Long-term Care - At what cost, to whom? Understanding the Costs of Institutional vs. Home-based Long-term Care

We are taking this opportunity to say, "Thank You!" for your interest in our work researching evidence-based cost accounting in long-term care.

On Tuesday, May 13 we held a gathering to share what we learned from a year-long Scoping Review to answer the question, "How much does it cost to operate a long-term care bed in an institutional setting? How does this cost compare to the cost of operating a long-term care bed in a home-based setting?"

We had seventeen attendees in-person and another thirty-five joined online through the Zoom platform. We are very grateful to all who attended.

Below you will find the original powerpoint files in .pdf and a summary of the small group discussions.

Our next step is to publish a series of ten short articles on this blog to share out the work presented on May 13 in more detail. Our goal is to continue fostering and facilitating conversations toward implementing evidence-based cost accounting to improve management and oversight of long-term care bed operations across institutional and home-based settings.

Please feel free to share this work with friends, family and colleagues, especially those households impacted by home-based caregiving work.

This first link provides access to view the Scoping Review powerpoint presentation file.

Link to access Scoping Review presentation file on Google Drive

This second link provides access to view the Family Caregiving Cost Accounting powerpoint presentation file:

Link to access Family Caregiving Cost Accounting presentation file on Google Drive

The session closed with reports from small group discussions guided by the following questions:

Small Group Discussion SUMMARY

GROUP 1

We have been talking about aging for many years, it is surprising to be at this point, that people are providing care at home without adequate supports
Thinking about caring settings as part of a spectrum that includes aging in place, with additional supports as needed before necessitating moving into a long-term care institution

for example, if a senior has a fall at home, their mobility is impacted, but there is a support system to allow them to maintain their quality of life at home without causing undue stress on the family to make up the difference

GROUP 2

The need for our healthcare system and our health research system to allow for patients and citizens to be supported in asking fundamental research questions
The calcuation of time was a striking datapoint
The need for a monitoring system

the quality of life of the person being cared for
the quality of life of the person providing care

A registry for families providing care

support for the families in the form of knowledge and resources
support for their quality of life, and the quality of life of the person receiving care

Not every family as the resources to provide a good level of care
Pilot project in the Northwest Territories whereby and hourly wage given to family or members of the community to provide care
How do we monitor the number of hours family members provide (home-based or family members in institutional settings), whether to do that or not
The need for options and choice for both families and people requiring care

some sort of bridging services between home and institutional settings

GROUP 3

Similarities to experiences of families with children with medical complexity

opportunities for transferability for parents who are dealing with caregiving work due to pediatric medical complexity
test this economic framework in other areas with other populations

Talking about societal expectations

families have responsibility for caregiving, an expectation that you are going to raise your children
dealing with complex issues or medical issues beyond the norm

what is the fair distribution of responsiblity
what is the burden you have, what is a reasonable expection of the burden each of us will carry
how do we deal with that in a family context

Registry idea made good sense

identifying people who have needs
identifying people who are doing caring work
targeting supports to those who need them

Example of Colorado - a program that supports familly caregivers

training and compensation

Rethink the boundaries between home-based settings and institutional settings

a flexible model over time

people at home w/ institutional supports drawing into the home
people in institutional settings with family supports drawing into the institution

Knowledge translation - next steps

powerful mixed methods
combining good data with lived experience
incorporating arts expression to add dimensions of communication

GROUP 4

The families experience of caregiving

health authority leadership

curious about how things went they way they went
where system supports could have been different
how the story could have been changed by different interventions of formal system