Long-term care: It's an important subject for any retiree, and increasingly so as we get even further on in years. Yet, while everyone acknowledges its importance, relatively few seem willing to discuss the issues surrounding LTC. That's unfortunate, because only through discussion and planning can we ensure that we will be prepared for problems and make the most of all the resources available to us.

According to a recent Manulife Financial survey, 82 per cent of Canadian baby boomers reported concerns that long-term-care needs could affect their retirement income and assets, 54 per cent of respondents had family or friends who had required long-term care and 38 per cent had provided assistance to someone needing long-term.

"The reality is that we're living longer, having fewer children to depend on and there is a strong likelihood of needing long-term care someday, especially if we live to age 85 [and beyond]," says gerontologist Dr. Rubin Becker. "Appropriate planning increases our ability to secure care, allowing us to remain at home for as long as possible in [our] old age, and it provides for a better quality of life, if and when facility-based care is needed."

The Manulife surveys also showed that the majority (54 per cent) of respondents doubted that government programs would be able to meet their long-term-care needs, a view the statistics support. "Don't make the mistake of thinking the government will be there for you," says Jacqueline Figas, a consultant and author specializing in aging at Mississauga based Health Assured Financial Group.

Figas points out that in 1966 there were seven people in the workforce for every retiree, but shortly there will be a surge in the number of people retiring (i.e., the baby boomer generation), with the first wave hitting age 65 in 2011. By 2015 the ratio of workers per retiree will drop to three to one.

"Government programs are largely supported by tax revenue generated by today's workforce," Figas says. "The health-care system will be most impacted by the growth in the age 80-plus segment – it will double in 20 years and triple in 40 years – as this group comprises the heaviest users of the system. Caring for these aging baby boomers will be a major issue."

Planning is particularly important for women, for a number of reasons. The Manulife literature points out that:
•    women boomers have fewer, more transient children;
•    women spend their lives as the caregivers and in old age often have no one to turn to for their own care;
•    male counterparts tend to be uncomfortable in a primary caregiver role;
•    women tend to outlive their spouses or partners;
•    in their advanced age, women face savings shortfalls.


Page 1 of 4 -- On page 2, learn about the trends in home care options.Growth in home care
That stark picture isn't as bad as it sounds, though. While the health-care system will become increasingly pressured, there's been a growing philosophical as well as practical emphasis in recent years on home care as an alternative to high-cost institutionalized care.

A Health Council of Canada report released early this year – "Fixing the Foundation" – was applauded by the Canadian Home Care Association (CHCA) for its reaffirmation of federal commitment to home-based care. "The integration of primary health-care and home-care services is essential to providing quality care in the community," says CHCA executive director Nadine Henningsen, in a press release responding to the report. "Home care expands the reach of primary health-care teams and supports physicians and their patients to access and navigate the health-care system."

Indeed, the demand – and preference – for home-based care has been enormous. CHCA notes on its website that "from 1970, when Ontario first established a publicly funded home-care program, to 1988 when all provinces and territories supported publicly funded programs, home care has become a critical component of the health system. The number of home-care recipients has increased by almost 100 per cent from 1995 to 2006, to reach an estimated one million Canadians."

One result of this trend has been the creation of a variety of programs aimed at helping all chronically ill or disabled persons – not just retirees – remain within their homes and communities as long as possible.

Demands on caregivers
However, the trend towards home-based care has resulted in a growing burden for informal caregivers, usually other family members, with sometimes distressing results.

According to a recent Statistics Canada study called "Balancing Career and Care," more than 1.7 million Canadian adults aged 45 to 64 provided informal care to almost 2.3 million seniors who had long-term disabilities or physical limitations. Of those caregivers, most were employed, and many of them, especially those working full-time, felt they were being pulled in many directions. A large number of these people reported feelings of guilt because they believed they should have been doing more to help, or should have been doing better at their jobs. More than 40 per cent of women who provided over one hour of care a week reported "substantial" feelings of guilt.

These feelings intensified in direct proportion to their paid hours worked. Those providing four hours or more of care per week were more likely to reduce their work hours, change their work patterns or turn down a job offer or promotion. Among this group, 65 per cent of women and 47 per cent of men who were working more than 40 hours a week were substantially affected.


Page 2 of 4 -- Find out how you can plan ahead to avoid unnecessary demands on caregivers on page 3.
"Every day we encounter family caregivers who want the best for their aging family members, but don't know how to fit it all in," says Sharon Galway, a nurse and owner of Home Instead Senior Care in North York. "This generation of seniors is living longer. Their children are still raising families and are not prepared for caring for older parents with needs. For these family caregivers, stress is a constant companion."

Indeed, in a study of 8,000 caregivers conducted by Home Instead (one of the world's largest home-care service providers for seniors), 91 per cent of family caregivers said they have episodes of feeling anxious or irritable, 73 per cent have disturbed sleep patterns and 56 per cent seem irritable more frequently. The Statistics Canada study also found that, when asked what would be most useful in letting them continue to help others, most caregivers replied that they would like occasional relief, especially those who combined longer hours of work with a high-intensity of caregiving.

Growth of the home-care industry
Fortunately, another result of the home-care trend has been a proliferation of organizations such as Galway's. While the costs for a full-time caregiver may still be prohibitive for many retirees, using these services to give family members some respite can be a very cost-effective solution. "The fee for our companion support is $19.95 an hour for a minimum of three hours," Galway says. "The services we can provide include making meals, doing the shopping and the laundry, providing help getting in and out of bed, and so on. If overnight companionship is required, our rate is $130 to $140 for a regular 12-hour shift."

Communication is important
While all these home-care services can go a long way towards relieving the burden on loved ones, many difficulties can be avoided or minimized through advance discussions.

A second study by Home Instead led its researchers to coin the phrase "the 40/70 rule" – "if you are 40 years old, or your parents are 70, it's time to start talking about the subject," says James Cooke, formerly of Home Instead in Etobicoke. "Waiting until the senior parent is 80 or older, when there is increasing likelihood of more severe health issues, can often lead to problems."

The Home Instead survey found that adult children have the most difficulty talking to their senior parents about independence issues, including leaving their home for a retirement residence or nursing home, as well as personal hygiene, financial matters and driving issues.

Further planning tips
While communication is critical, there are several other areas that should be addressed in planning for tomorrow's needs.

Jacqueline Figas summarizes these in a three-step action strategy:

1. Plan in advance for a medical emergency: "When an emergency arises and paramedics arrive, the individual may not be able to communicate clearly," Figas says. "Even if a spouse is present, that person may not have a clear and quick recollection of essential information because of the stress of the moment. For that reason, you should document all of the essential information – conditions, medications, family doctor and so on – so that the paramedics can grab the information and get off to the hospital immediately. And always wear any medical alert bracelet you may have."


Page 3 of 4 -- On page 4, Figas offers more advice to consider while planning your long-term care options.

In addition to documenting all past and present health information, Health Emergency Advance Planning also entails the drafting of a living will or advance directive that deals with key medical decisions others may be called upon to make on your behalf. "Health Assured has developed a kit called ‘My-MEDIC-Notes' [www.my-medicnotes.ca]. It provides the tools that literally walk you through this planning process," Figas adds.

2. Design your home to accommodate aging at home: "If you're planning to renovate or modify your home, make sure the changes are appropriate for future needs," Figas says. "If [you are building] a two-storey house, then have the closets stacked above one another so they can be converted to an elevator, if ever required. Wider hallways, rails for the bathroom, doorbells and phones with redundant signals (visual as well as auditory)… There are a whole variety of ideas."

"If you want more inspiration, visit some websites dealing with Transgenerational Design and FlexDesign," Figas suggests. "You can find them through www.forseniors.ca."

3. Build a health insurance portfolio today to deal with health expenses of tomorrow: Long-term-care insurance can be a valuable investment, given that most retirees will at some point have need of the extra income, if not during the home-care period then eventually if they must leave home for a retirement or nursing residence. Ideally, LTC insurance should be bought as early in life as is practical; by the time you're retired, the premiums can become prohibitive, depending on your age and particularly your health.

At the same time, you should familiarize yourself with the costs of facility care in your province. All provinces have user fees for their nursing homes, although residents may qualify for government funding to offset part or all of those fees. The bottom line is that while the prospect of needing long-term care may seem daunting, the proliferation of home based solutions and increasingly creative insurance products, coupled with careful planning and communication, can make the reality far more appealing. So the next time you're thinking about cleaning the house or getting a checkup, take a moment to also give some thought to your future needs.


Page 4 of 4 -- On page 1, learn more about what long-term care is, and why you may want to create a personal plan.