Future Care For Canadian Seniors: The Conference Board of Canada

Future Care for
Canadian Seniors.
A Status Quo Forecast
REPORT NOVEMBER 2015
Future Care for Canadian Seniors: A Status Quo Forecast

Greg Hermus, Carole Stonebridge, and Klaus Edenhoffer
Preface
This report was prepared for the Canadian Alliance for Sustainable Health Care
Future Care for Canadian Seniors research series. The report is the second in
this series and presents the results of a status quo forecast of the future demand
and supply of continuing care supports for Canadian seniors over the next
30 years. This long-term projection of demand and supply highlights various
pressure points that could occur in a status quo environment and identifies
areas that stakeholders should concentrate on to make progress. The report
offers unique quantitative takeaways that inform policies, plans, service delivery,
andinfrastructure.
To cite this report: Greg Hermus, Carole Stonebridge, and Klaus Edenhoffer. Future Care for Canadian
Seniors: A Status Quo Forecast. Ottawa: The Conference Board of Canada, 2015.
2015 The Conference Board of Canada*
Published in Canada | All rights reserved | Agreement No. 40063028 | *Incorporated as AERIC Inc.
An accessible version of this document for the visually impaired is available upon request.
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The Conference Board of Canada and the torch logo are registered trademarks of The Conference
Board, Inc. Forecasts and research often involve numerous assumptions and data sources, and are subject
to inherent risks and uncertainties. This information is not intended as specific investment, accounting, legal,
or tax advice. The findings and conclusions of this document are entirely those of The Conference Board of
Canada, not of the Alliance investors or the reviewers. Any errors and omissions in fact or interpretation remain
the sole responsibility of The Conference Board of Canada.
CONTENTS

EXECUTIVE SUMMARY
1 Introduction
Chapter 1
Chapter 2
Projecting Continuing Care Needs of Seniors
6 Background
11
The Situation Today
28
Chapter 3
Continuing Care Needs of SeniorsBase-Case Projection
29
The Situation in the Future
45 Summary
46
49
52
56 Conclusion
57
57
60 Limitations
63
63
65
70
74
78 Bibliography
Chapter 4
of Projection
Financial Implications
Human Resource Implications
Infrastructure Implications
Chapter 5
Over the Short Term
Over the Medium Term
Chapter 6
Appendix A
Methodology Used to Assemble the Current Economic Footprint of Continuing Care
Supports for Seniors in Canada
Home Living Indicators
Community Living Indicators
Facility Living Indicators
Appendix B
Demographic Assumptions Used in the Status Quo Forecast of Continuing Care Supports
for Seniors in Canada
Appendix C
Acknowledgements
This report has been prepared for The Conference Board of Canadas
CanadianAlliance for Sustainable Health Care (CASHC) under the direction of
Louis Thriault, Vice-President, Public Policy. It was researched and written by
Greg Hermus, Carole Stonebridge, and Klaus Edenhoffer. Funding was provided
by CASHC investors.
We would like to thank the reviewers of the draft report including Owen Adams,
Vice-President Health Policy and Research, Canadian Medical Association;
JimMurphy, Vice-President Healthcare Strategy and Business Development,
Sykes Assistance Services Corporation; Chris Linton, Vice-President Client
Services, Closing the Gap Healthcare Group; Pascal Roberge, Manager
Expenditures and Forecasting, Health Canada; Brent Mizzen, Director
Policy Development, Canadian Life and Health Insurance AssociationInc.;
and MatthewStewart, Associate Director Forecasting and Analysis,
TheConferenceBoard ofCanada for their valuable feedback.
The findings and conclusions of this document are entirely those of The
Conference Board of Canada, not of the Alliance investors or the reviewers.
Anyerrors and omissionsin fact or interpretation remain the sole responsibility
ofTheConference Board ofCanada.
About the Canadian Alliance for Sustainable HealthCare

The Canadian Alliance for Sustainable Health Care (CASHC) was created
toprovide Canadian business leaders and policy-makers with insightful,
forwardlooking, quantitative analysis of the sustainability of the Canadian
healthcare system and all of its facets.
The work of the Alliance is to help Canadians better understand the conditions
under which Canadas health care system is sustainablefinancially and in
a broader sense. These conditions include the financial aspects, institutional
and private firm-level performance, and the volunteer sector. CASHC publishes
evidence-based, accessible, and timely reports on key health and health care
systems issues.
Research is arranged under these three major themes:
Population Health
The Structure of the Health Care System
Workplace Health and Wellness
Launched in May 2011, CASHC actively engages private and public sector
leaders from the health and health care sectors in developing itsresearch
agenda. Some 33 companies and organizations have invested in the initiative,
providing invaluable financial, leadership, andexpert support.
For more information about CASHC, and to sign up to receive notificationof new
releases, visit the CASHC website at www.conferenceboard.ca/CASHC.
CASHC Member Organizations

Champion Level
Deloitte LLP
Ontario Ministry of Health and Long-Term Care
Lead Level
Provincial Health Services Authority (PHSA) of British Columbia
Ministre des Finances (Quebec)
Sun Life Financial
Workplace Safety and Insurance Board of Ontario
Partner Level
Alberta Health
British Columbia Ministry of Health
Green Shield Canada
Health Canada
Johnson & Johnson Medical Companies/Janssen Inc. Canada
LifeLabs Medical Laboratory Services
Loblaw Companies Limited
Mercer (Canada) Limited
Scotiabank
The Co-operators Group Limited
The Great-West Life Assurance Company
Workers Compensation of Nova Scotia
Xerox Canada Ltd.
Participant Level
Alzheimer Society of Canada
Canadas Research-Based Pharmaceutical Companies (Rx&D)
Canadian Association for Retired Persons (CARP)
Canadian Association for Chain Drug Stores
Canadian Blood Services
Canadian Dental Association
Canadian Medical Association
Centric Health
Consumer Health Products Canada
Health Partners
Manitoba Health
The Arthritis Society
The Hospital for Sick Children
Trillium Health Partners
Workplace Safety & Prevention Services
EXECUTIVE SUMMARY
Future Care for Canadian

Seniors: A Status Quo
Forecast
At a Glance
The status quo forecast indicates that by 2026, over 2.4 million Canadians age
65+ will require paid and unpaid continuing care supportsup 71 per cent from
2011. By 2046, this number will reach nearly 3.3 million.
The reliance on unpaid caregivers and volunteers to provide continuing care

supports will grow dramatically and could compound the perceived level of
unmet or under-met needs of seniors.
The forecast has pressing implications for public spending, the labour market,
and housing and institutional infrastructure.
Responding to these needs in an efficient and sustainable manner will require

collaboration among the diverse mix of public and private stakeholders that
make up the continuing care sector.
Find Conference Board research at www.e-library.ca
Future Care for Canadian Seniors
Canada is
grappling with
theimplications of
the demographic
bulge of aging
baby boomers.
Delivering high-quality, effective, and

sustainable health and social care services is
a top priority for Canadian governments and
for many organizations in both the private and
public sectors. The provision of continuing care
supports is one of most pressing challenges
facing these stakeholders as they look to
balance health care service demands and
costs in the context of an aging population.
This challenge is a key focus of the Conference
Boards Canadian Alliance of Sustainable Health
Care, explored through its research series Future
Care for Canadian Seniors. This report is the
second in the series and presents the results of
a status quo forecast of the future demand and
supply of continuing care supports for Canadian
seniors over the next 30 years.
Canada is grappling with the implications of the demographic bulge
of aging baby boomers and wondering just how concerned it should
be about the associated impacts on health and social services. Our
status quo projection of the future continuing care needs of Canadian
seniors suggests that if current patterns continue, Canada should be
concerned, especially if the country wants to provide the same level of
services together with the same cost-sharing arrangements. That said,
experimentation with various reforms is proceeding across Canada,
all in an effort to diverge from the status quo by finding more effective
and sustainable approaches to managing the continuing care needs
ofseniors.
While many of the challenges in the continuing care sector are
known, this report presents unique, quantitative takeaways that are
possible using consistent terminology and consistent methodology.
These takeaways provide critical insights for stakeholders including
ii
Executive Summary | The Conference Board of Canada
policy-makers, health provider associations, educational institutions,

and the business community as they continue to develop and prioritize
policies, and make plans for investment, service delivery, and
infrastructure for the coming decades.
The continuing care supports included in our analysis encompass
all forms of assistance provided to seniors who can no longer live
independently, as well as the assistance provided to those who
can. These supports are delivered in private homes, retirement
communities, residential or long-term care homes, and other facilities
in the community; they include health supports, personal and social
supports, accommodation supports, voluntary donations and services,
and caregiving. Under a status quo scenario, our forecast and analysis
of continuing care supports for Canadian seniors reveals several
implications central to discussions about policy, infrastructure, labour,
and spending.
1. Demand and expenditures for continuing care supports will rise
dramatically. By 2026, it is estimated over 2.4 million Canadians

age 65years and older will require paid and unpaid continuing care
supportsa 71 per cent increase over 2011. By 2046 this number will
reach nearly 3.3 million. In conjunction, total spending on continuing care
supports for seniors (across all 10 provinces) is projected to increase,
along with inflation, from $28.3 billion in 2011 to $177.3 billion in 2046.
With nearly two-thirds of this spending continuing to be provided by
governments, spending growth will significantly exceed the pace of
revenue growth for most provinces.
2. The tremendous growth in spending projected does not account
for the perceived unmet and under-met needs of seniors that are
significant and projected to worsen. While current estimates are
likely to underestimate the number of seniors stating they have unmet
continuing care needs, the base-case projection suggests that the
situation could get far worse. By 2046, an estimated 458,000 seniors
could express unmet or under-met needsup substantially from the
current estimate ofabout 200,000.
iii
3. The reliance on unpaid caregivers and volunteers to provide
continuing care supports will grow dramatically. Canadas approach

to continuing care has relied heavily on the level of support provided
by unpaid caregivers and volunteers. In 2011, an estimated 5.3 million
Canadians provided some level of unpaid continuing care to seniors.
By 2046, over 11.6 million Canadians will need to provide some level
of unpaid continuing care support to seniors. While our analysis does
not include a valuation of unpaid supports, the ability to meet the
future demands for unpaid care will prove challenging and could result
in even greater spending by public and/or private sources, along with
anincreasing number of seniors with unmet or under-met needs.
4. The challenges associated with meeting the continuing care needs
of seniors requires a singular focus on efficiency and a reality

check. As governments in Canada struggle with a legacy of deficits
and an environment of tempered growth, responding to the need for
increased spending on continuing care supports will require difficult
decisions. To better inform these decisions, the drivers of growth must
be better understood and managed. Not only will the decisions affect
the delivery and cost-sharing arrangements of providing continuing
care supports, they will also affect other segments of health care such
as acute care. In the end, these difficult decisions will need to clearly
establish what seniors can expect from governments.
5. Labour demand for the continuing care sector will outpace general
labour force growth. The delivery of continuing care services to seniors

currently accounts for 235,000 full-year jobs within the health care sector
alone, with the majority of these jobs being health care aides (also called
personal support workers or continuing care assistants). Labour demand
for continuing care will increase at a projected 3.1 per cent annual pace
until 2026, before growth ramps up to an even faster 3.7 per cent annual
pace between 2026 and 2036. This rate of increase will far exceed
the modest 1 per cent annual growth in employment projected. Issues
around education and training, compensation, and work environment
for health care aides are just a few of the areas where employers,
iv
Executive Summary | The Conference Board of Canada
academic institutions, governments, and the profession itself will need

to collaborate to ensure the market matures sufficiently to address the
projected demand.
6. 85 years 65 years: Short-, medium-, and long-term priorities
should reflect changes as the baby boomer cohort ages and

needs evolve. Younger seniors have different needs for continuing care
supports than older seniors. Among those who require paid continuing
care supports, older seniors tend to have greater needs related to issues
with cognition, behaviour, and physical function. Understanding these
needs is important because it affects the level and costs of service,
where the person resides (or should reside), and also the type of worker
responsible for providing care.
In sum, the results of our forecast suggest that there will be many
challenges on the horizon, but also many opportunities to address these
challenges for the multitude of stakeholders that shape the future care
needed by Canadian seniors. The continuing care sector is built on a
mix of diverse public and private stakeholders, each with the potential
to bring to the table the very best policies and practices needed to
meet these future care needs in an efficient and sustainable manner.
Partnership and collaboration among this diverse community will be
essential, not optional.
CHAPTER 1
Introduction
Chapter Summary
This second report in the Future Care for Canadian Seniors research series
explores the potential demand for continuing care supports among Canadian
seniors and the implications for supply to keep pace over the horizon to 2046.
The forecast of both demand and supply are based on the status quo, or current
patterns of support.
The unique takeaway of this report is the quantitative identification of
pressure points, which can be used to help develop policies and make plans
for investment, service delivery, labour supply and skills, and infrastructure
overthecoming decades.
The proportion of
Canadians 65 and
older is growing,
and has many
implications for the
future health and
social services and
housing needs of
Canadian seniors.
The proportion of Canadians who are seniors

(65and older) is growing, and this trend is
projected to continue over the foreseeable
future. The proportion of the eldest seniors
those aged 85 years of age and olderis
projected to grow even faster. This has many
implications for the future health and social
services and housing needs of Canadian
seniors. It will affect the plans, policies, and
budgets of governments; programs and
training offered by academic institutions; and
the planning and investments by businesses
that supply services, products, and housing
for seniors.
The living arrangements and health and social services used by todays
seniors are influenced by factors such as age, personal preference,
family supports, income, health, and independence. The availability of
government and community programs, the extent of public funding or
private insurance for these supports, and the availability and affordability
of local private purchase options also influence the type and amount of
services demanded and used.
Understanding how each of these factors affects the current use
of continuing care supports and accommodation is necessary for
developing an estimate of tomorrows needs. Stakeholders need good
estimates of the future demand for care and housing in order to prepare
appropriately and develop the capacity to meet future needs. Forecasts
help governments understand the impact an older population will have
on the health and social service spending and, in turn, their fiscal
capacity to meet future commitments. Forecasts allow governments to
better understand which pressure points may be most pronounced and,
Chapter 1 | The Conference Board of Canada
as a result, look at finding viable options (such as reallocating spending,

addressing health and functionality issues, or implementing different
models of care) to alleviate some of those challenges going forward.
This report follows Future Care for Canadian SeniorsWhy It Matters,1
asynthesis of both the care landscape for seniors and some of the
central issues going forward. The central objective is to explore the
use of continuing care supports by Canadian seniors and to estimate
the future demand and supply over the horizon to 2046. We define
continuing care supports as all forms of assistance provided to seniors
who can no longer live independently, as well as the assistance provided
to those who can. These supports are delivered in private homes,
retirement communities, residential or long-term care homes, and other
facilities in the community. They include health supports, personal and
social supports, accommodation supports, voluntary donations and
services, andcaregiving.
For this report, the focus is to establish and discuss the implications
of a status quo or base-case scenario founded on current patterns
of supports. We present our analysis of this supply and demand, the
pressure points that exist going forward in a status quo environment,
anda synthesis of the issues arising from these pressure points that
require action by all stakeholders. While many of these pressure
points have been discussed in other studies and reports, the unique
contribution of this report is the quantitative takeaways that are
generated using consistent terminology and methodology. These
takeaways provide critical insights for stakeholders, including policymakers, health provider organizations, educational institutions, and
the business community, as they develop policies and make plans for
investment, service delivery, and infrastructure for the coming decades.
A future report will focus on a range of scenarios that could
affect thedemand and need for services and the associated
supply-siderequirements.
1 Stonebridge, Future Care for Canadian Seniors.

ResearchSeries
The Conference Board of Canadas Canadian Alliance for Sustainable Health
Care (CASHC) provides Canadian business leaders and policy-makers with
forward-looking, quantitative analysis of the sustainability of the Canadian
health care system. CASHCs research series Future Care for Canadian Seniors
follows the Conference Boards economic analysis of the home and community
care sector in Canada, and takes a broad look at the care needs of todays and
tomorrows seniors, the services and investments needed to meet these needs,
and the pressure points that exist in the continuing care sector.
The series began with a primer, Future Care for Canadian SeniorsWhy It
Matters, that synthesized the challenges and opportunities in the Canadian
continuing care sector. The primer reiterated many of the challenges and
opportunities in the sector identified by other organizations, including the
Canadian Home Care Association,2 the Canadian Nurses Association,3 the
Canadian Medical Association,4 and the Canadian Life and Health Insurance
Association,5 to name a few. Many reports, including government strategy and
planning documents, have identified the need to build on what is known and
develop capacity plans for the sector. This second report in the research series
provides a forecast that informs government capacity planning and provides
a foundation for scenario exploration, strategic planning, and, ultimately, the
development of solutions to address the future care needs of Canadian seniors.
Canadian Home Care Association, Portraits of Home Care.
Canadian Nurses Association, Health Is Where the Home Is.
Canadian Medical Association, CMA Submission.
Canadian Life and Health Insurance Association, CLHIA Report on Long-Term

CarePolicy.
CHAPTER 2
Projecting Continuing Care

Needs of Seniors
Chapter Summary
An estimated 29 per cent of Canadian seniors currently need and receive
continuing care supports, most commonly seniors living in private dwellings.
Meanwhile, 200,000 Canadian seniors currently report their continuing care
needs are not being fully met. This is a conservative estimate, as it does
not account for potential unmet needs of seniors in retirement and long-term
carehomes.
In 2011, an estimated $28.3 billion was spent on continuing care supports for
seniors. Of this, $18.1 billion came from public sources, with the rest coming
outof-pocket or through private insurance.
The delivery of continuing care services to seniors currently supports nearly

235,000 full-year jobs in the health sector. Of those, 148,600 are for health
careaides (also called personal support workers, among other terms).
Unpaid continuing care to seniors was provided by an estimated 5.3 million

Canadians in 2011.
Background
Understanding
thecontinuing
careneeds of
seniors also brings
to attention the fact
that many seniors
today have unmet
or under-met
needs.
The analysis in this report centres on

understanding the continuing care needs of
seniors (those 65 and older) today and on
estimating those needs over the next few
decades. Where possible, the analysis segments
seniors into three distinct age cohorts: younger
seniors (age 6574), older seniors (age 7584),
and the eldest seniors (age 85+). This use of
age cohorts differentiates seniors from being a
homogenous category, but it should be noted
that aging in and of itself is, of course, not
an illness.
The continuing care supports included in this analysis encompass
all forms of assistance provided to seniors who can no longer live
independently, as well as the assistance provided to those who can.
Forthis report, continuing care supports are defined to exclude acute
care services provided in a general hospital or a physicians office. While
these services are a key part of an integrated approach to health care,
they are beyond the scope of this particular analysis.
Currently, continuing care supports are delivered in private homes,
retirement communities, residential or long-term care homes, and
other facilities in the community. The conceptual framework shows that
continuing care supports include health supports, personal and social
supports, accommodation supports, voluntary donations and services,
and caregiving. (See Exhibit 1.) Understanding the continuing care needs
of seniors also brings to attention the fact that many seniors today have
unmet or under-met needs.1
Rothermann and Hoover, Seniors Use of and Unmet Needs for Home Care; Turcotte,
Canadians With Unmet Home Care Needs.
Exhibit 1
Continuing Care Supports Provided
Residential setting
Paid supports
Unpaid supports
Home living
Community living
Facility living
Health supports
Health supports
Health supports
Other personal/social supports
Accommodation supports
Accommodation supports
Caregiving
Caregiving
Caregiving
Voluntary/charitable
Source: The Conference Board of Canada.
For this report, we aligned the residential care settings (identified in

Exhibit 1) with the dwelling classifications used by Statistics Canada
in its coding and reporting of many key data productsparticularly
the census (National Household Survey) and various health-related
surveys, including the Canadian Community Health Survey (CCHS)
and the General Social Survey (GSS). In some instances, the data
products provide comprehensive coverage across multiple residential
settings, whereas for others the data may be limited to only specific
residential care categories. By aligning the residential care settings used
in this report with those used by Statistics Canada, it provides a better
understanding of not only the coverage reported but also the degree to
which coverage might be under-reported, particularly as it relates to the
care of seniors.
In this report, home living aligns with activities provided to seniors living
in private dwellings. Meanwhile, community living and facility living both
correspond with activities that are provided to seniors living in collective
dwellingsas defined by Statistics Canadas Census Dictionary.
While the home living distinction is relatively straightforward, the specific
division between community living and facility living is a bit more
challenging. In this study, the distinction is drawn by identifying facility
living with seniors living (also referred to as residing) in chronic care
and long-term care hospitals and long-term care homes (also known as
nursing homes) that provide 24-hour medical and professional nursing
supervision on-site. In this analysis, facility living excludes group homes
or institutions for the physically handicapped, as well as treatment
centres and group homes or institutions for people with psychiatric
disorders or developmental disabilities. Facility living also includes
seniors occupying an acute care bed or non-acute bed (such as a mental
health care bed or rehabilitation bed) while waiting for placement in a
more appropriate setting or care at home. This situation is commonly
referred to as alternate level of care, or ALC.
With that distinction for facility living, community living then applies to
all remaining health care and related collective dwelling establishments.
While our definition of community living includes the specific category
residences for senior citizens from the census, it also includes
long-term care institutions that do not provide 24-hour medical and
professional nursing supervision on-site. While community living is the
broad term used in this report, it comprises three commonly used and
distinct residential care environments: assisted living, supportive living,
and independent living. The distinctions between these three care
environments vary among jurisdictions, but for this report, independent
living corresponds to seniors residing in retirement homes where the bulk
of the continuing care expenditures are financed out-of-pocket and/or
through private insurance. Contrary to independent living, assisted living
and supportive living both rely on public sector financing to cover a larger
share of the continuing care costs. In this report, the main distinction
between assisted living and supportive living is an even greater reliance
on public sector funding, principally in the form of rental assistance.
It should be noted that the provision of continuing care supports
across all residential settings is achieved through both paid and unpaid
activities. In many respects, paid continuing care supports supplement
the unpaid care and support provided by family, friends, and community
members or volunteers.
Paid continuing care supports can be publicly funded through
The financial
environment
governments
in Canada face
is challenged
by tempered
economic growth
and a legacy
ofdeficits.
government programs or privately purchased out-of-pocket or through

insurance programs. In many cases, recipients receive a mix of both
publicly and privately funded continuing care supports. In terms of
service delivery, these supports may be provided through public
organizations, private for-profit organizations, non-profit organizations,
charitable organizations, or a mix of these organizations.
The level of continuing care supports received by seniors depends on
many factors, including the individuals specific needs and awareness
of available supports, the availability of caregiver support, the scope
of funding provided publicly in the local area, the level and availability
of private insurance coverage, and the individuals ability to pay out-ofpocket tosupplement the services publicly funded.
Economic pressures are an important factor to consider when projecting
the funding required to deliver continuing care supports into the future.
It comes as no surprise that the financial environment governments in
Canada currently faceand are expected to face over the next several
yearsis challenged by tempered economic growth and a legacy of
deficits. Complicating this is the growth trend in total health care costs.
For example, a recent forecast completed by the Conference Board
suggests that under a status quo scenario (in which future changes
in real health care costs continue to trend as they have over the past
30 years), total public health care costs in Canada will increase from
$137billion (in 201314) to just under $400 billion by 203435.2 Under
this situation, health care spending in 203435 would account for 55per
cent of all provincial government revenuesup significantly from the
42per cent that health care spending represented in 201314.
Even using a more conservative hypothesisone that assumes real
health spending will remain fixed on an age-adjusted per capita basis
the analysis by the Conference Board suggests that total health care
spending would still exceed $345 billion in 203435 and account for
roughly 50 per cent of all provincial revenues.
2
Beckman, Fields, and Stewart, A Difficult Road Ahead.
Finding more
effective solutions
to address the
health andsocial
care needs of
seniors should be
a top priority.
Under either scenario, it is estimated that the share of health spending

attributed to the care of seniors will increase from 46 per cent today
to 60 per cent in 203435. Given the difficulty that provinces will have
in trying to balance escalating health care costs against many other
commitments, finding more effective solutions to address the health
andsocial care needs of seniors should be a top priority.
The challenge posed by escalating health care costs to the fiscal
sustainability of governments, particularly subnational governments
(provincial, territorial, and local), was recently highlighted in the
Parliamentary Budget Officers Fiscal Sustainability Report 2015. The
findings of the report suggest that while the federal governments net
debt is on a sustainable path that would result in debt being eliminated in
35years, subnational government net debt is projected to be unsustain
able and would rise to over 200 per cent of GDP after 75 years. The
report notes that the primary driver of unsustainable finances at the
subnational level is the health sector, where spending growth is driven by
aging demographics and enrichment growththat is, the additional costs
associated with advances in medical science, technological innovation,
and changes in disease patterns that extend beyond demographic
factors alone.
The analysis in this report focuses only on the provision of continuing
care supports to seniors, as this segment represents an important and
complicated piece of the overall health care puzzle for governments
to find workable solutions to. The complexity of identifying solutions
is complicated by the degree to which continuing care currently relies
on paid services financed through out-of-pocket and private insurance
sources, as well as unpaid services delivered by caregivers, volunteers,
and charitable organizations. The division between public and private
payment differs among jurisdictions and is subject to change depending
on factors such as policies and programs that affect public funding,
as well as individual willingness and/or ability to pay for services to
supplement care or substitute for public funding. A recent survey
conducted by EKOS Research Associates for the Conference Board
found that among respondents who stated additional home care services
10
were needed but not provided, 44 per cent indicated this was because
they were on a waitlist for public provision or because it was perceived to
cost too much.3
The Situation Today

As was the case with our Home and Community Care in Canada:
An Economic Footprint report, even generating a pan-Canadian
understanding of the current landscape in the provision of continuing
care activities is challenging because of the variety of terms and
definitions used and the associated difficulties in finding comparable and
consistent data across all jurisdictions. As a result, the assembly of data
reflecting the current landscape required a wide range of data sources
and proxies. Based on the variety of data sources used to compile the
analysis, the most appropriate base year to use was 2011.
Unfortunately, because the forecast model required the data related
to both the demand and supply of continuing care supports to be
disaggregated by age and gender, this resulted in significant data
gaps in the territories. With few exceptions, the data related to formal
and informal home and community care, alternate level of care (ALC),
complex continuing care (CCC), and community living was not available
in a manner that allowed for a breakdown by age and gender. Because
of the difficulty of imputing realistic estimates for all the missing values
and to maintain a conservative approach, the decision was made to
report on Canadian figures that excluded the territories.
It should be noted that a conservative approach was used to assemble
the data on continuing care support at the provincial level. For these
reasons, the resulting tabulations likely underestimate both the supply
and demand of continuing care supports across Canada to some
As part of research on the future care for seniors, the Conference Board commissioned
EKOS Research Associates to survey 4,000 Canadians about their experiences with and
perceptions of home and community care. The figure quoted comes from this survey.
11
degree. As a result, the focus of the figures in this report is to present

a holistic view of both the current and projected provision of continuing
care support using the most consistent set of indicators.
Seniors Receiving Continuing Care Supports

The compilation of data suggests that nearly 2.3 million Canadians (of all
ages) received some form of continuing care support in 2011. Of those,
just over 1.4 million were seniors (65 years and older). (See Table 1.)
Table 1
Canadians Receiving Continuing Care Supports, by Province
andAge, 2011
All ages
Seniors
(65 years+)
2,282,159
1,434,261
38,110
17,647
9,972
6,719
Nova Scotia
79,730
46,615
New Brunswick
65,208
39,481
Quebec
542,213
353,038
Ontario
882,105
570,955
Manitoba
91,951
57,810
Saskatchewan
69,998
43,922
Alberta
194,853
115,034
British Columbia
308,019
183,040
Total provinces
Newfoundland and Labrador
Prince Edward Island
12
Of the various residential care settings involved, continuing care

supports were provided most broadly to seniors in home living (private
dwellings). In fact, nearly 1.1 million seniors received paid and/or unpaid
services in this residential care setting.4 (See Table 2.) While nearly
900,000 seniors received some level of informal (or unpaid) care, nearly
500,000 received formal (paid) continuing care supportstypically
identified as home and community care services.
Table 2
Seniors Receiving Continuing Care Supports, by Residential Setting, 2011
Facility living
Total
Longterm care
homes
Alternate
level of
care
Complex
continuing
care
Total
156,081
203,840
184,566
6,407
12,867
1,434,261
12,576
2,101
2,970
2,747
153
70
17,647
5,053
505
1,161
1,135
26
6,719
Nova Scotia
37,858
2,330
6,427
5,954
373
100
46,615
New Brunswick
31,237
3,512
4,732
4,316
331
85
39,481
Quebec
238,900
68,459
45,679
40,548
978
4,153
353,038
Ontario
452,486
36,893
81,576
76,164
2,599
2,813
570,955
Manitoba
43,203
4,145
10,462
9,388
459
615
57,810
Saskatchewan
33,130
3,062
7,730
7,264
145
321
43,922
Alberta
78,709
18,436
17,889
15,726
536
1,627
115,034
141,188
16,638
25,214
21,324
807
3,083
183,040
Total provinces
Home living
Community
living
1,074,340

British Columbia
4 Statistics Canada, Canadian Community Health Survey.
13
While difficult to measure precisely, it is estimated that over

156,000Canadians received continuing care services in a community
living residential setting in 2011. This broad category includes a wide
range ofresidential settings encompassing independent, assisted, and
supportive living facilitiesat times all under one roof. For practical
purposes, these facilities provide a middle ground on the service
continuum between the level of care received through home care and
that received in long-term care homes offering 24-hour medical and
professional nursingsupervision.5
Nearly 204,000 seniors received continuing care supports in facility living
establishments in 2011. This residential setting includes long-term care
homes, alternate levels of care, and complex continuing care. Long-term
care homes provide medical and professional nursing supervision and
residency to nearly 185,000 seniors.6 Meanwhile, nearly 13,000seniors
received continuing care services in a complex continuing care hospital.7
In addition to the number of seniors who reside in a purpose-built
continuing care facility, it is conservatively estimated that a further
6,400 seniors were awaiting placement in general hospitals for alternate
levels of care.8 (Although the alternate level of care category is not a
designated care setting and is instead the result of issues associated
with patient flow, it is analyzed as a separate category within facility living
because of its specific costs and ramifications.)
5 Statistics Canada, 2011 Census of Population.

6 Statistics Canada, Long-Term Care Facilities Survey; Statistics Canada, Residential Care
Facilities Survey.
7 Statistics Canada, 2011 Census of Population.
8
The number of seniors in alternate levels of care was estimated by using 85 per cent of
the total alternate level of care figures in the Canadian Institute for Health Informations
Discharge Abstract Database and Hospital Morbidity Database, 200809. The 85 per cent
figure came from CIHIs Health Care in Canada, 2011, which reported that seniors make
up nearly 85 per cent of all alternate level of care patients.
14
Overall, an estimated 29 per cent of Canadian seniors currently

receive continuing care services. (See Table 3.) The ratio of seniors
receiving continuing care is estimated to be highest in Manitoba and
lowest in Newfoundland and Labrador. Perhaps not surprisingly, data
from Statistics Canadas 2011 census also show that the proportion of
seniors living in a collective dwelling, such as a long-term care home or
supportive housing, increases rapidly with age (2 per cent aged 65 to
74versus 31 per cent aged 85 and over).9
Table 3
Share of Seniors Receiving Continuing Care Supports, by Residential Setting, 2011
Facility living
Total
Longterm care
homes
Alternate
level of
care
Complex
continuing
care
Total
3.2
4.1
3.7
0.1
0.3
29.0
15.3
2.6
3.6
3.3
0.2
0.1
21.5
22.2
2.2
5.1
5.0
0.1
0.0
29.5
Nova Scotia
24.7
1.5
4.2
3.9
0.2
0.1
30.4
New Brunswick
25.2
2.8
3.8
3.5
0.3
0.1
31.9
Quebec
19.0
5.4
3.6
3.2
0.1
0.3
28.1
Ontario
24.1
2.0
4.3
4.1
0.1
0.1
30.4
Manitoba
25.1
2.4
6.1
5.4
0.3
0.4
33.5
Saskatchewan
21.6
2.0
5.0
4.7
0.1
0.2
28.6
Alberta
19.4
4.5
4.4
3.9
0.1
0.4
28.4
British Columbia
20.5
2.4
3.7
3.1
0.1
0.4
26.6
Home living
Community
living
Total provinces
21.8
Turcotte and Sawaya, Senior Care: Differences by Type of Housing.
15
Alternate Level of Care and Forecasting Future

Care for Seniors
Patients are designated as having an alternate level of care (ALC) when they are
in a hospital but no longer require intensive care and are awaiting transfer to a
more appropriate setting such as a home, long-term care home, or supportive
housing. ALC can be a function of many things, including a lack of appropriate
space in other settings, availability and wait times for home care services,
availability of caregiving supports, and patient and family preferences for a given
setting or facility.
The issue of ALC and its impacts on patients (both those waiting to get in and
those waiting to get out of hospital) and health costs has been documented
extensively. Despite well-intended policies and programs, ALC remains an
ongoing and significant issue for health planners and funders. In December
2014, there were 4,093 ALC-designated patients in acute and post-acute beds
in Ontario.10 While the ALC rate (percentage of inpatient beds occupied by ALC
patients) in Ontario fluctuates monthly, in July 2011 it was 14.3 per cent, and in
December 2014, it remained at 14.3 per cent.11 Also important are trends in how
long ALC patients wait in a hospital bed for transition to another setting, and
which setting they are waiting for.
The ALC issue lies at the complex intersection of publicly funded hospital care
and mixed public and private funding and delivery for continuing care supports
outside hospitals. While future trends of ALC rates across Canada are uncertain,
this component of continuing care supports will continue to be important when
projecting supply and demand.
10 Access to Care, Alternate Level of Care.

11 Ibid.
16
Just under 200,000

Canadian seniors
have reported
their continuing
care needs are not
being fully met.
Unmet Needs of Seniors

Aside from the collective 2.3 million Canadians (of all ages) who currently
receive continuing care supports in some capacity, a further 461,000
Canadians have reported continuing care needs they feel are not being
met. Of those Canadians expressing unmet continuing care needs, just
over 109,000 are reported to be seniors.12
Furthermore, of those who currently receive continuing care services,
a further 350,000 Canadians have reported their needs are being only
partially met. Of those, just over 90,000 are seniors.13
In total, just under 200,000 Canadian seniors have reported their
continuing care needs are not being fully met. These estimates are likely
quite conservative considering that the data sourceStatistics Canadas
2012 General Social Surveyfocused only on home care needs and did
not include seniors residing in collective dwellings. As a result, the level
of under-met needs of seniors in retirement homes or long-term care
homes is not included.
Of the seniors surveyed in the General Social Survey, young seniors
(those aged 6574) made up the largest segment (44 per cent) with
unmet or under-met needs. (See Table 4.)
12 Turcotte, Canadians With Unmet Home Care Needs.

13 Statistics Canada, Long-Term Care Facilities Survey.
17
Table 4
Seniors With Unmet or Under-Met Continuing Care Needs, by Age, 2011
All seniors (65+)
6569
7074
7579
8084
85+
199,741
41,318
46,200
40,707
37,032
34,483
3,832
1,217
571
702
714
629
1,030
154
308
298
124
146
Nova Scotia
6,585
1,677
1,566
1,021
1,117
1,203
New Brunswick
6,822
1,978
2,930
1,004
448
464
Quebec
42,775
9,694
12,166
4,563
8,509
7,850
Ontario
89,361
13,562
19,780
25,665
15,847
14,502
Manitoba
8,040
2,382
987
834
1,837
2,000
Saskatchewan
4,913
1,800
1,554
741
389
426
Alberta
12,821
2,665
2,833
2,380
2,620
2,327
British Columbia
23,559
6,190
3,505
3,498
5,428
4,936
Total provinces
Sources: Statistics Canada; The Conference Board of Canada.
Unfortunately, the data on unmet and under-met needs are not extensive
enough to identify the additional number of hours that would be required
to satisfy the needs of seniors or the additional funding that would be
necessary to provide these supports.
Understanding the Consequences of Unmet and

Under-Met Needs
Unmet and under-met needs for continuing care supports, such as waiting
too long for needed services, or not receiving enough of the right type of
services, can have many consequences. As part of their overall reform efforts,
governments and regional health decision-makers may adjust the publicly
funded continuing care supports they provide. Sometimes this means reducing
or eliminating homemaking or personal support services for some clients,
directing clients to different agencies to receive supports, or helping clients
18
understand how they can access private pay supports. For some people,
these supports are a critical link to remaining at home instead of living in
long-term care.
Projects like the research done using the Balance of Care policy planning tool
show that projections of continuing care supports could change if communitybased supports were enhanced for some seniors who were eligible for long-term
care.14 Getting the balance right is important for individuals and for ensuring the
most efficient use of scarce publicly funded health care resources.
It should be noted that the level and distribution of continuing care

support provided varies not only based on each distinctive residential
care setting but also by jurisdiction. It is also important to recognize that
much of the continuing care support provided is done through unpaid
care by family, friends, volunteers, and charities.
Public and Private Expenditures on Continuing Care

Supports for Seniors
Even using a conservative approach, our analysis estimates that the
total spending on continuing care supports for seniors was $28.3 billion
in 2011. (See Table 5.) Overall, $18.1 billion was estimated to come from
public sources, with the remaining $10.2 billion paid by individuals out-ofpocket or through private insurance. Unfortunately, the data do not allow
for a breakdown of these private sources.
14 Williams and others, The Balance of Care.
19
Table 5
Public and Private Spending on Continuing Care Supports
forSeniors, 2011
($ millions)
Public
Private
Total
18,112.0
10,218.9
28,330.9
298.1
116.2
414.3
66.8
44.8
111.6
Nova Scotia
640.4
263.0
903.4
New Brunswick
583.9
224.3
808.2
Quebec
5,200.3
2,505.3
7,705.6
Ontario
5,987.8
4,046.6
10,034.4
Manitoba
954.7
404.9
1,359.6
Saskatchewan
728.7
266.8
995.5
Alberta
1,546.6
1,016.4
2,563.0
British Columbia
2,104.7
1,330.6
3,435.3
Total provinces
At a national level, two-thirds (66 per cent) of the spending on continuing

care supports is provided by various levels of government. However, at
a provincial level, the share contributed by public sector sources ranges
from 75 per cent in Newfoundland and Labrador and inNew Brunswick
to 62 per cent in P.E.I and in Ontario.
Of the total $18.1 billion spent by governments on continuing care,
the largest share is directed toward long-term care institutions, at
$8.3billion. This is followed by home living at just over $3.7 billion, with
care in complex care hospitals amounting to $2.5 billion and care for
alternate level of care patients at $1.9 billion. Meanwhile, public support
for continuing care supports delivered to seniors in community living
establishments is estimated at nearly $1.7 billion. (See Table 6.)
20
Table 6
Spending on Continuing Care Supports for Seniors, by Source and
Residential Setting, 2011
($ millions)
Public
Private
Total
18,112.0
10,218.9
28,330.9
Home living
3,741.3
2,696.9
6,438.2
Community living
1,662.3
4,049.5
5,711.8
12,708.4
3,472.5
16,180.9
Long-term care home
8,280.6
3,152.1
11,432.7
Alternate level of care
1,913.3
110.5
2,023.8
Complex continuing care
2,514.5
209.9
2,724.4
Total residential settings
Facility living
Overall, of the total $10.2 billion spent by private sources (including both
out-of-pocket costs and private insurance), the largest share is directed
toward providing continuing care support to seniors in community
living, at $4.0 billion. This is followed by seniors residing infacility living
establishments at $3.5 billion and home living at $2.7 billion.
Broken down by age, younger seniors (those aged 65 to 74 years
old) account for an estimated 16 per cent of all continuing care costs.
Meanwhile, older seniors (those between 75 and 84 years of age)
and the eldest seniors (those 85 years of age and older) account for
36per cent and 48 per cent, respectively, of all continuing care costs.
(SeeTable 7.)
21
Table 7
Spending on Continuing Care Supports for Seniors, by Age, 2011
($ millions)
Public
Private
Total
18,112.0
10,218.9
28,330.9
6569
1,307.8
669.3
1,977.1
7074
1,752.7
953.9
2,706.6
7579
2,538.7
1,431.6
3,970.3
8084
3,887.9
2,331.8
6,219.7
85+
8,624.9
4,832.3
13,457.2
All seniors (65+)
Providers of Paid Continuing Care Supports

toSeniors
As there are no definitive statistics available on the level and composition
of workers who provide continuing care support specifically to seniors,
this report uses case-mix classifications to help assign resource
utilization. Case-mix classifications are used as a tool for allocating
resources to support people in need by applying algorithm-like
procedures to sort individuals with various needs into a specified number
of categories. One widespread example of a case-mix classification is
the resource utilization groups (RUGs) identified using an international
assessment tool called InterRAI. In Canada, the specific assessments
are housed and reported (to various degrees) by the Canadian
Institute for Health Information (CIHI). Using this reporting structure,
people in need of care are broadly categorized into 23 distinct RUG
categories for home care and 44 distinct RUG categories for long-term
care.15 For public dissemination, it is common to find that the detailed
RUG categorization used for both home care and long-term care
are aggregated into seven major categories: rehabilitation, extensive
services, special care, clinical complex, impaired cognition, behavioural
problem, and reduced physical functions.
15 Canadian Institute for Health Information, How RUG-III (44 Group) Case Mix Index Values
Are Calculated.
22
Tables 8 and 9 show the RUG-III (RUG version three) distribution by

age of seniors who received both home care and institutional care,
as captured by CIHI during its 201314 fiscal year. It should be noted
that data were not available for all provinces or for all patients in the
participating provinces. To various degrees, resource utilization groups
were available for long-term care facility clients in Ontario, Manitoba,
Newfoundland and Labrador, Nova Scotia, Alberta, B.C., and Yukon,
aswell as home care clients in Ontario, B.C., and Yukon.
The summary view in the tables consists of the aggregate seven
categories and is rolled up to include both males and females. It should
be noted that our forecast model uses data at the more disaggregated
RUG level and broken down by gender. Still, the tables presented
here illustrate that the RUG distribution changes as seniors age. In
general, the distribution shows that younger seniors are more likely
to be categorized as needing rehabilitation, extensive services, and
special care, while older seniors are more likely to be categorized
as having impaired cognition, behavioural problems, and reduced
physical functions.
Table 8
Distribution of Home Care Recipients by RUG-III Classification and Age, 201314
(per cent)
All seniors (65+)
6569
7074
7579
8084
85+
100.0
100.0
100.0
100.0
100.0
100.0
Rehabilitation
5.1
6.2
5.4
5.2
4.8
4.5
Extensive services
1.6
2.4
1.9
1.4
1.3
1.3
Special care
2.6
4.8
3.2
2.4
1.9
1.7
Clinical complex
22.0
28.5
25.8
21.8
19.7
17.9
Impaired cognition
11.5
8.3
9.9
11.7
13.0
12.8
1.4
1.2
1.6
1.5
1.6
1.3
55.8
48.6
52.1
56.1
57.8
60.5
Total RUG-III Classification
Behavioural problem
Reduced physical functions
Sources: Canadian Institute for Health Information; The Conference Board of Canada.
23
Table 9
Distribution of Long-Term Care Recipients by RUG-III Classification and Age, 201314
(per cent)
All seniors (65+)
6569
7074
7579
8084
85+
100.0
100.0
100.0
100.0
100.0
100.0
Rehabilitation
9.5
14.5
13.2
11.6
10.0
8.2
Extensive services
3.7
6.0
5.0
4.1
3.7
3.3
Special care
7.7
11.6
9.2
8.3
7.3
7.3
Clinical complex
21.7
23.8
23.8
23.3
22.1
20.8
Impaired cognition
11.6
10.3
11.1
12.1
12.7
11.2
1.6
2.7
2.5
1.7
1.9
1.3
44.2
31.1
35.2
38.9
42.4
48.0
Total RUG-III classification
Behavioural problem
Reduced physical functions
Sources: Canadian Institute for Health Information; The Conference Board of Canada.
This analysis is important because it shows that the delivery of

continuing care supports to each category is unique and has an impact
not only on the costs and level of service needed or received but also
on the occupation of worker responsible for providing the care. The
classification is also important because it may affect the level and costs
associated with medical equipment and supplies.
Since various service categories are assigned to each resource
utilization group, it is possible to attribute the level of resources required
for each continuing care recipient. This is done by accounting for the
level of support received from various health occupations, including
nurses, therapists, health care aides, and others. In our analysis, this
information was used to estimate the number of full-year jobs supported
in providing continuing care supports specifically to seniors by various
health care occupations. (For this analysis, we have not included medical
practitioners, such as family physicians or gerontologists, involved in
senior care.)
24
Conservatively, it is estimated that the delivery of continuing care

services to seniors currently supports nearly 235,000 full-year jobs within
the health care sector alone. In this report, a job is defined as work for
the period of one year, regardless of whether it is full-time or part-time.
Ajob may be work for 10 hours per week or 40 hours per week, as long
as it is for one year. If the work is for only three months of the year, then
it only counts as only one-quarter of a job.
Of those jobs, 148,600 are for health care aidesalso called personal
support workers, care aides, continuing care assistants, or resident
care aides. A further 34,000 full-year jobs are supported as registered
nurses and 28,500 as registered or licensed practical nurses. Nearly
5,200fullyear jobs are supported as physiotherapists, 3,600 as
occupational therapists, and 1,500 as speech language therapists. In
addition, over 1,600 full-year jobs are supported as specific therapist
aides. It should also be noted that considerable resources are required
to coordinate the continuing care services that seniors receive. In fact,
it is estimated that this task supports employment of nearly 12,000 fullyear jobs in case management and other health care administration.
(SeeTable 10.)
Table 10
Employment Supported by Continuing Care Support
ofSeniorsbyOccupation, 2011
(full-year equivalent jobs)
Total for all occupations
234,815
Registered nurse
34,013
Registered/licensed practical nurse
28,443
Health care aide
148,595
Physiotherapist
5,153
Occupational therapist
3,569
Speech-language therapist
1,513
Specific therapist aides
1,613
Case management and other
11,916
25
Table 11 shows the provincial distribution of the nearly 235,000 full-year

jobs supported in 2011 as a result of providing continuing care support
toseniors.
Table 11
Employment Supported by Continuing Care Support
ofSeniorsbyProvince, 2011
(full-year equivalent jobs)
Total provinces
234,815
3,899
1,231
Nova Scotia
8,265
New Brunswick
6,831
Quebec
54,726
Ontario
93,732
Manitoba
12,884
Saskatchewan
7,384
Alberta
17,315
British Columbia
28,549
Providers of Unpaid Continuing Care Services

toSeniors
It is estimated that, in 2011, more than 1 million seniors received unpaid
continuing care support provided by caregivers across all residential
settingshome, supportive, and facility living establishments. (See
Table 12.) While the vast majority of seniors receiving unpaid continuing
care supports lived at home, an estimated 182,000 seniors receiving
unpaid continuing care supports resided in community and facility living
establishments. According to Statistics Canadas General Social Survey
for 2012, each senior recipient of unpaid care received an average of
21.9 hours of help per week. Combining these two estimates suggests
26
that over 1.2 billion hours of unpaid continuing care is provided annually
to seniors. The General Social Survey also reported that, on average,
each senior received help from a total of nearly five different individuals,
including family members, friends, or other unpaid providers. In total,
an estimated 5.3 million Canadians provided some level of unpaid
continuing care to seniors in 2011.
Table 12
Seniors Receiving Unpaid Continuing Care Supports by Province
and Residential Setting, 2011
Home living
Community/
facility living
Total residential
settings
888,944
181,838
1,070,783
10,953
2,622
13,575
4,296
869
5,165
Nova Scotia
32,543
4,403
36,946
New Brunswick
23,609
4,407
28,015
Quebec
193,788
59,596
253,384
Ontario
373,070
59,076
432,147
Manitoba
34,943
6,912
41,855
Saskatchewan
28,239
5,622
33,861
Alberta
67,392
18,190
85,583
120,111
20,141
140,253
Total provinces
British Columbia
27
CHAPTER 3
Continuing Care Needs

of SeniorsBase-Case
Projection
Chapter Summary
Over 2.4 million Canadian seniors will need and receive paid and unpaid
continuing care supports in 2026a 71 per cent increase over 2011. By 2046,
this number will reach nearly 3.3 million.
Spending on continuing care for seniors across all 10 provinces will increase
from $28.3 billion in 2011 to $177.3 billion in 2046. With two-thirds of this
spending provided by governments, spending growth will significantly outpace
revenue growth for most provinces.
By 2046, over 11.6 million Canadians will be counted on to provide some level
ofunpaid continuing care support to seniors.
Labour demand growth for the continuing care sector is projected to far exceed
overall labour force growth.
The Situation in the Future

The objective of the status quo, or base-case,
projection is to highlight the degree to which
continuing care demands in the future will
change based on various relationships that exist
today. This means that changes in the number
of seniors needing continuing care support
will be largely driven by demographic (age and
gender) factors. It also means that, under the
base-case projection, the distribution of how
those needs will be met will be based on the
distribution of how continuing care supports
aredelivered today.
The base-case projection in this report also assumes that the ageadjusted unit costs associated with providing continuing care supports
will remain fixed in real terms; however, total costs will change as a result
of changes in real demand and inflation. While the assumption of fixed
age-adjusted unit costs may be considered by many as a conservative
assumption, it should be remembered that these costs undoubtedly
include some level of inefficiency.
It should also be noted that the base-case projection also assumes
that current protocols for diagnosis and treatment will continue over the
forecast horizon. This assumption implies that any current overdiagnosis
and treatment and/or underdiagnosis will continue in the future.
While the status quo projection is not specifically intended to predict
what continuing care for seniors will look like in the future, it is intended
to provide various stakeholders with quantitative benchmarks that can be
used to prioritize the possible challenges faced and begin (or continue)
to implement more effective and efficient approaches to deal with
those challenges.
29
To remain conservative in estimating future continuing care needs, the
Over 2.4 million

Canadian seniors
will need and
receive continuing
care supports
in2026.
base-case projection assumes that needs will be mitigated somewhat

by a factor known as healthy aging. Basically, healthy aging assumes
that, on average, seniors in the future will be healthier than seniors
today.1 While most observers agree that average life expectancies from
birth, and even from age 65, are expected to continue to increase for
many years, the more contentious assumption appears to be linked
to an overall reduction in the time spent living with chronic illness or
disability. (This is generally referred as a compression in morbidity.)
Therefore, readers should be advised that in the absence of the healthy
aging assumption, the resulting projections for continuing care needs
ofseniorswould be even higher.
For further details on the demographic assumptions used in the status
quo forecast of continuing care supports for seniors in Canada, please
refer to Appendix B.
Seniors Receiving Continuing Care Services

Incorporating The Conference Board of Canadas long-term demographic
projections, the base-case scenario estimates that over 2.4 million
Canadian seniors will need and receive continuing care supports in
2026a 71 per cent increase over 2011. The number of seniors needing
and receiving continuing care is projected to exceed 3 million by 2036
and reach nearly 3.3 million by 2046. (See Table 13.)
Fries, Bruce, and Chakravarty, Compression of Morbidity.
30
Table 13
Current and Projected Future Number of Seniors Receiving
Continuing Care Supports, 201146
2011
2026
2036
2046
1,434,261
2,454,868
3,016,521
3,288,862
Home living
1,074,340
1,840,022
2,264,457
2,468,067
Community living
156,081
265,691
322,338
351,334
Facility living
203,840
349,155
429,726
469,461
Long-term care home
184,566
316,035
389,074
424,960
Alternate level of care
6,407
10,981
13,517
14,707
12,867
22,139
27,135
29,794
Complex continuing care
Assuming that the share of seniors living in various residential settings

remains as it was in 2011, the base-case projections suggest that the
largest share of seniors needing and receiving continuing care supports
in the future would live at home. In fact, the number of seniors receiving
continuing care at home is projected to increase to over 1.8 million by
2026 and continue to expand to reach nearly 2.3 million by 2036 and
2.5million by 2046. While the bulk of seniors in this residential setting are
assumed to receive some level of informal (or unpaid) care, the number
of seniors needing and receiving paid care services is expected to reach
850,000 in 2026 and exceed 1 million by 2036 and 1.1 million by2046.
Aside from the continuing care support provided in home living, more
seniors are expected to need and receive continuing care supports in
community and facility living establishments. Specifically, under the
base-case scenario, it is estimated that long-term care institutions
would provide medical and professional nursing supervision to
nearly 320,000seniors by 2026 and 390,000 by 2036. In 2046,
over 420,000seniors would receive this level of care in long-term
care institutions.
31
Meanwhile, it is estimated that nearly 30,000 seniors would receive

continuing care services from a complex continuing care hospital in
2046. Without further progress on alternate level of care wait times,
itis expected that at any given time throughout the year, nearly
15,000seniors would be waiting in hospitals for alternate levels of
carein 2046.
The base-case projection suggests that the age range expected to
grow the fastest will be the eldest seniors (those 85 years and older).
(See Table 14.) Interestingly, while females are projected to continue
to outnumber males in needing and receiving continuing care support
across all age groups, males 85 years of age and older will form the
strongest growth segment.
Table 14
Current and Projected Future Number of Seniors Receiving Continuing Care Supports,
byAgeand Gender
2011
2026
2036
2046
20112046 growth
1,434,261
2,454,868
3,016,521
3,288,862
129%
6569
191,842
329,121
269,461
260,778
36%
7074
235,383
454,801
474,179
390,891
66%
7579
250,977
478,778
562,093
479,929
91%
8084
321,616
514,366
706,969
777,717
142%
85+
434,443
677,801
1,003,820
1,379,546
218%
Male seniors (65+)
461,177
829,430
1,019,812
1,102,106
139%
6569
75,582
128,721
103,837
99,640
32%
7074
85,216
165,694
172,658
139,889
64%
7579
78,856
153,964
181,023
153,308
94%
8084
105,437
178,677
248,068
275,528
161%
85+
116,086
202,374
314,226
433,742
274%
All seniors (65+)
(continued )
32
Table 14 (contd)
Current and Projected Future Number of Seniors Receiving Continuing Care Supports,
byAgeand Gender
2011
2026
2036
2046
20112046 growth
Female seniors (65+)
973,084
1,625,438
1,996,709
2,186,756
125%
6569
116,260
202,050
168,106
164,254
41%
7074
150,168
290,736
303,963
254,397
69%
7579
172,122
324,440
381,116
327,455
90%
8084
216,176
334,201
457,057
498,886
131%
85+
318,357
474,010
686,467
941,765
196%
Unmet Needs of Seniors

Under the base-case scenario, an estimated 458,000 seniors will have
unmet or under-met needs in 2046up substantially from the nearly
200,000 seniors who report having unmet or under-met continuing care
needs today. This is a conservative estimate, given that it excludes
the under-met needs of those living in collective dwellings, such as
nursing homes.
Without further progress on reducing unmet or under-met needs, the
base-case scenario shows that older seniors (those aged 7584) will
come to represent the largest segment (44 per cent) of seniors with
unmet or under-met needs. Furthermore, the level of unfilled needs is
projected to increase by over 280 per cent for the eldest seniors, those
85 years and older. (See Table 15.)
Public and Private Spending on Continuing Care

forSeniors
Under the base-case projection, the total spending on the provision of
continuing care supports for seniors across all 10 provinces is projected
to increase, along with inflation, from $28.3 billion in 2011 to $62.3 billion
in 2026, $111.9 billion in 2036, and $177.3 billion in 2046. (See Table 16.)
The rate of increase by 2046 is expected to have been dramatic across
all provinces, ranging from 382 per cent growth in Saskatchewan to
714per cent growth in Alberta.
33
Table 15
Current and Projected Future Number of Seniors With Unmet or Under-Met Continuing Care
Needs, by Age
2011
2026
2036
2046
20112046 growth
199,760
342,210
420,236
458,120
129%
6569
41,317
68,516
62,666
66,811
62%
7074
46,199
86,496
100,706
90,864
97%
7579
40,713
75,797
100,055
93,947
131%
8084
37,036
57,550
88,767
106,726
188%
85+
34,494
52,390
87,167
131,455
281%
All seniors (65+)
Sources: Statistics Canada; The Conference Board of Canada.
Table 16
Public and Private Spending on Continuing Care Supports for Seniors
($ millions)
2011
2026
2036
2046
20112046 growth
28,330.9
62,320.4
111,899.2
177,267.9
526%
414.3
958.6
1,695.0
2,463.8
495%
111.6
249.5
454.9
692.1
520%
Nova Scotia
903.4
1,841.0
3,237.0
4,784.3
430%
New Brunswick
808.2
1,710.6
2,994.1
4,418.8
447%
Quebec
7,705.6
16,811.6
28,543.5
42,726.3
454%
Ontario
10,034.4
22,421.9
41,065.2
66,420.2
562%
1,359.6
2,529.3
4,456.7
7,053.7
419%
995.5
1,692.1
2,927.5
4,796.1
382%
Alberta
2,563.0
6,332.4
12,104.8
20,869.7
714%
British Columbia
3,435.3
7,773.4
14,420.5
23,042.9
571%
Total provinces
Manitoba
Saskatchewan
34
Focusing solely on public spending associated with the provision of

continuing care supports for seniors suggests that overall spending will
increase from $18.1 billion in 2011 to $39.1 billion in 2026, $72.2 billion
in 2036, and $117 billion in 2046for an overall annual average rate of
5.5 per cent between 2011 and 2046. (See Table 17.) By 2046, the total
rate of increase is expected to have been dramatic across all provinces,
ranging from 387 per cent growth in Saskatchewan to 753 per cent
growth in Alberta.
Table 17
Public Spending on Continuing Care Supports for Seniors
($ millions)
2011
2026
2036
2046
20112046 growth
18,112.0
39,147.1
72,249.5
116,978.9
546%
298.1
688.6
1,248.3
1,843.7
518%
66.8
148.0
276.7
429.8
544%
Nova Scotia
640.4
1,294.3
2,318.6
3,480.7
444%
New Brunswick
583.9
1,227.0
2,188.3
3,277.0
461%
Quebec
5,200.3
11,289.7
19,861.1
30,447.8
485%
Ontario
5,987.8
13,184.4
24,723.1
40,973.9
584%
Manitoba
954.7
1,743.9
3,130.5
5,025.3
426%
Saskatchewan
728.7
1,212.6
2,132.0
3,548.4
387%
Alberta
1,546.6
3,683.5
7,381.3
13,184.8
753%
British Columbia
2,104.7
4,675.1
8,989.6
14,767.5
602%
Total provinces
35
Table 18 contrasts public spending growth between 2011 and 2026

with nominal GDP growth for Canada and the provinces. Nominal
GDP growth is the measure that is widely used as an indicator for
revenue growth.
Except for Saskatchewan and Manitoba, the projected increase in public
spending for continuing care of seniors will exceed the growth in nominal
GDP for all provinces. The degree to which public spending exceeds
nominal GDP growth reflects the degree to which changes will need
to occur and/or difficult spending decisions will need to be made to
accommodate growing needs.
Table 18
Public Spending on Continuing Care Supports vs. Nominal GDP,
20112026
Annual growth
inpublic
expenditures
(%)
Annual growth
innominal GDP
(%)
Difference
(percentage
points)
Total provinces
5.3
4.0
1.3
5.7
2.2
3.5
5.5
3.4
2.1
Nova Scotia
4.8
3.1
1.7
New Brunswick
5.1
3.2
1.9
Quebec
5.3
3.5
1.8
Ontario
5.4
3.9
1.5
Manitoba
4.1
4.1
0.0
Saskatchewan
3.5
3.5
0.0
Alberta
6.0
4.0
2.0
British Columbia
5.5
4.1
1.4
36
At a national level, the base-case scenario assumes that in 2046,

$117billion would be paid by public sources, with the remaining
$60.3billion coming from private insurance and out-of-pocket sources.
Across all provinces, the base-case projection suggests that the
majority of expenditures will continue to be paid through public sources.
(SeeTable 19.)
Table 19
Public and Private Spending on Continuing Care Supports for Seniors by Province, 2046
($ millions)
Public
Private
Total
Public share
ofspending
116,978.9
60,289.0
177,267.9
66%
1,843.7
620.1
2,463.8
75%
429.8
262.3
692.1
62%
Nova Scotia
3,480.7
1,303.6
4,784.3
73%
New Brunswick
3,277.0
1,141.8
4,418.8
74%
Quebec
30,447.8
12,278.5
42,726.3
71%
Ontario
40,973.9
25,446.3
66,420.2
62%
Manitoba
5,025.3
2,028.4
7,053.7
71%
Saskatchewan
3,548.4
1,247.7
4,796.1
74%
Alberta
13,184.8
7,684.9
20,869.7
63%
British Columbia
14,767.5
8,275.4
23,042.9
64%
Total provinces
37
Overall, of the total $177.3 billion spent by both public and private
sources in 2046, the largest share (61 per cent) will continue to be
directed toward providing continuing care support to seniors in facility
living establishments. Meanwhile, the costs associated with providing
continuing care support to seniors living at home is projected to increase
to $36.9 billion, with a further $32.3 billion spent on seniors residing in
community living facilities. (See Table 20.)
Table 20
Public and Private Spending on Continuing Care Supports for Seniors by Residential
CareSetting, 2046
($ millions)
Home living
Community living
Facility living
Total residential
care settings
36,897.5
32,279.7
108,090.8
177,267.9
451.4
397.2
1,615.2
2,463.8
126.8
103.6
461.7
692.1
Nova Scotia
1,107.5
417.3
3,259.5
4,784.3
New Brunswick
1,214.5
614.6
2,589.8
4,418.8
Quebec
7,659.5
10,139.0
24,927.8
42,726.3
Ontario
15,261.4
9,708.0
41,450.7
66,420.2
1,719.9
737.2
4,596.6
7,053.7
760.9
567.9
3,467.3
4,796.1
Alberta
3,166.4
5,582.9
12,120.5
20,869.7
British Columbia
5,429.2
4,012.0
13,601.7
23,042.9
Total provinces
Manitoba
Saskatchewan
38
The base-case projection suggests that the spending associated

withthe eldest seniors (those 85 years and older) will grow the most.
(See Table 21.) While the overall growth in spending between 2011 and
2046 is estimated to increase 526 per cent, the growth in spending on
continuing care for seniors 85 years and older is estimated at 677 per
cent. By 2046, seniors 85 years and older will account for 59 per cent
of all continuing care spendingup from the 47 per cent this group
currently represents.
Table 21
Public and Private Spending on Continuing Care Supports for Seniors, by Age
($ millions)
2011
2026
2036
2046
20112046 growth
28,330.9
62,320.4
111,899.2
177,267.9
526%
6569
1,977.1
4,497.3
5,022.4
6,641.2
236%
7074
2,706.6
6,909.9
9,806.7
10,919.5
303%
7579
3,970.3
10,047.5
16,180.8
18,630.8
369%
8084
6,219.7
13,156.6
24,749.3
36,572.7
488%
13,457.2
27,709.1
56,140.0
104,503.6
677%
All seniors (65+)
85+
39
Providers of Paid Continuing Care Services

toSeniors
Under the base-case projection, the provision of continuing care
supports to seniors is projected to sustain 373,400 full-year jobs in 2026,
over 537,500 in 2036, and 677,200 by 2046. (See Table 22.) The rate of
increase between 2011 and 2046 is expected to be significant across all
provinces, ranging from 118 per cent in Saskatchewan to 280 per cent
in Alberta.
Table 22
Employment Supported by Continuing Care Support of Seniors, by Province
(full-year equivalent jobs, all occupations)
2011
2026
2036
2046
20112046 growth
234,815
373,399
537,533
677,200
188%
3,899
6,621
9,414
10,913
180%
1,231
2,005
2,989
3,669
198%
Nova Scotia
8,265
12,288
17,053
19,766
139%
New Brunswick
6,831
10,516
14,594
16,968
148%
Quebec
54,726
86,898
117,755
138,928
154%
Ontario
93,732
151,474
221,843
286,138
205%
Manitoba
12,884
17,244
24,213
30,403
136%
7,384
9,161
12,524
16,093
118%
Alberta
17,315
30,392
47,433
65,778
280%
British Columbia
28,549
46,800
69,714
88,543
210%
Total provinces
Saskatchewan
40
To provide some context to the rate of increase in employment that

would be sustained by providing continuing care to seniors, Table 23
contrasts the growth against overall employment growth for Canada
and the provinces. The table shows that the projected increase in the
level of employment required in the provision of continuing care for
seniors is projected to exceed the rate of growth in overall employment
for all provinces on an annual basis between 2011 and 2026. Once
again, the degree to which employment in the provision of continuing
care of seniors exceeds overall employment growth projections reflects
the difficulty that provinces will likely face in attracting, training, and
retainingsuitable candidates.
Table 23
Labour Demand vs. Overall Employment, 20112026
Annual growth in labour demand
for continuing care (%)
Annual growth in
overall employment (%)
Difference
(percentage points)
Total provinces
3.1
1.0
2.1
3.6
-0.1
3.7
3.3
0.5
2.8
Nova Scotia
2.7
0.1
2.6
New Brunswick
2.9
0.3
2.6
Quebec
3.1
0.6
2.5
Ontario
3.3
1.2
2.1
Manitoba
2.0
1.1
0.9
Saskatchewan
1.4
1.0
0.4
Alberta
3.8
1.5
2.3
British Columbia
3.4
1.0
2.4
41
By 2046, it is projected that the provision of continuing care supports

to seniors would sustain 677,200 full-year jobs within the health care
sector alone (assuming that labour productivity in the health care sector
remains flat). Of those full-year jobs, 431,600 are projected to be for
health care aides. A further 97,200 full-year jobs would be supported as
registered nurses and 86,700 as registered or licensed practical nurses.
Almost 27,000 full-year jobs would be supported as physiotherapists,
occupational therapists, and speech, language therapists, combined with
another 4,900 full-year jobs for specific therapist aides. Coordinating the
continuing care services for seniors is projected to support employment
for 30,000 full-year jobs in case management and other health care
administration. (See Table 24.)
Table 24
Employment Supported by Continuing Care Support of Seniors, by Occupation
(full-year equivalent jobs, all provinces)
2011
2026
2036
2046
20112046 growth
234,815
373,399
537,533
677,200
188%
Registered nurse
34,013
53,972
77,446
97,210
186%
Registered/licensed practical nurse
28,443
44,968
66,786
86,706
205%
148,595
235,981
340,965
431,604
190%
Physiotherapist
5,153
8,334
11,404
13,526
163%
Occupational therapist
3,569
5,774
7,894
9,353
162%
Speech-language therapist
1,513
2,448
3,344
3,958
162%
Specific therapist aides
1,613
2,570
3,794
4,892
203%
11,916
19,353
25,901
29,952
151%
Total for all occupations
Health care aide
Case management and other

42
Providers of Unpaid Continuing Care Supports

toSeniors
In 2046, it is also projected that nearly 11.7 million Canadians will need
to provide some level of unpaid continuing care support to address
seniors needs to the same degree as in 2011. (See Table 25.) Overall,
this army of unpaid caregivers would need to provide over 2.6 billion
hours of care annually to the nearly 2.5 million seniors who will require
unpaid continuing care support. (See Table 26.)
To appreciate the degree to which unpaid care will be stretched in the
future, it is important to put it in perspective from the point of view of
potential caregivers. Using this perspective, by 2046, 27 per cent of
potential caregiversbasically all Canadians who themselves dont
require continuing care supportwill need to provide some level
of unpaid support to seniors. This compares with the 17 per cent
of potential caregivers who currently provide some level of unpaid
continuing care supports to seniors.
Table 25
Providers of Unpaid Continuing Care Services to Seniors, by Province
(number of providers)
2011
2026
2036
2046
20112046 growth
5,300,374
8,914,523
10,827,820
11,661,355
120%
67,198
111,008
125,523
121,303
81%
25,566
42,672
50,809
51,221
100%
Nova Scotia
182,884
285,923
322,342
309,654
69%
New Brunswick
138,675
220,822
250,954
246,306
78%
Quebec
1,254,248
1,984,567
2,254,247
2,346,678
87%
Ontario
2,139,125
3,677,928
4,616,621
5,004,024
134%
Manitoba
207,181
317,535
376,377
408,130
97%
Saskatchewan
167,612
245,089
286,178
316,676
89%
Alberta
423,634
825,965
1,067,370
1,266,956
199%
British Columbia
694,251
1,203,014
1,477,399
1,590,406
129%
Total provinces
43
Table 26
Seniors Receiving Unpaid Continuing Care Supports, by Province and Residential Setting, 2046
Home living
Community/facility living
2,045,506
413,606
2,459,112
20,639
4,941
25,580
8,984
1,818
10,801
Nova Scotia
57,517
7,782
65,299
New Brunswick
43,770
8,170
51,940
Quebec
378,470
116,391
494,861
Ontario
910,979
144,255
1,055,234
Manitoba
71,853
14,212
86,065
Saskatchewan
55,692
11,087
66,780
Alberta
210,385
56,787
267,172
British Columbia
287,217
48,163
335,380
Total provinces
44
CHAPTER 4
Summary of Projection
Chapter Summary
The status quo forecast reveals several pressure points related to financing,
labour, and infrastructure.
As the demands for government spending exceed overall revenue growth,

difficult choices and reforms targeting efficiency will be required.
Likewise, the labour projections arising from the forecast suggest it is
imperative for stakeholders to collaborate on a health human resource plan

for the continuing care sector. Health care aides are a notable occupation
thatrequiressignificant attention.
The growth in the number of seniors requiring some form of community
or facility living arrangements also requires coordinated public and private

investment in infrastructure to meet future needs.
Theincrease
in associated
costs of providing
continuing care
supports to
seniors becomes
more pronounced
with the aging
of the Canadian
population.
The current situation and the status quo

base-case projection shine a spotlight on the
implications of the current approach to providing
continuing care supports for Canadian seniors
today and in the future, unless changes are
made. Continuing care supports for seniors
are most widely provided to seniors who live at
home; however, a significantnumber of seniors
receiving continuing care supports reside
incommunity and facility living establishments.
The analysis in this report highlights the large role that health care aides
have in delivering continuing care supports to seniors. It also highlights
the reliance that delivering continuing care supports has on public
sourcesin particular, the share of total public spending directed toward
providing continuing care supports to seniors in long-term care facilities
and other facility living establishments.
What is also clear is that, under the status quo base-case projection,
theincrease in demand and associated costs of providing continuing
care supports to seniors becomes much more pronounced with the
aging of the Canadian population. With the urgency to find more effective
ways to meet the needs of seniors already increasing, there are several
broad implications that result from the status quo base-case projection.
Financial Implications
The results of the analysis suggest that, under a status quo projection,
public spending on continuing care would conservatively increase at
an annual pace of 5.5 per cent (out to 2046). While financing this rate
of growth is technically possible, analysis in The Conference Board of
Canadas report A Difficult Road Ahead: Canadas Economic and Fiscal
Prospects suggests this level of public spending growth would require
46
provincial and territorial governments to make many difficult choices that

would result in sizable budget reallocations over both the medium and
longer term.
In fact, without significantly increasing taxes or changing federal
government transfers, provincial and territorial governments would need
to freeze real age-adjusted spending per capita on health, education,
and social services while cutting other program spending by over
12percent just to balance their budgets by 201718. Without the
means to implement significant reforms that improve efficiency, one
consequence of reducing funding over the short term has been to further
expose continuing care gaps. It could be argued that publicly funded
continuing care support to seniors who live at home (home care) has
witnessed the most dramatic changes as a result.
Fortunately, the analysis in A Difficult Road Ahead: Canadas Economic
and Fiscal Prospects suggests that after budgets are balanced, the
provinces and territories will be able to allocate slightly more resources
to health care. However, because of slower expected revenue growth,
the growth in total health care spending is likely to be limited to just
4.8per cent per year, including inflation. With spending on continuing
care needs of seniors representing about 15 per cent of the overall public
spending on health care, the projected growth in spending on continuing
care for seniors would limit spending on all other health care segments
to 4.6 per cent per year.
Even if the financial means were possible for provinces and territories to
provide continuing care support to seniors under the baseline projection,
it is likely that status quo projection of continuing care supports would
still not be the preferred option. The reasons for this include:
1. The status quo scenario does not address current unmet or
undermet needs of seniors. In fact, because of the growing senior

population, the number of seniors with unmet or under-met needs
willdramaticallyincrease.
47
2. The status quo scenario continues to rely on unpaid carefamilies,
friends, and volunteersto satisfy a large share of the continuing

care needs of seniors. Our analysis shows that the burden of care will
increase dramatically on those able to provide this care. In fact, the
analysis suggests that governments and other stakeholders would be
wise to explore creative approaches that enhance the availability of
both paid and unpaid care providers. For example, interest in providing
supports for family caregivers has been growing, informed by research
and initiatives such as the federal Canadian Employers for Caregivers
Plan1 and provincial caregiver benefits programs.2 Furthermore, efforts
to bolster stronger intergenerational connections between young and
old continue to foster the type of awareness and sensitivity that could
strengthen caregiving between related and unrelated individuals.
New technologies are helping to facilitate communication between
the frail elderly and their distant family members and friends.3 Other,
more unconventional approaches are happening in countries like the
Netherlands, where some university students live rent-free in small
apartments in retirement homes.4 In exchange, these students spend a
minimum of 30 hours per month engaged in a variety of activities with
residents of the home. These activities help to counter social isolation
and loneliness encountered by some residents.
3. The base-case projection does not recognize the increased desire
among seniors to receive care in their home and/or in community

living options. While these options on the surface appear to represent
a significant cost savings to government, they require much more
coordination of care among various care providers both from within
as well as outside the health care sector. It should also be noted that
facilitating the development of new community living options likely
requires significant capital investments that could reduce their overall
cost advantages. Another implication of delivering a greater share
1
Employment and Social Development Canada, Canadian Employers for Caregivers Plan.
For example, Nova Scotias Caregiver Benefit program, http://novascotia.ca/dhw/ccs/

caregiver-benefit.asp.
Technologies for Aging Gracefully, InTouch.
Reed, Dutch Nursing Home Offers Rent-Free Housing.
48
The labour demand

required to provide
continuing care
support to seniors
is projected to
increase at an
annual rate of
growth of 3.1 per
cent out to 2026.
ofcontinuing care supports to seniors in home and community living

environments is that, in many cases, the financial burden of providing
that care shifts from the public sector to that of the care recipient.
Aswasalready mentioned, increasing the demand for supports in
non-facility living environments places additional pressures on unpaid
caregivers, volunteers, and charitable organizations to fulfill the
expanded continuing care needs.
Human Resource Implications

The modelling results suggest that, under the status quo projection, the
labour demand required to provide continuing care support to seniors
is projected to increase at an annual rate of growth of 3.1 per cent out
to 2026. This growth in labour demand is significantly higher than the
overall projected growth in employment of 1 per cent per year. The
Conference Board of Canadas overall projection of employment within
health care and social assistance is of growth of 1.6 per cent per year.
The degree to which the projections outweigh the growth in the overall
employment is even more pronounced in specific provinces.
After 2026, the modelling suggests that human resource demands will
further intensifyincreasing by an annual average rate of 3.7percent
to 2036. Once again, this growth is significantly higher than theoverall
projected growth in employment of 0.7 per cent per year. The Conference
Board of Canadas overall projection of employment within health care
and social assistance forecasts growth of only 1 per cent per year.
Between 2036 and 2046, the modelling suggests that the human
resource demands of providing continuing care supports to seniors
will moderate, but is still projected to increase at an annual rate of
2.3 percent. Even during this time period, the demand is likely to
faroutweigh the overall growth in employment.
49
The modelling results clearly illustrate that it is imperative that the

planning for health occupations be done strategically and effectively
in order to ensure that the human resource capacity will be available
when needed.
Continuing Care for Seniors and the Health Care

Aide Market
Health care aides, also known as personal support workers or home support
workers (among other terms), are a critical part of Canadas health and social
care system. This workforce provides a significant share of the care delivered
to Canadian seniors living in their homes or in residential care facilities. Their
services are crucial to the health, well-being, and independence of an aging
population, and a key support for unpaid caregivers.
Health care aides in continuing care are employed by a variety of organizations
(e.g., long-term care institutions, and home care and community care
businesses) with a range of structures (public, private non-profit, charitable,
and private for-profit). They can also be contracted privately by individuals or
families, sometimes as live-in caregivers. New provincial registries of health care
aides/personal support workers are starting to provide some insights into this
workforce, but there is still much to be learned about the market that employs
them and other variables such as compensation, recruitment and retention,
education and training, and skill mix.
The importance of this segment of the continuing care workforce should be top
of mind for governments and Canadians. As the number of older Canadians
grows in the coming decades, the country will increasingly need more of these
workers. For example, in the United States, occupational projections to 2020
suggest that some of the fastest growth is expected in health care, health
care support, and personal care occupations.5 Similarly in Canada, the aging
population and need for continuing care is expected to drive demand for health
U.S. Bureau of Labor, Fastest Growing Occupations.
50
care assistants,6 and it has been suggested that the need for community care
workers could double in the next decade.7 An Alberta projection forecasts
114per cent growth in the need for health care aides by 2020.8
The health care aide market has mixed funding and delivery, thus the demand
for their employment and services is tied to both public funding and private
purchase. Public funding for community home support is constantly under
pressure as governments seek to manage their sizable fiscal deficits. As a
result, publicly funded health care aide services are increasingly targeted to
high-needs populations, leaving some individuals to source other community
resources or pay for care privately. But private purchase is complicated by
factors such as financial constraints and/or willingness to pay, as well as a
lackof knowledge of the market (including access, quality, and cost).
The health care aide industry, particularly the portion that provides services in
homes and the community, is also beset with a number of issues. Unlike most
other health care providers, health care aides are an unregulated profession,
meaning they do not require a licence from a regulatory agency to work in the
field. The profession is subject to inconsistent education and training standards,
poor compensation and role clarity, difficult working conditions, and recruitment
and retention problems. Scope-of-practice parameters dictate what an aide can
and cannot do and, in turn, affect whether other individuals need to be included
as part of the paid or unpaid care environment. Furthermore, a portion of the
market is based on paid companions and migrant live-in caregivers supplied
through Canadas Live-In Caregiver Program, which is subject to its own unique
issues for both the employee and employer.
Leaders in the health care aide profession, the firms that employ these aides,
and the academic institutions that train them, along with the government
agencies that purchase their services on behalf of Canadians, will need to
significantly increase their collaborative efforts to ensure this market matures
sufficiently to address the future demand in the coming years.
Employment and Social Development Canada, Assisting Occupations.
Born and Laupacis, Ontarios Plan.
Bloom, Duckett, and Robertson, Development of an Interactive Model.
51
Infrastructure Implications
If the current
patterns of usage
and length of stay
in long-term care
homes continue, by
2026 Canada will
need an additional
131,000 spaces for
Canadian seniors.
Most older Canadians prefer to live in their own home as they age, and
as they grow older they tend to downsize from single-detached homes to
apartments and condominiums. In the decades to come, many of these
will be one-person households.9
Sometime around age 75 and older, there is usually a shift from living
in this private home arrangement into a collective dwelling such as a
retirement home, supportive housing, or a long-term care home. In 2011,
44 per cent of Canadians age 90 or older lived in a collective housing
arrangement.10 Our estimate is that 360,000 seniors currently live in
either community or facility living environmentsspecific establishments
designed to accommodate the needs of older Canadians.
Our base-case projection suggests (assuming existing patterns of
use) that in just over a decade, the number of seniors living in one of
these forms of residence will grow to over 610,000. Under the basecase projection, by 2046 this will increase further to reach nearly
821,000seniors. Once again, these figures are conservative estimates
since theydo not include seniors with unmet needs living at home who
may be waiting to move into one of these residencies. For example,
in 201213 in Ontario, 34,312 individuals were on the waitlist for their
preferred choice of a long-term care residence.11
The continuum of housing currently supplying these needs includes
independent living arrangements in retirement dwellings and supportive
housing, as well as dependent living in complex continuing care and
long-term care homes. If the current patterns of usage and length of
stay in long-term care homes continue, by 2026 Canada will need an
additional 131,000 spaces for Canadian seniors, growing to an additional
240,000 spaces by 2046.
Canada Mortgage and Housing Corporation, Canadian Housing Observer 2013, 59.
10 Ibid.
11 Ontario Ministry of Health and Long Term Care, Table 6G: Case Management PA
7250930: LTC Placement, CCAC MIS Comparative Reports 2012/2013YE.
52
This growth will require significant public and private sector investment
in building the infrastructure to meet this demand. But will the residential
care patterns of today be what the leading edge of baby boomers,
reaching about 75 years old in a decade, want or need? And how
will changes in lengths of stay in residential care environments affect
this demand?
Getting the right mix along the continuum of private home living to
supportive and residential living is critical. An over- or undersupply of
an undesired or unneeded type of housing means a lost opportunity to
invest scarce public resources and private capital in other areas. For
example, an oversupply of independent housing (such as retirement
homes) and undersupply of supportive housing and long-term care
residences has been reported in some jurisdictions, leaving some
residences operating at very low capacity.12
Some governments are attempting to bolster the development of more
supportive housing options. For example, in Alberta $180 million in
grants are being made available to help private and non-profit operators
build 2,600 new continuing care spaces over three years, with 2,200 of
those for supportive living.13 These living arrangements are thought to be
a less costly (for public payers), more appropriate alternative to long-term
care beds for many seniors. Supportive housing is best viewed as part
of an overall continuum of continuing care supports along which many
seniors move. For example, research from B.C. has found that most
assisted-living residents in that province come from the community, with
some publicly funded home health services in place, and about half of
the residents in assisted living subsequently move on to residential longterm care.14 Eligibility criteria established by governments determines the
setting and level of supports provided, at least for the publicly funded
portion of supports.
12 Chu and McKay, B.C. Seniors Lost in Care Homes Chasm.

13 Government of Alberta, Number of New Seniors Spaces Exceeds Expectations.
14 McGrail and others, Who Uses Assisted Living in British Columbia?
53
But the seniors of tomorrow may be more interested in private pay

retirement and care environments than todays seniors. Within
the industry, there are some who are counting on a healthier and
wealthier seniors cohort to demand high-end private pay retirement
accommodation, including private pay for dementia care that has
historically been in the domain of traditional long-term care institutions.15
When considering the question of what kind of living arrangements
seniors want and need, the Canada Mortgage and Housing Corporation
says, What seniors expect or would prefer in living arrangements as they
age are not necessarily the arrangements they will eventually choose to
accept.16 The lack of congruity between what older Canadians say they
would prefer and what they can actually choose for living arrangements
makes it difficulteven with the best market intelligencefor the
housing industry to develop appropriate capacity. Housing arrangements
that are flexible and adaptable to changing needs can help address
thischallenge.17
Changes in Health and Functionality

The base-case projection in this report is founded on current patterns of
investment and use, specifically as they relate to home care, long-term care,
and other continuing care supports. Underlying this use is a certain pattern of
health and functionality, which is affected by the prevalence and incidence of
diseases and conditions. In fact, the base-case projection could be viewed as
conservative in that it integrates a healthy-aging hypothesis that assumes, on
average, seniors in the future will have somewhat better health and thus depend
less on continuing care supports.
The presence or absence of certain conditions such as cognitive impairment,
incontinence, or mobility restrictions can tip at-risk seniors from independent
functioning to a dependent state where they require housing and other supports,
15 Lewington, Not Your Grandmothers Retirement Home.

16 Canada Mortgage and Housing Corporation, Housing for Older Canadians.
17 Ibid.
54
or end up in hospital as an alternate level of care patient. For example, using

data from 200708, researchers Andrew Costa and John Hirdes found that
alternate level-of-care patients waiting for long-term care homes in Ontario had
more issues with functionality than seniors receiving home care, with cognitive
impairment present in over a third of the alternate level-of-care patients.18
Compared with home care clients, these alternate level-of-care patients had
about the same frequency of coexisting medical conditions, with the most
common diagnosis being arthritis, followed by non-Alzheimers dementia,
stroke,diabetes, and osteoporosis.
It is difficult to know whether and how the current patterns of health and
disability that shape the existing use of continuing care supports by Canadian
seniors will change in the future. Scientific advancements, new treatments for
disease, and programs to address functionality and independence could affect
the type of continuing care supports required by older Canadians in the future.
Technological advances such as remote home monitoring, virtual care visits,
andtools to foster remote social interaction with family or friends could also have
a significant impact. The National Centres of Excellence AGE-WELL network
is a federally funded research network with a mandate to accelerate innovation
in technology and aging.19 Research generated through the network will help
identify ways to leverage technology to help seniors remain independent and
safe in their homes.
In sum, capacity planning should include potential future scenarios of the most
promising developments and how these will translate into supply and demand of
continuing care supports.
18 Costa and Hirdes, Clinical Characteristics, 42.

19 AGE-WELL, About AGE-WELL.
55
CHAPTER 5
Conclusion
Chapter Summary
This forecast of continuing care supports for Canadian seniors presents a
compelling case for collaboration and partnership between the diverse mix
ofpublic and private stakeholders engaged in the continuing care sector.
The actions and initiatives put forward can be guided by short- and
mediumtermobjectives.
Scenario planning will be helpful if it can quantify and inform the impact of
various policies, programs, and investments, as well as guide decision-making.
Recent surveys
show that many
seniors, or family
members entrusted
to care for seniors,
still do not know
where to go
forcare.
While projections always incorporate a degree

of uncertainty, the numbers provided in this
report clearly articulate the need for change.
The change process will require stakeholders
to engage in dialogue with important short- and
medium-term objectives in mind.
Over the Short Term
Continue to look for ways to provide continuing care services to seniors
in a more effective manner. This will mean reducing costs associated

with alternate levels of care. This also means finding alternatives to
providing institutional care to seniors where other options are available.
The Balance of Care framework represents an approach that has
promise in this area.
Look at options to reduce unmet or under-met continuing care needs of
seniors. Recognizing that providing continuing care to seniors involves

a continuum of care, look for ways to improve the coordination of that
care. Doing so will help reduce the level of unmet or under-met needs.
While the end goal of this change will likely require changes in funding
allocations, other options can be incorporated over the short term.
In fact, recent surveys show that many seniors, or family members
entrusted to care for seniors, still do not know where to go for care.
Over the Medium Term

Engage in open and formal planning of continuing care at a regional
level. Specifically, within each health region, clearly articulate a vision for
how continuing care support will be provided. For practical purposes, it is
advised that the planning start with the level of service that is among the
most costly to run from the public perspective: long-term care institutions.
While regional migration has the potential to mitigate the effectiveness of
regional planning, the process should include the following:
57
Establish a benchmark level of the number of long-term care beds that
will be available based on evidence that identifies the most effective

threshold for servicing care needs. Determine the most effective
threshold based on standardized assessment criteria such as RUGS
or the Method for Assigning Priority Levels (MAPLean assessment
tool that uses a scale algorithm to prioritize clients based on their risk
for adverse outcome), but also consider the presence of caregivers and
the local setting (i.e., urban or rural).
Establish a realistic threshold for the number of seniors who could
effectively be cared for in their homes or through the community.

Again, this threshold could be based on RUGS and/or MAPLe, but
should also consider the presence of caregivers and the local setting.
If needed, develop a plan of action to facilitate additional development
of community living establishmentsa middle-ground alternative

between the continuing care services provided in home living and
those in facility living.
Based on the formal planning of continuing care at the regional level,
develop a plan to ensure that adequate human resources will be

available. Aside from paid providers, the analysis will also need to
understand the demands on unpaid care and, if necessary, look for
new ways to engage potential caregivers. The focus should include
bothunpaid and paid care.
As financial resources from both public and private sources will likely
continue to be constrained, it is advised to increasingly promote health

and wellness. While these initiatives may not directly translate into
significant savings in the provision of continuing care supports, they
arelikely to reduce the demands for acute care and physician visits.
While this change process will be incremental, a vital first step for
governments is to clearly understand and develop a plan of action
to manage the drivers of spending growth. One of the key outcomes
of thechange process should be to ensure full transparency with
Canadians around the publicly funded services and accommodation
supports they can expect if and when they need continuing care.
Although not specifically addressed in our analysis, it is also important
58
to recognize the critical connections that continuing care has to both

primary care and acute care as priorities are established and difficult
decisions made.
The figures in this forecast provide a quantitative perspective on the
future continuing care needs for Canadian seniorsif nothing changes
in the status quo. The societal, fiscal, and policy implications arising
from this forecastthe increased services, labour, and spending to meet
future needs, the demands for informal caregiving and the associated
productivity impacts in the workforce, and the infrastructure demands
for accommodation supportsare well known and echoed in recent
deliberations of Canadas premiers.1
The answer to the question what will the future look like for seniors with
continuing care support needs? largely depends on the type of levers
applied by all levels of governmentfederal, provincial and territorial,
and municipal. This will form the basis of what tomorrows seniors can
expect and demand from publicly funded continuing care supports.
Any proposed solutionsincluding those directed at funding, programs,
providers, or housingmust build on collaboration and partnership
between the diverse mix of public and private stakeholders that make
up the continuing care sector. The Future Care for Canadian Seniors
series will continue to explore the effectiveness of using various levers
in the form of customized scenarios. It is hoped that the results of these
scenarios will better inform the decisions needed to restructure continuing
care supports for seniors in an effective and sustainable manner.
Council of the Federation, Providing Services for an Aging Population.
59
CHAPTER 6
Limitations
Chapter Summary
The analysis acknowledges that it is difficult to accurately depict how
thecontinuing care needs of seniors are being met today because of

alackinconsistent terminology and reported data.
Furthermore, the status quo projection examined in this report assumes
thatcurrent patterns of diagnosis and treatment will remain unchanged over

theforecast horizon.
While the status quo projection is not specifically intended to predict what
continuing care for seniors will look like in the future, it is intended to provide
various stakeholders with quantitative benchmarks that can be used to prioritize
the possible challenges faced.
There is a lack
of consistently
reported data
on the number
of seniors who
receive continuing
care supports.
Long-term projections always incorporate a

degree of uncertainty. While the base-case
projection reported on this report is not
specifically intended to predict the continuing
care needs of seniors in the future, itdoes
provide a quantitative benchmark based
on current patterns of care as well as on
demographic projections for Canada and the
provinces. These demographic projections
are subject to uncertainty based on various
underlying assumptions, including fertility rates,
mortality rates, and net levels of immigration.
Additional areas of uncertainty surrounding the base-case projection
of continuing care needs stem from the various assumptions about
how seniors needs will be met in the future. One of these assumptions
is that age-adjusted unit costs will remain fixed in real terms. This is
likely to be a conservative assumption in the event that the demand for
continuing care supports exceeds the supply of continuing care supports.
It also assumes that any additional costs associated with advances
in medical science and technological innovation will be fully offset by
efficiency gains.
Another key assumption of the status quo projections is that current
patterns of diagnosis and treatment will remain unchanged over the
forecast horizon. For many of the reasons stated in this report, this is one
assumption that is not only likely to change but will be targeted to change.
Further areas of uncertainty in the projections stem from the difficulty in
accurately depicting how the continuing care needs of seniors are being
met today. In general, there is a lack of current and consistently reported
data on the number of seniors who receive continuing care supports
and on the level of spending involved to deliver these supports. The
data gaps are perhaps most pronounced for continuing care supports
provided to seniors residing in community living, as well as the level of
spending incurred by seniors to pay for continuing care supports either
out-of-pocket or through private insurance.
61
In many cases, key data products produced by Statistics Canada,

such as the Canadian Community Health Survey and the General
Social Survey, do not provide comprehensive data on both the number
of seniors receiving continuing care and the unmet needs of seniors
for continuing care. In many cases, this is because the scope of the
surveys is limited to respondents who reside in private dwellings. As a
result, figures related to the number of seniors receiving continuing care
supports in either community living or facility living environments are
not covered.
While much of the continuing care supports received by seniors residing
in facility living is provided by the various facilities themselves, there is
still a data gap related to unpaid supports and additional supports paid
either out-of-pocket or from private insurance.
The data challenges for seniors residing in community living include
those identified with both home living and facility living, with the further
challenge being a lack of consistency in how the terminology commonly
used to define the various segments of community livingassisted living,
supportive living, and independent livingis both defined and reported
on. In this report, we have restricted the identification of seniors residing
in community living to correspond with Statistics Canadascensus
definition of health-related collective dwellings that do not provide
24-hour medical and professional nursing supervision on-site.
The other significant challenge is that, in many cases, spending data
are reported by specific category of service only, without the ability to
isolate the share devoted specifically to the care of seniors or, ideally,
to seniors in various age cohorts. Unfortunately, this data shortcoming
most frequently applies to continuing care funded by the public sector.
For instance, in most cases, the level of public sector spending for home
care or care in long-term care facilities does not specify the age of the
care recipient.
Tell us how were doingrate this publication.

www.conferenceboard.ca/e-Library/abstract.aspx?did=7374
62
Appendix A | The Conference Board of Canada
APPENDIX A
Methodology Used to
Assemble the Current
Economic Footprint
of Continuing Care
in Canada
Home Living Indicators

Number of Continuing Care Recipients
inHomeLiving
The data source viewed as being most relevant in providing an estimate
of the number of Canadians who receive continuing care in home living
was Statistics Canadas Canadian Community Health SurveyHealthy
Aging, 200809. In particular, the Canadian Community Health Survey
(CCHS) provides details on the number and age of Canadians who
receive both paid and unpaid continuing care support. The share of care
not covered by government is further broken down into private agency,
neighbour/family/volunteer, and other.
63
Another source that provides an estimate of the number of care receivers

is Statistics Canadas General Social Survey. While this data source
is more current than the CCHS, the number of care receivers includes
more than just those who receive care in home living (private dwellings).
Public Spending on Home Living

For the public spending on continuing care supports of seniors in home
living to be consistent with the level of continuing care recipients in this
report, an estimate of average spending per recipient was generated
using provincial data provided by the Canadian Home Care Association
in its Portraits of Home Care in Canada 2013 report.
In aggregate, the total public spending on continuing care supports
for seniors in home living was derived by multiplying the calculated
average public spending per recipient by the total number of continuing
care senior recipients who received government-funded care in the
homeliving residential setting.
Private Spending on Home Living

As part of the research on the future care for seniors, the Conference
Board commissioned EKOS Research Associates to survey
4,000Canadians about their experiences with and their perceptions of
continuing care. Of the 4,000 respondents, 21 per cent indicated that
they or someone close to them had received care in the past 12 months
from provincial home care programs. In total, 631 respondents reported
on average weekly out-of-pocket spending for various continuing care
supports, including personal care, home care nursing, homemaking,
rehabilitative care, medical supplies and equipment, transportation,
pharmacy counselling, community supports, nutritional counselling,
respiratory care, and other miscellaneous costs. The average annual
out-of-pocket costs incurred were $5,448 per recipient. Unfortunately,
sample sizes do not permit unique provincial estimates of out-of-pocket
spending. (See Table 1.)
64
Table 1
Private Out-of-Pocket Costs for Seniors Receiving Continuing Care
Supports in Home Living
% of
respondents
who received
theservice
% of
respondents
who paid for
theservice
Personal care
44%
19%
$945
Home care nursing
40%
4%
$63
Homemaking
38%
42%
$555
Rehabilitation care
35%
15%
$770
Medical supplies and equipment
36%
45%
$2,214
Transportation
24%
72%
$198
Pharmacy counselling
17%
11%
$59
Community supports
16%
43%
$302
Nutritional counselling
13%
4%
$38
Respiratory care
11%
17%
$119
8%
30%
$183
Other
Total
Average
annual
spending
perrecipient
$5,448
Source: The Conference Board of Canada (EKOS-commissioned survey).
Community Living Indicators

Number of Continuing Care Recipients
inCommunity Living Environments
In this report, we restricted the identification of seniors residing in
community living environments to correspond with Statistics Canadas
census definition of health-related collective dwellings that do not
provide 24-hour medical and professional nursing supervision on-site.
Specifically, this includes residences for senior citizens and any longterm care institutions that do not provide medical and professional
nursing supervision on-site.
65
Public Spending on Community Living

To help calculate both public and private spending associated with
seniors residing in community living, data were assembled in a manner
that could disaggregate the care provided to seniors into three distinctive
groupings: assisted living, supportive living, and independent living.
In general, the public spending associated with the continuing care
supports of seniors diminished from assisted living to supportive living,
followed by independent living. While the level of continuing care needs
of seniors residing in these three care settings may, at times, not appear
to be dramatically different, the share of costs paid by public versus
private sources is. In general, a much higher share of the paid continuing
care supports for seniors residing in assisted or supportive living is
paid by public sources, whereas the opposite is true for independent
living. (See tables 2 and 3.) The calculations in Table 2 are based on
the Conference Board report Building From the Ground UpEnhancing
Affordable Housing in Canada, which provides data on public spending
on various levels of support for services and accommodation in
supportive housing.
Table 2
Public Spending on Assisted and Supportive Living
Environments,2011
($ per recipient)
On services
per day
On accommodation
perday
Total
per day
Total
annual cost
Assisted living
45
31
76
27,740
Supportive living
37
31
68
24,820
66
Table 3
Average Annual Pubic Spending on Independent Living
Environments, 2011
($ per recipient)
Total provinces
3,963
6,498
2,414
Nova Scotia
3,912
New Brunswick
4,214
Quebec
4,132
Ontario
3,335
Manitoba
4,951
Saskatchewan
3,387
Alberta
4,206
British Columbia
3,934
Note: Spending is calculated based on the share of population by age and gender needing
formalhome care services multiplied by the average public cost to deliver services per recipient
ineach province.
Private Spending on Community Living

To estimate the private spending associated with seniors living in
community living, it is also important to distinguish between the three
sub-categories that make up the category. For the most part, the private
spending associated with assisted living and supportive living is quite
comparable. In fact, rates tend to be based on what residents would
pay in long-term care facilities. The slight difference we calculated was
due to our definition of the assisted living segment, which assumes that
a higher share of residents received a government subsidy to help pay
for continuing care supports. So, while seniors living in the supportive
living sub-category are assumed to pay long-term care rates, seniors
residing in assisted living are assumed to pay about 12 per cent less.
(See Table4.) The 12 per cent reduction is based on various sources,
one of which was that seniors in assisted living in B.C. pay up to
67
70percent of their after-tax income, while those in long-term care pay

up to 80percent of their after-tax income. Meanwhile, other sources
have shown that level of government subsidy available within high-needs
supportive housing could be higher than 12 per cent.
Table 4
Average Private Spending on Assisted and Supportive Living
Environments, 2011
($ per recipient)
Assisted
Supportive
Combined
Total provinces
13,684
15,731
14,480
13,134
14,925
13,637
14,726
16,734
15,251
Nova Scotia
15,256
17,337
15,624
New Brunswick
12,843
14,594
13,044
Quebec
11,414
12,970
8,271
Ontario
17,401
19,774
18,387
Manitoba
13,490
15,330
15,330
Saskatchewan
14,076
15,995
14,374
Alberta
13,414
15,243
14,396
British Columbia
16,282
18,503
17,191
Note: The supportive component is calculated to be equal to long-term care, while the assisted
component is based on a share equal to 88 per cent of long-term care. The 12 per cent reduction is
assumed to cover a higher share of provincial subsidy. An example is the 70 per cent after-tax rate
that B.C. residents pay for assisted living versus the 80 per cent after-tax rate they pay for supportive
housing and long-term care homes.
In general, the associated private spending for seniors living in

independent living is higher than either assisted living or supportive
living. For this report, the average private spending on independent
living was based on reported average rents provided by the National
68
Seniors Housing Survey, conducted by Canada Mortgage and Housing

Corporation in 2011. In addition to the average rent paid, seniors were
also estimated to incur other costs associated with continuing care.
The source used to determine the average continuing care cost for
independent living was the same as that used for home carethe
commissioned EKOS survey. While the sample size was not large
enough to separately distinguish retirement homes, it was felt that most
of the cost categories would be applicable. Overall, the average annual
spending incurred by private sources for seniors living in independent
living environments was estimated at $34,811 in 2011. Provincially, the
figures ranged from a low of $26,034 in Quebec to $44,637 in Ontario.
(See Table 5.)
Table 5
Average Private Spending in Independent Living Environments, 2011
($ per recipient)
Total provinces
34,811
35,059
34,834
Nova Scotia
35,883
New Brunswick
29,423
Quebec
26,034
Ontario
44,637
Manitoba
36,738
Saskatchewan
36,637
Alberta
40,831
British Columbia
39,971
Sources: CMHC, Seniors Housing Report; The Conference Board of Canada

(EKOS-commissionedsurvey).
69
Facility Living Indicators

Number of Continuing Care Recipients in Facility
Living Environments
The number of seniors estimated to be residing in complex continuing
care was based on those living in chronic care and long-term care
hospitals, as reported in Statistics Canadas 2011 census. Meanwhile,
the number of seniors in alternate level of care was based on figures
in the Canadian Institute for Health Informations Discharge Abstract
Database and Hospital Morbidity Database, 200809. To isolate only
the number of seniors in alternate levels of care, only 85 per cent of the
total figures was used. The 85 per cent share was the same share as
reported by the Canadian Institute for Health Information to reflect the
seniors share of all alternate level-of-care patients. To get a gender and
age breakdown of seniors in alternate levels of care, the distribution was
assumed to resemble the gender and age breakdown reported in the
census for seniors living in general and specialty hospitals.
For long-term care homes, the figures reported in this report were
based on those provided by Statistics Canadas 2011 Long-Term Care
Facilities Survey. For the most part, these figures were lower than figures
from the 2011 census for nursing homes. The reason for this is that the
Long-Term Care Facilities Survey provided data only on facilities that
provided level II or above care. Meanwhile, the 2011 census appeared
to include facilities that did not provide level II or above care. For this
reason, any differences between the number of seniors reported to be
residing in nursing homes (from the census) and the number reported in
the Long-Term Care Facilities Survey were assumed to be assisted living
(basically the highest level of care below what could be provided in longterm care facilities).
Public Spending on Facility Living

The level of public spending associated with long-term care homes
came from custom tables provided by Statistic Canadas Long-Term
Care Facilities Survey. Meanwhile, the public spending associated
70
with residents in ALC were calculated based on daily rates that were
estimated to be 6.7 times higher than those attributed to patients in longterm care facilities.1 Furthermore, the public spending associated with
seniors residing in complex continuing care was estimated to be 65 per
cent of the daily rate associated with ALC patients.2 (See Table 6.)
Table 6
Average Pubic Spending in Facility Living Environments,
perDay,2011
($ per recipient)
Long-term
care home
Alternate level
of care
Complex
continuing
care
Total provinces
138
922
599
149
998
648
114
767
499
Nova Scotia
156
1,042
678
New Brunswick
158
1,060
689
Quebec
152
1,021
663
Ontario
121
810
527
Manitoba
138
922
599
Saskatchewan
174
1,167
759
Alberta
124
828
538
British Columbia
108
721
468
Note: Rate for long-term care home is based on Statistics Canadas Long-Term Care Facilities Survey;
rate for alternate level of care is calculated based on 6.7 times the average rate in long-term care
homes; rate for complex continuing care is calculated based on 65 per cent of the rate for alternate
levels of care.
North East Local Health Integration Network, HOME First Shifts Care of Seniors
toHOME.
Leisureworld Senior Care Corporation, An Emerging Leader in Canadian Seniors

Livingand Care, Annual Report 2012, 4.
71
Private Spending on Facility Living

The private spending associated with long-term care institutions was
generated using averages calculated from custom tables provided by
Statistics Canadas Long-term Care Facilities Survey. On top of this, data
from the EKOS survey was also used to estimate the additional out-ofpocket costs incurred by residents to supplement continuing care needs.
(See Table 7.)
Table 8 shows the details of the additional out-of-pocket costs incurred
by patients to supplement continuing care needs. Without sufficient
sample sizes to distinguish between the private out-of-pocket costs
incurred by residents residing in alternate levels of care or in complex
continuing care, it was assumed the costs would be similar to those of
long-term care residents. Furthermore, the analysis also assumed that
the basic daily rates paid by residents in alternate levels of care and in
complex continuing care would also be fairly comparable to those paid
by long-term care residents.
Table 7
Average Private Spending in Facility Living Environments, 2011
($ per recipient)
Average rent
Additional
out-of-pocket
costs
Combined
Total provinces
14,772
2,306
17,078
12,619
2,306
14,925
14,428
2,306
16,734
Nova Scotia
15,031
2,306
17,337
New Brunswick
12,288
2,306
14,594
Quebec
10,664
2,306
12,970
Ontario
17,468
2,306
19,774
Manitoba
13,024
2,306
15,330
Saskatchewan
13,689
2,306
15,995
Alberta
12,937
2,306
15,243
British Columbia
16,197
2,306
18,503
Sources: Statistics Canadas Long-term Care Facilities Survey (LTCFS) and Residential Care Facilities
Survey (RCF); The Conference Board of Canada (EKOS Commissioned Survey).
72
The Conference Board of Canada
Table 8
Private Out-of-Pocket Costs for Seniors Receiving Continuing Care
Supports in Facility Living Environments
% of
respondents
who received
the service
% of
respondents
who paid for
the service
Dental
76%
36%
$194
Transport
76%
31%
$243
Medical equipment
76%
23%
$163
Personal support/companionship
76%
17%
$1,185
Therapies (OT/PT/speech)
76%
13%
$115
Bathing
76%
12%
$82
Nursing
76%
9%
$160
Other
76%
18%
$165
Total
Average
annual
spending
perrecipient
$2,306
Sources: Statistics Canada; The Conference Board of Canada (EKOS-commissioned survey).
73
APPENDIX B
Demographic
Assumptions
Used in the Status
Quo Forecast of
Continuing Care
in Canada
The demographic starting point (2011) used to develop the status
quo forecast of continuing care supports for seniors in Canada was
consistent with that provided by Statistics Canadas 2011 National
Household Survey. In particular, the aggregate demographic profile
for Canada and the provinces was constructed using the age and
gender breakdowns provided for residents living in both private and
collective dwellings.
For subsequent years beyond 2011, the demographic growth ratesby
age and genderthat were used in the status quo forecast of continuing
care supports for seniors were consistent with those that were used to
produce the Conference Boards long-term economic outlook for Canada
74
Appendix B | The Conference Board of Canada
and the provinces in 2014. The Conference Board of Canada uses

Statistics Canadas population models to arrive at its long-term forecast
of the Canadian population.
While the full details on the extent of assumptions used are beyond the
scope of this report, they are provided in the Canadian Outlook LongTerm Economic Forecast: 2014 and Provincial Outlook Long-Term
Economic Forecast 2014 reports.
See tables 1, 2, 3, and 4 for a summary of demographic projections
used in the status quo forecast of continuing care supports for seniors
in Canada.
Table 1
Projections of Total Population, by Province
2011
2026
2036
2046
20112046 growth
33,362,790
39,177,427
42,607,150
45,382,736
36%
514,470
538,175
510,440
478,214
7%
140,175
149,902
154,312
155,920
11%
Nova Scotia
921,400
933,191
918,477
880,434
4%
New Brunswick
751,045
761,074
746,566
716,746
5%
Quebec
7,901,915
8,917,236
9,398,884
9,773,245
24%
Ontario
12,847,930
15,151,675
16,796,288
18,111,025
41%
Manitoba
1,208,100
1,433,154
1,588,859
1,733,473
43%
Saskatchewan
1,033,265
1,286,341
1,413,589
1,542,650
49%
Alberta
3,644,810
4,909,569
5,532,536
6,120,294
68%
British Columbia
4,399,680
5,097,110
5,547,199
5,870,733
33%
Total provinces
75
Table 2
Population Projections of Seniors Aged 65+, by Province
2011
2026
2036
2046
20112046 growth
4,938,430
8,610,429
10,702,866
11,812,670
139%
82,100
140,642
162,991
161,483
97%
22,780
39,429
48,117
49,729
118%
Nova Scotia
153,365
248,643
287,292
282,941
84%
New Brunswick
123,635
204,155
237,790
239,269
94%
Quebec
1,257,700
2,063,651
2,402,434
2,563,988
104%
Ontario
1,878,290
3,348,935
4,308,312
4,787,566
155%
Manitoba
172,450
274,084
332,961
370,154
115%
Saskatchewan
153,695
233,053
278,900
316,402
106%
Alberta
405,700
820,263
1,086,390
1,322,041
226%
British Columbia
688,715
1,237,573
1,557,677
1,719,097
150%
Total provinces
Table 3
Population Projections of Women Aged 65+, by Province
2011
2026
2036
2046
20112046 growth
2,743,105
4,622,992
5,740,412
6,370,765
132%
44,585
75,842
88,815
89,895
102%
12,645
21,690
26,679
28,086
122%
Nova Scotia
85,435
135,409
157,730
157,876
85%
New Brunswick
68,375
108,898
127,796
129,813
90%
Quebec
710,755
1,117,043
1,295,953
1,382,197
94%
Ontario
1,045,215
1,808,328
2,319,940
2,601,206
149%
Manitoba
97,165
145,836
176,889
199,850
106%
Saskatchewan
85,400
122,731
145,212
163,891
92%
Alberta
221,575
430,366
565,715
687,844
210%
British Columbia
371,955
656,851
835,682
930,108
150%
Total provinces
76
Appendix B | The Conference Board of Canada
Table 4
Population Projections of Men Aged 65+, by Province
2011
2026
2036
2046
20112046 growth
2,195,325
3,987,437
4,962,454
5,441,905
148%
37,515
64,800
74,177
71,587
91%
10,135
17,740
21,437
21,643
114%
Nova Scotia
67,930
113,235
129,563
125,066
84%
New Brunswick
55,260
95,257
109,993
109,456
98%
Quebec
546,945
946,608
1,106,481
1,181,791
116%
Ontario
833,075
1,540,607
1,988,372
2,186,360
162%
Manitoba
75,285
128,248
156,072
170,304
126%
Saskatchewan
68,295
110,323
133,688
152,511
123%
Alberta
184,125
389,897
520,675
634,198
244%
British Columbia
316,760
580,722
721,995
788,988
149%
Total provinces
77
APPENDIX C
Bibliography
Access to Care. Alternate Level of Care (ALC) December 2014. Toronto:
Cancer Care Ontario, December 2014.
AGE-WELL. About AGE-WELL. n.d. www.agewell-nce.ca/about-us
(accessed July 27, 2015).
Alzheimer Society of Canada. Rising Tide: The Impact of Dementia on
Canadian Society. Ottawa: Alzheimer Society of Canada, 2010.
Beckman, K., D. Fields, and M. Stewart. A Difficult Road Ahead:
Canadas Economic and Fiscal Prospects. Ottawa: The Conference
Board of Canada, 2014.
Berta, W., A. Laporte, R. Deber, A. Baumann, and B. Gamble. The
Evolving Role of Health Care Aides in the Long-Term Care and Home
and Community Care Sectors in Canada. Human Resources for Health
(BioMed Central) 11, no. 25 (2013).
Bloom, J., S. Duckett, and A. Robertson. Development of an Interactive
Model for Planning the Care Workforce for Alberta: Case Study. Human
Resources for Health 10, no. 22 (2012).
Born, K., and A. Laupacis. Ontarios Plan for Personal Support
Workers. Healthy Debate. May 10, 2012. www.healthydebate.
ca/2012/05/topic/community-long-term-care/personal-support-workers
(accessed March 9, 2013).
Cadieux, Marie-Andre. Comprehensiveness of the RUG-III Grouping
Methodology in Addressing the Needs of People With Dementia in
Long-Term Care. MA Thesis. Ottawa: Telfer School of Management,
University of Ottawa, 2012.
78
Appendix C | The Conference Board of Canada
Canada Mortgage and Housing Corporation. Canadian Housing

Observer 2013. Ottawa: CMHC, 2013.
. Housing for Older Canadians: The Definitive Guide to the Over-55
Market, Volume 1. Ottawa: CMHC, 2015.
. Seniors Housing Report. Ottawa: CMHC, 2011.
Canadian Healthcare Association. Home Care in Canada:
FromtheMargins to the Mainstream. Ottawa: CHA, 2009, 152.
. New Directions for Facility-Based Long Term Care. Ottawa:
CHA,2009, 172.
Canadian Home Care Association. Portraits of Home Care in Canada
2013. Mississauga: Canadian Home Care Association, 2013.
Canadian Institute for Health Information. Caring for Seniors
WithAlzheimers Disease and Other Forms of Dementia. Ottawa:
CIHI,2010,21.
. Continuing Care Reporting System (CCRS) Metadata, F2014-2592.
CD. Ottawa, ON, 2014.
. Discharge Abstract Database and Hospital Morbidity Database,
200809. n.d. www.cihi.ca/en/types-of-care/hospital-care/acute-care/
dad-metadata.
. Health Care in Canada, 2010. Ottawa: CIHI, 2010.
. Health Care in Canada, 2011. Ottawa: CIHI, 2011.
. How RUG-III (44 Group) Case Mix Index Values Are Calculated,
2011CCRS Technical Document. Ottawa: CIHI, 2011.
. Selected Characteristics of Home Care Clients 20132014. n.d.
www.cihi.ca/en (accessed July 27, 2015).
. Selected Characteristics of Residents in Continuing Care Facilities
20132014. n.d. www.cihi.ca/en (accessed July 27, 2015).
79
Canadian Life and Health Insurance Association Inc. CLHIA Report on

Long-Term Care Policy. Toronto, Montreal, Ottawa: CLHIA, 2014.
Canadian Medical Association. CMA Submission: The Need for Health
Infrastructure in Canada. Ottawa: CMA, 2013.
Canadian Nurses Association. Health Is Where The Home Is. n.d.
www.cna-aiic.ca/~/media/cna/page-content/pdf-en/health-is-where-thehome-is_leave-behind.pdf?la=en (accessed August 5, 2015).
Chu, Richard, and Joel McKay. B.C. Seniors Lost in Care Homes
Chasm. Business in Vancouver. Vancouver, B.C., May 7, 2012.
Comas-Herrera, A., S. Northey, R. Wittenberg, M. Knapp, S.
Bhattacharyya, and A. Burn. Future Costs of Dementia-Related
Long-Term Care: Modelling Scenarios About the Future. International
Psychogeriatrics 23, no. 1 (2011): 2030.
Costa, A., and J. Hirdes. Clinical Characteristics and Service Needs of
Alternate-Level-of-Care Patients Waiting for Long-Term Care in Ontario
Hospitals. Healthcare Policy (Longwoods), 2010: 3246.
Costa, A., J. Poss, T. Peirce, and J. Hirdes. Acute Care Inpatients
With Long-Term Delayed-Discharge: Evidence From a Canadian Health
Region. BMC Health Services Research 12, no. 172 (2012).
Council of the Federation. Providing Services for an Aging Population.
New release, St. Johns: Council of the Federation Secretariat, 2015.
Council on Healthy Aging. Healthy Aging: Lessons From Denmark.
Council on Healthy Aging Meeting. Held at Ottawa, January 15, 2014.
Cummings, G., T. Spiwek, S. Hewko, S. Cooper, S. Lynch, and H.
Huynh. Shining a Light on the Unregulated Healthcare Aide Workforce.
Edmonton: University of Alberta, 2013.
Employment and Social Development Canada. Assisting Occupations in
Support of Health Services. Canadian Occupational Projection System
(COPS). n.d. www.23.hrsdc.gc.ca/occupationsummarydetail.jsp?&tid=54
(accessed February 9, 2015).
80
. Canadian Employers for Caregivers Plan. January 19, 2015.

www.esdc.gc.ca/eng/seniors/cecp/index.shtml (accessed July 29, 2015).
Fries, J., Bruce, B., Chakravarty, E. Compression of Morbidity 1980
2011: A Focused Review of Paradigms and Progress. Edited by Wojtek
Chodzko-Zajko. Journal of Aging Research Volume 2011 (April 2011): 10.
Government of Alberta. Number of New Seniors Spaces
Exceeds Expectations. March 12, 2015. http://alberta.ca/release.
cfm?xID=378379179B849-E4CD-677A-F8DA58138F17C4DB
(accessedApril 28, 2015).
Health Quality Ontario. Measuring Up. Toronto: Health Quality
Ontario,2014.
Leisureworld Senior Care Corporation. An Emerging Leader in Canadian
Seniors Living and Care, Annual Report 2012. Markham: Leisureworld
Senior Care Corporation, 2013.
Lewington, Jennifer. Not Your Grandmothers Retirement Home.
TheGlobe and Mail, July 22, 2013.
McGrail, K., and others. Health Care Services Use in Assisted
Living: ATime Series Analysis. Canadian Journal on Aging 32, no. 2
(June2013): 17383.
McGrail, Kimberlyn M., and others. Who Uses Assisted Living in British
Columbia? An Initial Exploration. Vancouver: UBC Centre for Heath
Services and Policy Research, April 2012.
McGuire, Catherine, Karen Mauney, and Julie Fralich. Case Mix
and Dementia in Maine Nursing Homes. Presentation to the Maine
Legislative Commission to Study Long Term Care. October 16, 2014.
North East Local Health Integration Network. HOME First Shifts Care of
Seniors to HOME. North Bay: North East LHIN, 2011.
81
Ontario Hospital Association; Ontario Association of Community Care

Access Centres. Alternate Level of Care (ALC) Capacity Challenges and
Long-Term Care Placement. A Roundtable Discussion: Key Messages
and Suggested Actions. Toronto, 2012.
Ontario Long Term Care Association. This Is Long-Term Care 2014.
Markham, Ontario: Ontario Long Term Care Association, 2014.
Ontario Ministry of Health and Long Term Care. Table 6G: Case
Management PA 7250930: LTC Placement, CCAC MIS Comparative
Reports 2012/2013YE. Health Data Branch Web Portal. n.d.
https://hsimi.on.ca/hdbportal/user (accessed 2015).
Parliamentary Budget Officer. Fiscal Sustainability Report 2015. Ottawa,
Ontario: PBO, 2015.
Poss, Jeffrey W. Validation of Resource Utilization Groups Version III
for Home Care (RUG-III/HC), Evidence From a Canadian Home Care
Jurisdiction. Medical Care (Lippincott Williams & Wilkins) 46, no. 4
(2008): 380387.
Reed, Carey. Dutch Nursing Home Offers Rent-Free Housing. PBS
Newshour: The Rundown. April 5, 2015. www.pbs.org/newshour/
rundown/dutch-retirement-home-offers-rent-free-housing-students-onecondition/ (accessed August 17, 2015).
Rothermann, Michelle, and Melanie Hoover. Seniors Use of and Unmet
Needs for Home Care, 2009. Ottawa: Statistics Canada, 2009.
Stall, N., G. Cummings, and T. Sullivan. Caring for Canadas Seniors Will
Take Our Entire Health Care Workforce. Healthy Debate. September 5,
2013. www.healthydebate.ca/2013/09/topic/community-long-term-care/
non-md-geriatrics (accessed September 6, 2013).
Statistics Canada. 2011 Canadian Census of Population. 2011.
www12.statcan.ca/census-recensement/index-eng.cfm.
. Canadian Community Health SurveyHealthy Aging 200809.
CD.Ottawa, May 12, 2010.
82
. Census Dictionary. 2012. www12.statcan.gc.ca/censusrecensement/2011/ref/dict/index-eng.cfm (accessed August 22, 2015).

. General Social Survey, Cycle 21: Family, Social Support and
Retirement, Public Use Microdata File Documentation and Users
Guide. Catalogue no. 12M0021G. CD. Ottawa, April 2009.
. General Social Survey, Cycle 26: Caregiving and Care Receiving,
Public Use Microdata File, Documentation and User Guide. Catalogue
no. 89M0031X. CD. Ottawa, August 2014.
. Long-Term Care Facilities Survey (LTCFS), 2011 and
2012. April 10, 2014. www23.statcan.gc.ca/imdb/p2SV.
pl?Function=getSurvey&SDDS=5203 (accessed January 2015).
. Residential Care Facilities (RCF). July 17, 2012.
www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=3210
(accessedJanuary 2015).
Stonebridge, Carole. Future Care for Canadian SeniorsWhy It Matters.
Ottawa: The Conference Board of Canada, 2013.
Sutherland, J., N. Repin, and R.T. Crump. The Alberta Health Services
Patient/Care-Based Funding Model for Long Term Care: A Review
and Analysis. Vancouver: UBC Centre for Health Services and Policy
Research, 2013.
Sutherland, Jason M., and R. Trafford Crump. Exploring Alternative
Level of Care (ALC) and the Role of Funding Policies: An Evolving
Evidence Base for Canada. Ottawa: Canadian Health Services
ResearchFoundation, 2011.
Technologies for Aging Gracefully Lab. InTouch: Technologies to Combat
Social Isolation and Loneliness. 2013. www.taglab.utoronto.ca/projects/
technologies-combat-isolation/ (accessed March 30, 2015).
The Conference Board of Canada. Building From the Ground Up
Enhancing Affordable Housing in Canada. Ottawa: CBoC, 2010.
83
Turcotte, M., and C. Sawaya. Senior Care: Differences by Type of

Housing. Ottawa: Statistics Canada, 2015.
Turcotte, Martin. Canadians With Unmet Home Care Needs. Statistics
Canada, Ottawa: Statistics Canada, 2014.
U.S. Bureau of Labor. Fastest Growing Occupations. Occupational
Outlook Handbook. January 8, 2014. www.bls.gov/ooh/fastest-growing.htm
(accessed February 9, 2015).
Williams, A.P., and others. The Balance of Care. Toronto: Canadian
Research Network for Care in the Community, 2009.
84
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Future Care for

REPORT NOVEMBER 2015

Future Care for Canadian Seniors: A Status Quo Forecast

The Situation Today

The Situation in the Future

About the Canadian Alliance for Sustainable HealthCare

CASHC Member Organizations

Future Care for Canadian

The reliance on unpaid caregivers and volunteers to provide continuing care

Responding to these needs in an efficient and sustainable manner will require

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Future Care for Canadian Seniors

A Status Quo Forecast

Delivering high-quality, effective, and

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Executive Summary | The Conference Board of Canada

policy-makers, health provider associations, educational institutions,

dramatically. By 2026, it is estimated over 2.4 million Canadians

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Future Care for Canadian Seniors

A Status Quo Forecast

3. The reliance on unpaid caregivers and volunteers to provide

continuing care supports will grow dramatically. Canadas approach

of seniors requires a singular focus on efficiency and a reality

labour force growth. The delivery of continuing care services to seniors

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Executive Summary | The Conference Board of Canada

academic institutions, governments, and the profession itself will need

should reflect changes as the baby boomer cohort ages and

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The unique takeaway of this report is the quantitative identification of

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Future Care for Canadian Seniors

A Status Quo Forecast

The proportion of Canadians who are seniors

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Chapter 1 | The Conference Board of Canada

as a result, look at finding viable options (such as reallocating spending,

1 Stonebridge, Future Care for Canadian Seniors.

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Future Care for Canadian Seniors

A Status Quo Forecast

Future Care for Canadian Seniors

Canadian Home Care Association, Portraits of Home Care.

Canadian Nurses Association, Health Is Where the Home Is.

Canadian Medical Association, CMA Submission.

Canadian Life and Health Insurance Association, CLHIA Report on Long-Term

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Projecting Continuing Care

An estimated 29 per cent of Canadian seniors currently need and receive

continuing care supports, most commonly seniors living in private dwellings.

Meanwhile, 200,000 Canadian seniors currently report their continuing care

The delivery of continuing care services to seniors currently supports nearly

Unpaid continuing care to seniors was provided by an estimated 5.3 million

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Future Care for Canadian Seniors

A Status Quo Forecast

The analysis in this report centres on

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Chapter 2 | The Conference Board of Canada

Other personal/social supports

Other personal/social supports

Other personal/social supports