Most older adults in Canada want to remain at home for as long as possible as they age. However, some individuals with mild or moderate health conditions or physical limitations are admitted to long-term care even though they potentially could have been cared for at home with the proper supports.

Our latest analysis measured the percentage of people newly admitted to long-term care who had similar health characteristics as those living at home with formal supports. We found that in 2018–2019, about 1 in 9 newly admitted residents in long-term care homes potentially could have been cared for at home. This represents more than 5,000 long-term care spaces in reporting provinces and territories.

Staying at home for as long as possible can offer a better experience for many people, and can help ensure that long-term care beds are reserved for those with complex needs who require full-time care. This data can help identify where there are gaps in services and contribute to meaningful changes that improve the health care experiences of patients and families. — Mélanie Josée Davidson, Director, Health System Performance

About 1 in 9 newly admitted long-term care residents potentially could have been cared for at home.

Why do some enter long-term care early?

Residents and family members of residents admitted to long-term care told us they experienced various barriers to remaining at home:

Difficulty navigating the health care system — People experienced confusion and challenges around who to contact, what services were available, the amount of time required to coordinate services and the lack of continuity across the system.

Financial barriers — Because publicly funded home care does not cover all costs associated with caring for someone at home, some families experienced significant out-of-pocket expenses. Those living in rural and remote communities faced higher travel costs for medical appointments and limited availability of home care services and supports.

Responsiveness — People emphasized the importance of reliable home care staff, as well as the need for services that were flexible to the changing needs of the person receiving care.

Access to special services — People highlighted the need for social and emotional support, help with non-medical needs and services tailored to their language and cultural needs.

New long-term care residents who potentially could have been cared for at home were more likely to live in rural areas and to live alone compared with other new residents.

Who could have been cared for at home?

People who lived in rural areas were over 50% more likely than those living in urban areas to be admitted to long-term care when they potentially could have been cared for at home. This may be due to fewer home care services being offered in rural and remote areas.

Despite having lighter care needs, people living alone were twice as likely as those living with family members to be admitted to long-term care.

Similar to other new residents, 2 in 3 are women, and over 50% are age 85 and older.

In Canada, more women are admitted to long-term care since, on average, women live longer than men. Because of this, they are more likely to live alone and less likely to have an unpaid caregiver who can provide support when needed, which can lead to early admission to long-term care.

How is COVID-19 affecting long-term care?

This data pre-dates COVID-19; however, the pandemic has brought ongoing challenges within the long-term care sector to the forefront, with a high number of COVID-19–related deaths and outbreaks occurring in long-term care, assisted living and other seniors’ care homes across the country. This has highlighted the need to ensure that only those with the highest care needs are admitted to long-term care. Our data can act as a baseline for ensuring that Canadians get the care they need, in the appropriate setting and at the appropriate time.

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