2P40

• Collective Residential options in Ontario

  • Supportive Housing
  • Retirement Housing
  • LTC homes
• 3 basic models of care in Canada

  • Medical model
  • Social model
  • Health promotion model
• Canada's 4 HC Priorities for the next decade


  • Improving access to HC services & primary care
  • Increasing efficiency, decreasing backlogs in care
  • Improving access to mental health & substance use services
  • Modernizing HC systems & digital tools
• 3 principles of "normalization" of nursing homes


  • Keep a normal rhythm of the day, week, year
  • Pay a normal amount of respect (decision making)
  • lead a normal social life
• Romanov Report recommendations


  • Home care, home support services
  • Meals on Wheels
  • Transportation services
  • Supportive housing
  • Assisted living
• Why are seniors drivers for HC cost increase?

  75% have long-term chronic conditions & visit physicians more often, Stay at hospitals for a longer period of time
• Why are seniors not a major cost driver?

  Modest cost driver (0.9%)
• What costs more?


  • General inflation
  • General population increases
  • Medical technology
  • Doctor's choices (drugs, treatment)
• Streams of LTC in Canada

  • For-profit nursing homes
  • Charitable non-profit homes
  • Municipal homes for the aged
• Green House model


  • Returns control, dignity, a sense of well-being to elders, their family & direct staff
  • Operate under nursing home licenses but give freedom to individuals
• 3 pillars of Canada's pension plan

  • Government programs
  • Workplace retirement savings arrangements
  • Personal savings
• Reasons why women have low-incomes in old age

  • Income inequality
  • Women tend to have part-time jobs (no PRPPS)
  • Not all employers have survivor pension for widows
• Direction Canada's Pension Plan is going

  • Government pension programs will increase clawback of OAS benefits
  • Becoming social assistance model
  • Ongoing enhancing to protect younger workers
  • Fewer private employment pensions
  • Will become dual pension system: (1) Public pension system (low income) (2) Private pension system (mid-high income)
• Federal Transfer Programs (no direct contribution required)


  • Old Age Security (OAS)
  • Guaranteed Income Supplement (GIS) (low-income)
  • Allowance (ALW) - Spouses/common-law or survivors of OAS pensioners
• 2 types of Pension Plans

  • Savings plan: Employers & workers share half-half contribution
  • Transfer plan: Money paid in today pay the pensions of retired person today
• Private Pension & Savings

  • RPP (Registered Pension Plans) - private employer sponsored pension plans
  • RRSP (Registered Retirement Savings plans)
  • TFSA (Tax-Free Savings Account)
• Defined Benefit Pension Plan

  States how much an employee can expect to earn in retirement based on a formula that takes into account years of services & highest salary; the company guarantees the benefit based on this formula.
• Defined Contribution Pension Plan

  A defined contribution plan states how much a person will pay into their pension account (often matched to some degree by the company); this plan defines the contribution but does not guarantee the outcome, the outcome in retirement will depend on how well the employee's investments do over time.
• Two major challenges for expanding leisure activity in later life


  • Getting older people motivated & interested in activities
  • Having caregivers be involved & supportive of activities
• What influences the selection & level of participation in leisure activities?

  • Health
  • SES
  • Gender
  • Cohort
  • Partner/Group
  • Region's weather
  • Social & cultural values
  • Reduced social skills (use on social isolation)
• Health Benefits of volunteering for older adults

  • Reduce depression
  • Improve physical function
  • Social connectedness
  • Increased self-esteem
• Barriers to volunteering in later life

  • Time constraints & Health Issues & Physical functioning
  • Financial constraints
  • Transportation
  • Information & opportunity
  • Inadequate volunteer management
• What is needed to reduce barriers to older adult's leisure & social participation?

  • Structural level (policy levels) need to keep responding
  • Provide a wide range of leisure options to accommodate diverse conditions of health, SES, preferences
  • Individual level need to reduce psychological barriers so identity matches the framework of the environment
• FlexHousing


  Provides easy access to let people stay in their homes as they age
• Home Adaptations for Seniors' Independence (HASI)

  For building modifications to address physical needs & barriers
• 8 domains of age friendly communities

  • Outdoor spaces & buildings
  • Transportation
  • Housing
  • Social participation
  • Respect & social inclusion
  • Civic participation
  • Communication & information
  • Community support & health services
• Alternative Transportation Programs


  • Public Transportation
  • Transportation Brokerage
  • Mobility Club
  • Dial-a-ride Vans
  • Accessible taxi services (Uber)
• Social support


  The help and assistance we give to and receive from others (= Reciprocal Exchange)
• 3 models of social support

  • Task Specificity Model
  • Hierarchical Compensatory Model
  • Functional specificity of Relationships model
• Convoy model of support


  People have a dynamic network of close ties around the individual, with the closest ties in the closest circle
• Support given by older people

  • Financial & material support
  • Childcare/Grandparenting
  • Help with daily chores
  • Emotional support
• Challenges related to elder abuse

  • Currently mandatory reporting laws differ for each province
  • Legal means of addressing abuse often has negative consequences
  • Inadequate support (family, justice system)
  • Views of abuse depends on culture
  • Lack of knowledge by older persons about where to seek assistance in case of domestic abuse
• Interventions for Elder Abuse

  • Empower older people
  • Professionals need more education
  • More research
  • Social media (advocacy, increase awareness)
• General trend of death & dying in older age

  Soften from acute illness to chronic illness, often a slow decline with intense crises at the end, can include pain, loss of functions, discomfort
• What older people worry about at the end of life

  • Avoiding prolongations of dying
  • Receiving adequate pain relief
  • Having control of treatment options
  • Staying in touch of loved ones
  • Relieving burden to family
• As of 2023, more people are receiving some form of Palliative care, more people are at home to palliative support, but there are greater barriers for those non-seniors, living in rural area, dementia, homelessness, First Nations.
• Theory of dying process

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• "Good" death vs. "Bad" death

  Depends on a person's POV, "Good" death - lack of pain, quick, surrounded by loved ones, sense of dignity, control, & preparedness, "Bad" death - slow, painful, or quick & unexpected, dependent on age, process of dying, circumstances, readiness
• Medical Assistance in Dying (MAID)

  • Providing the patient of the means to end their own life (e.g. prescribe fatal dose of meds)
  • Directly administering an agent to the end of a patient's life
• Why is MAID controversial?

  PRO-MAID: a compassionate act, choice of active euthanasia as a right to modern society (right to death), CON-MAID: It's legalized murder, potential for murder of those judged to be mentally/physically incapable