Long-Term Care

• Long term care


  The entire continuum of care that ranges from receiving in-home help with daily tasks to institutionalized care
• Types of long term care

  • Home care
  • Assisted living
  • Nursing homes
• Home care


  • Broad array of medical and social services that are available to people who are still living in their own homes and that are provided by health care professionals, paid caregivers, and volunteers
• Benefits of home care

  • Maintained sense of identity
  • Maintained sense of control & autonomy
  • Familiarity of surroundings & community
  • Prevention or delay of institutionalization
  • Cost effective
• Who is more likely to use home care

  • Are single
  • Have lower income
  • Have more health problems; need more support
  • Have more physical limitations
  • Had a recent hospitalization
• Assisted living


  Government regulated housing with a supportive environment (hospitality & personal care services) to adults who have physical and functional health challenges, can live independently (but not unaided), and can make decisions on their own behalf
• Ideal attributes of assisted living facilities

  • Physical space has a residential appearance/feel
  • "Care" provided to promote normal lifestyle of resident
  • Meeting residents' routine services and special needs
• Nursing homes


  A government regulated type of medical institution that provides a room, meals, skilled nursing and rehabilitative care, medical services, and protective supervision. Residents have multiple health conditions and/or moderate/severe cognitive impairment (dementias), often extremely frail - usually the last option
• How to increase the sense of home in nursing homes

  • Individual given time and voice in the placement decision
  • Defining home predominantly in terms of family and social relationships
  • Developing continuity between home and nursing home via through activities & living arrangements
• Elder abuse is common in some Canadian nursing homes
• Elder abuse


  Includes physical, sexual, and psychological abuse; financial exploitation; neglect; and violation of rights
• Differences between traditional nursing homes and "culture change" models

  • Hierarchical vs Voices of residents & carers respected
  • Focused on physical needs vs Focused on emotional and psychological needs
  • Routines for residents & front-line workers efficient, standardized, cost-driven, rule-compliant focus vs Enables continued growth and treats everyone as individuals
  • Residents often isolated from family & community vs Encourages connections & contributions to family & community
• Key principles of the Eden alternative


  • Close and continued contact with plants, animals and children. Elders can care and be cared for.
  • Daily life that includes variety and spontaneity
  • Maximizing decision making by Elders & their families
  • Creating an Elder-centered community focused on the well-being of Elders & workers
• Key features of the Green House project

  • Offering older adults individual homes within a small community of 6 to 10 residents and skilled nursing staff
  • Open‐plan layout of shared spaces, with the centerpiece being the hearth and surrounding seating area
  • Designed to feel like home
• Community based services and the concept of aging in place


  The principle that with appropriate services, older adults can remain in their own homes, or at least in their own communities
• Modifications in the home to support aging in place

  • Stay connected
  • Remove tripping hazards
  • Open space between rooms
  • Lower water heater temp
  • Improve lighting
  • Put grab bars in shower
  • Move items to easy reach
  • Reduce fire hazards
• Alternative level of care patients (ALC)

  Lack of home care support so they reside in hospitals but no longer need such a high level of care but are simply waiting for a long‐term care bed. Medically stable but have symptoms of dementia and are waiting for nursing homes that can provide the right level of behavioural support
• Adult day programs


  Older adults who need assistance or supervision during the day receive a range of services in a setting that is either attached to another facility, such as a nursing home, or is a stand‐alone agency
• Respite care


  Provides family caregivers with a break while allowing the older adult to receive needed support services
• Competence-press model


  Predicts an optimal level of adjustment that institutionalized persons will experience when their levels of competence match the demands, or "press," of the institutional environment
• Know the general costs associated with each type of long-term care. Are they expensive?

  Assisted = expensive Eden = expensive Nursing homes = cheaper Homecare = cost-effective
• Describe factors related to adjustment to transitions (relocation) to new residences:

  • cumulative frailty (physical and/or cognitive), 
  • catastrophic health event
  •  a fall or a stroke
  • Systematic reasons
  • Lack of home care resources/funding
  • Associated with feelings of regret, grief, depression and relief
• • Discuss possible challenges found in some Canadian nursing homes
  • Basic problems in meeting the needs of the average resident 
  • Room temperature 
  • Physical features of the environment
  • Ability to control your environment
  • Attitudes allowing abuse predicted by burnout, role conflict, & role ambiguity
• What are the trends associated with living in long term care in Canada

  • Long‐term care is a provincial/territorial responsibility in Canada,
  • variability both within and across regions in how long‐term care is structured and financed.
  • Depending on where you live in Canada, the cost of living in a nursing home can be quite high