SPOR EA - Cost Accounting for Long-term Care Beds - Conclusions - Comparative Cost

INTRODUCTION

This article is the eighth of ten short pieces reporting the work presented on May 13, 2025. On that day we held a knowledge mobilization event to share out what we had learned from a Strategic Patient Oriented Research (SPOR) Evidence Alliance (EA) funded study to find out what research has been published on cost accounting for operating long-term care beds in institutional and family-based settings.

In the previous article we reported time costs as reported in the Scoping Review, and then actual time costs collected over 33 months in a family caregiving home.

In this article we compare costs reported in the Scoping Review, and the actual costs incurred operating a long-term care bed for a frail elder with complex needs in a family caregiving home (case study of one).

1. SCOPING REVIEW

There were no studies in the research literature reporting evidence-based costs for operating a long-term care bed in an institutional or a home-based setting.

Where we were able to find any costs reported, we also found a large range of costs across studies. The minimum numbers reported were difficult to rationalize, they would need further investigation to understand. For example, how could the cost for nursing services be $216 per year?

There were no studies specifically investigating the cost of operating long-term care beds across multiple institutional settings so there were no numbers to establish a consensus based on research literature for a baseline cost assigned to operate a long-term care bed. There were no Canadian studies that reported costs that could be used for comparative analysis.

When we could not find any studies reporting evidence-based cost accounting for long-term care in institutional settings we looked for any cost accounting reports to use for the purposes of this Scoping Review. The Office of the Seniors Advocate BC provided a summary report dated 2023 for the Long-Term Care and Assisted Living Directory. They reported an average per diem rate for Long-Term Care facilities in 2022 - 2023 was $255.76 per day or $7,700 per month.

We don't know how the number is calculated, what portion is covered by MSP, what is paid out of pocket by families. We don't know how unpaid time provided by families is calculated - either as a quantity of hours that augment the service provided by the institution, or the rate per hour that would be used to quantify the value of that time.

For the purposes of this report, we used the per diem number from the Office of Seniors Advocate BC to compare costs between an institutional setting and our case study of one home-based caregiving operation.

2. FAMILY CAREGIVING

We were able to calculate a reasonable representation of cost accounting for operating a long-term care bed in a home-based setting over a 33 month period.

We calculated the costs per year as follows:

These costs were rolled up to provide an overall summary:

This period covered 1,008 days of caregiving operations for a frail elder with complex needs. The family provided 24/7 coverage throughout that time. Medical care for services covered by MSP were not included in this reporting - we did not have access to those numbers.

The unpaid time contributed by family caregivers was valued at a rate of $5/hr - as explained in article 7/10 - Time Cost.

The per diem cost for home-based family caregiving operation was $224.97 per day, or $6,871.82 per month.

3. GROUP DISCUSSION

The main point from the group discussion, with regards to cost comparison, was the observation of how close the numbers were between the per diem rate from the Office of Seniors Advocate BC and the results from our case study of one. The main point here was that there are costs for Materials and Time that are being expended by families operating a long-term care bed in their home.

CONCLUSIONS

We used our 33 month timeline to compare the cost of operating a long-term care bed in an institutional setting and a home-based setting.

The cost difference per diem between the two settings was $30 per day based on the data we had available. The cost per month based on a 30 day month was estimated to be $779 per month.

Our admittedly limited cost analysis indicates that we cannot categorically support the idea that it is cheaper to have someone at home. Further research is needed to fully understand the costs of operating long-term care beds in institutional and home-based settings. It is possible, with further study, that a case could be made for supporting home-based caregiving operations, at least to ensure the families do not suffer socio-economic hardship for the operating a long-term care bed in their home.

Institutional long-term care settings have advantages of economy of scale, a single worker can care for multiple care recipients, however, an institutional setting must conform to labour legislation, so there is a need for more care workers to provide 24/7 coverage. At present there is no labour legislation protecting home-based family caregivers from burn out.

A single institutional building can house multiple care recipients, however, the increased size and risk of operating an institution needs to be considered in relation to a home providing a long-term care bed for one care recipient and also housing for the family is residence. The cost per bed for building new long-term care infrastructure is almost the same as building or refurbishing a family home that could house a family and a home-based long-term care bed.

The time cost for operating a long-term care bed needs to be calculated across the various roles and responsibilities entailed in caring for a frail elder with complex needs. In an institutional setting, the time cost for leadership, administration, management and coordination, as well as day to day operations, has not been factored. Similarly in a home-based setting, where the primary caregiver is typically handling all those roles and responsibilities, there hasn't been any time on task study to factor the level of risk being managed on a day to day basis by the primary caregiver and how that work would be valued.

Economies of scale need further study and analysis to determine the most efficacious use of long-term care budgets and the current and escalating shortage of long-term care beds, as well as the continuing crisis of housing affordability across Canada.