In the Sept.10 release of the National Institute on Ageing (NIA) first report in a series of three – Enabling the Future Provision of Long Term Care in Canada – there is much to digest over more than one reading, but it is a clearly articulated piece in four distinct sections. You might want to take a linear read through to understand the Long Term Care narrative – establish the basic context, the challenges and the opportunities for the delivery, as well as what the NIA calls the emerging enablers and opportunities to support the future provision of Long Term Care.
One of the troubles with the phrase Long Term Care is that for many people it sounds like a last stop destination for when your declining health in old age catches up with you and you end up in an institutionalized building (often still called a nursing home), where you live out your final days, and die. My father who was in such a place for a time, with his wit and humour intact referred to it as “the big house”, nodding back to the1930 prison film, as he plotted the big break out.
For those with no familiarity of Long Term Care and for those suddenly thrust into the caregiving of an older adult, what is likely the real break out for everyone in this NIA report is that we have a much broader view to work with. One that takes us far from just “the big house” care home. We look here at a continuum of care in terms of how, where and what care is experienced. Our understanding even of the words Long Term is expanded in this report.
After reading through the section on the challenges, past and present, of our Long Term Care system in Canada, a clarifying diagram (A Conceptual Framework Supporting Future Long Term Care) emerges at the front of the Opportunities section, graphically demonstrating this continuum of care. The diagram presents four segments of characteristic profiles of people, from those healthy with minimal care issues/needs, to those with complex care issues/needs living in designated buildings.
In the description of this very helpful conceptual framework diagram, it is helpful knowing that “the needs of older adults are dynamic and can change in either direction along the continuum of care.” As the report also states, it “is agnostic of age but focuses more on the combinations of issues and needs that, with increasing complexity, can significantly impact a person’s ability to live independently in the place of their choice.”
Let’s make our investments in a continuum of life course care.
At the baseline of the NIA report’s opportunities discussion, with its meaty 37 pages of dialogue with great examples of care provision innovations, is the optimistic statement that “The majority of older Canadians can look forward to living healthy and active lives for much of the extended life expectancy that Canadians have gained over the last fifty years.”
If we accept that the promise of longevity will continue for the next fifty years and beyond then we have to make our investments in a continuum of life course care. Which brings us to a major point the report makes, that innovations in care provision must be “primarily ones that enable ‘healthy ageing’ and reflect a growing preference older Canadians have to remain independent and to ‘age-in-place’ for as long as possible.”
What this NIA report so neatly does on page 78, is tie things back to the global Age-Friendly Communities movement as initially launched by the WHO back in 2006/7 – an “approach to community development focused on the health and well-being of people of all ages and across the life course.”
However, as long as we are working on these evolving frameworks labeled as Long Term Care, we need to speak to and engage with future generations who will inherit what we are innovating. It will be more important to improve and clarify the language, demystify the system, and make the work of age friendly health and home care a more appealing career choice. This 2019 NIA Report should be required reading. It serves to educate, providing a platform for informed discussion on a range of ideas at a time we need it most.