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A health-care worker re-enters the building at the Laurier Manor in Ottawa, a long-term care facility, on April 26, 2020.Justin Tang/The Canadian Press

Frances Woolley is a professor of economics at Carleton University.

In 2021, 37.4 per cent of people providing long-term care for a loved one at home in Canada were in distress. They felt angry, depressed, distressed or unable to cope. In Ontario, that percentage reached 42.2 per cent.

This is not surprising. Public home care services leave something to be desired. For example, the B.C. Office of the Seniors Advocate recently reported that “most home support clients do not receive daily service and most receive an hour or less of service on the days they do receive it.”

The alternatives to home care are little better. Publicly funded long-term care homes receive the bulk of government spending. But that system is, in the words of a 2020 Royal Society of Canada report, “woefully inadequate.” It can take many months to get a bed, and the quality of care once in a home is variable.

Governments are taking steps to make things better. The federal government has issued LTC standards and has pledged to introduce a Safe Long-Term Care Act. Provinces are increasing LTC spending. Last year the Ontario government announced a commitment to provide 31,705 new beds. But this is less than the 40,000 people currently waiting for a space as of December, 2020. At best, these new initiatives will provide a marginal improvement – or, more likely, temporarily stop things from getting worse.

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While the current state of LTC might feel like a crisis, it’s more like the calm before the storm. The oldest baby boomers are in their late 70s. But over the next two decades, the percentage of Canada’s population over the age of 85 is projected to at least double. Although people are living longer, the number of years that the typical elder can expect to spend in poor health has not changed. Experts predict that the portion of Canadian GDP going to finance long-term care will need to increase by almost three percentage points over the next two decades to cover these care costs. Put another way, if every province and territory were to double the amount they raise through sales taxes, it would almost pay for increased LTC costs.

So, what can we do?

Long-term care insurance is one solution. The Japanese model, which finances long-term care insurance via a special tax paid by everyone over the age of 40, might be one to adopt. However, an insurance program that pays for older citizens but does not ask them to contribute is an unwarranted cash grab from younger generations, and undesirable on equity and efficiency grounds.

Increased immigration is no panacea. Immigration cushions the impact of population aging. Without it, the prospects for LTC would be even worse. But Canada does not have the infrastructure needed to accommodate the number of immigrants required to reverse population aging.

More spending on home care is desirable. But the idea that spending a bit more on home care will reduce the number of people living in residential care – and save money overall – is a fantasy. Residential care is, for most families, a last resort – and two or three more hours a week of home care will not be the factor that decides whether a loved one enters a long-term care facility. More home care would relieve the sometimes intolerable burdens experienced by those providing care at home – but not save money.

The best policy options fund care adequately and fairly. They make the allocation of care dollars transparent and provide neutrality between care options. Adequate funding means finding more revenue sources. One possibility is to ask those who can afford it to pay for a greater portion of their residential care costs. This could be achieved by considering assets as well as income when calculating an individual’s ability to contribute to the cost of their care. Another alternative is to raise broad-based taxes.

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But fairness also means not overburdening younger generations. If any taxes are raised to pay for long-term care, they should be the taxes that are paid by older people just as much as younger ones, such as property and estate taxes and, to a lesser extent, sales taxes.

Alternatively, if we can’t afford to pay the full cost of care, we should focus on making sure that everyone who needs it gets a fair share of the funds available by having clear and transparent criteria for allocating care, and funding home and institutional care comparably. Yes, better-off individuals in publicly funded nursing homes might have to pay more toward the cost of their care. But funding levels would be less arbitrary than they are at present.

There are hard choices to be made – but none is as hard as seeing a loved one suffer.

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