in LTC
The COA strongly encourages the Ontario Government to use its upcoming budget to significantly increase its investments in quality, person-centred LTC and increase the salaries and benefits of the core health care workers who deliver this care to our very vulnerable Ontario older adults.
The staffing targets of 4 hours/day/resident for long-term care contained in the new LTC Act must be implemented immediately as an essential requirement for every home. The province should also require 60 additional minutes/day from allied professional staff. Residents, families, and staff cannot wait until 2024-25 for such needed changes. Additionally, the COA advocates for all homes to be required to publicly report their staffing ratios in a timely fashion and that appropriate measures be applied to those homes that don’t deliver this minimum level of care.
The budget must support permanent wages and benefits increases for LTC staff to address the long-standing disparity between health care workers (HCW) in LTC and hospitals.
Retention and recruitment of quality staff are paramount. HCWs are leaving the field due to low wages and inadequate benefits and the ever-increasing staff shortages which affect the conditions of work. Further, the COA expects significant and long-term investments in the training of needed HCWs.
The COA, therefore, believes that the next Ontario budget should provide additional investments in improving long-term care as quickly as possible and urgently put in place policies and measures fostering the retention and recruitment of quality health care workers in LTC.
Planning for the future of LTC homes
The planning for LTC homes must address the increasing diversity of needs across Ontario’s population. There should be additional incentives contained in the budget to build homes to meet these needs in all parts of the province, especially in light of the unanticipated impact of Bill 7 on older adults from ethnic and language minority groups who are limited in the LTC options that meet their unique needs and the added stress of being admitted to a LTC home far from family and their community.
Funding should be provided to provide grants to train and transition all LTC homes to person-centred care models.
The Long-Term Quality Centre provided for in the new LTC Act should be funded immediately to guide the best practices in LTC.
The other areas where investments are urgently needed are in the building standards for LTC. The government should provide flexible capital and operating funding for all homes to renovate all ward rooms into private rooms and all new and renovated LTC homes should be built with private rooms with private bathrooms. The budget needs to support all LTC homes in providing air conditioning in all rooms and public areas.
To support the most vulnerable older adults, the COA strongly recommends that the budget increase capital funding and subsidies to encourage increased not-for-profit and municipal LTC home development and renovation.
Rebuilding public confidence in the health care system
Public opinion polling suggests that health care is becoming the most important concern for Ontarians. Wait times and gaps in hospital capacity and primary care are shaking public confidence in the health care system.
Ontario has fewer hospital beds per population than its OECD peers. We continue to have significant numbers of patients, often older adults, stuck in hospitals on wait lists for more appropriate levels of care (ALC).
As we reinvest in health care, address bed capacity gaps, and improve access to appropriate levels of care, we need to be mindful of potential ageist perceptions concerning older adults and their consumption of health care resources.
Fixing the gaps in the health care system now is an urgent priority that will benefit all age groups across society, not just older adults.
Section 2 | Home & Community Care
More and better care is needed not just in long-term care homes, but also for those waiting for long-term care including home care, community supports, and respite care. More care staff including allied professionals continues to be urgently required.
It is recognized that older adults want to live and participate in their communities for as long as possible and there are strong social, health, and financial benefits for older adults, communities, and governments. Most older adults do not want to live in institutional settings, but rather they want to maintain their independence in their community. Supporting older adults to age in the community through investments in home and community care is essential.
Investing in home and community care services
Providing the level of home and community care required for older adults and family members to age in the community continues to stretch families’ resources and capacity to their limits. The development of a person-centred care model for home and community care, which is based on an individual’s needs, is urgently required. This should include provisions and funding that support the purchasing of equipment to allow for aging in the community (e.g., refundable tax credits for direct and indirect out-of-pocket expenses like equipment, medication, transportation, private-pay care, home modifications, etc.). The government also needs to provide family caregivers with supports and respite so that they can continue to play their essential role in the circle of support for their older family members who are living in the community. There is also the need to increase options available such as Supportive Housing programs and other novel types of supported living arrangements for older adults.
Addressing the health human resource crisis
Investments in increasing human resource capacity in health care needs to be a central element of increasing capacity for home and community care. This should include a combination of novel educational approaches to upgrade skills, increased recruitment into health care programs in all settings, incentives for individuals to enter into the health care retention programs, and addressing long-standing wage issues including compression among various health care providers. Such investment supports the right level of care across the continuum of care and supports smooth transitions of older adults between settings.
Section 3 | Age-Friendly Housing
The province of Ontario is facing a housing crisis that needs to be fixed. Home ownership costs are spiraling, and many renters are desperate to find affordable, appropriate housing.
In January 2020, the City of Ottawa declared a housing crisis and homelessness emergency. Ottawa’s population over 65 is expected to reach 25% by 2035. Current housing options are financially difficult or out-of-reach for many older adults. Twenty-five percent (25%) of older residents (65+) are renters, with 54% of those spending 50% of their income on housing, far above the recommended affordability index of 30%. In 2020, the average rent in Ottawa increased by 8% and with an increase of 13.5% over the previous two years. The waiting list for social housing is over 12,000, with older adults making up over 40% of this list.
Increasing the commitment to affordable and accessible housing options for older adults
Immediate action is needed to increase purpose-built age-friendly housing that is both affordable and accessible and that has access to services that allow people to age in place and in the community.
The COA recommendations for the government to make significant financial commitments to the Ottawa region to create more affordable and accessible housing options, including rental units to match older adults’ demographic place in our urban and rural areas, ensuring that 18% of new units are suitable for older adults right now and moving to 25% by 2036.
In addition, we recommend investing in and providing grants and incentives for innovative housing options that allow older people to age and live in the community as long as possible such as Naturally Occurring Retirement Communities – with social support programs (NORC-SSPs), community co-operative housing, intergenerational housing, and affordable assisted living.
More and better care as well as age-friendly housing options are required now and for the foreseeable future to address population aging. To meet this challenge, additional investments and measures are essential and must be part of a comprehensive and sustainably funded plan.
As stated in this communication, COA strongly encourages the Government of Ontario to invest in an Age-Friendly Ontario. Providing grants and incentives for innovative housing options that allow older people to age and live in their community for as long as possible will help achieve this goal. This will best promote both the wellbeing of older adults and the best use of limited taxpayer funds.
We trust that the Ontario government will positively consider those issues and concerns by incorporating appropriate measures and funding in the 2023 Ontario Budget.
President, Board of Directors
Approved by the Board of Directors, February 13, 2023