SPOR EA - Cost Accounting for Long-term Care Beds - Findings - Material Cost

Friends of the family brought us an electronic reclining chair for Mom to use for socializing and meals. Her eldest son made her a custom table for reading, writing and dining. The chair made it so we could change her position and elevate her legs as needed. She spent many hours in that chair.

INTRODUCTION

This article is the sixth of ten short pieces reporting the work presented on May 13, 2025 to report what we learned about research in Long-term Care Cost Accounting for institutional and home-based operations. We developed cost accounting categories derived from Project Management Institute (PMI) practice standards and frameworks. This approach divides costs into Materials (expenditures accounted by receipts) and Time (expenditures accounted by hours x rate per hour).

Scoping Review findings were extracted from a collection of 37 studies through a four stage process: 1) Search Strategy and Execution; 2) Abstract Revew and Full Text Data Extraction and Review; 3) Synthesis; and 4) Report Write-Up and Briefing Notes. Findings on Material Cost were identified as a specific sub-set of overall cost accounting results.

Family Caregiving findings were compiled from credit card and bank statements, as well as receipts submitted by family for compensation from Mom's account. As Mom's Primary Caregiver, I had Power of Attorney over her financial affairs, including her bank account. For this report I was able to download and code 33 months of financial data to present the Material cost of operating a long-term care bed in our home.

Group Discussion about Material Cost was collected after each presentation and during the final question process to close the event.

We started planning to bring Mom home more than a year before she finally made the move. During this year we incurred Material costs to renovate the bathroom and prepare the household for a frail elder with complex needs.

1. SCOPING REVIEW

We did not find any studies that specifically reported the Material cost of operating a long-term care bed for the period 2014 to 2024. We did not find any studies that proposed a cost category framework for collecting and reporting this type of data.

Findings in general with regards to costs were that there was a large range of costs reported per patient per year, it was hard to compare across settings and categories and there were no Canadian studies that aligned with our objectives for this Scoping Review.

In 2017, Gibbard (Gibbard, 2017) reported to the Conference Board of Canada that the estimated annual operating cost for on long-term care bed was $75,000 (2017 dollar values). Gibbard did not separate out the Material cost from the Time cost of operating a long-term care bed.

Gibbard, R. (2017). Sizing Up the Challenge. Meeting the Demand for Long-Term Care in Canada.

According to an online inflation calculator, $75,000 in 2017 was worth 91,430.41 in 2024. We are looking at an estimated cost of $90,000 per year to operate a long-term care bed. That would be $7500 a month or $247 per day to operate a long-term care bed in an institutional setting in 2024.

In 2024, the Government of BC announced a $3.2 billion capital investment over ten years to create 5,354 long-term care beds, including 3,209 new beds and 2,145 replacement beds. The construction cost is $597,683.97 per bed. We don't know what budgets are in place to operate these beds, we also don't know what portion of those operating budgets would be assigned to Material cost.

All Hands-on-Deck: An Urgent Call to Action to Ensure Care for B.C. Seniors. (2024). [Pre-Election White Paper]. BC Care Providers Association.

We renovated the bathroom, removing the bathtub and installing a no-barrier shower base. We also installed handholds, as well as furnishing the shower and the bathroom for accessability.

Bathroom renovation almost done.

2. FAMILY CAREGIVING

Material costs reported in this presentation were compiled from records reviewed after the caregiving operation had ended. During the operation of our home-based long-term care bed, we were very careful to ensure all Mom's accounts were tracked and reported month to month. The living expenses for the family home - property tax, house insurance, mortgage payments, utilities, electricity, gas, Internet, entertainment, dining out (anything that was receipted) were easy to collect and code. Groceries, drugstore, incidental purchases, these were not so carefully tracked in the moment. for those amounts, I have used reasonable assumptions to assign a portion of cost to Mom's caregiving.

The process of bringing Mom home entailed two parallel projects: 1) prepare the suite with accessible accommodations; 2) prepare Mom to accept leaving her residential group home and moving in with us to take care of her

We tested the proposed cost accounting framework developed from the Scoping Review to code Material Costs as follows:

Over the 33 month timeline these cost categories were tallied and then subdivided by month and by day to give a per month average cost and a per day average cost.

Based on our calculations, the cost of operating a long-term care bed for a frail elder with complex needs (requiring 24/7 attendance) was

per month average $3,618.14
per day average $118.45

All material costs for running a home-based long-term care bed are rationalized in terms of Mom's health and well being. At this point in our process, we were facing unknown complications from the combined impact of Mom's increasing frailty and Covid restrictions. We worked to install communications infrastructure to meet needs in case Mom needed to go to the hospital.

3. GROUP DISCUSSION

Scoping Review - Are there any differences in funding between in-home, long-term care and home care services? We don't know exactly. We do know that there is a user contribution, and the health authority subsidizes, there is subsidized home support based on income testing.
Family Caregiving - If you had given up at some point, and said we need to move Mom into institutional care, the costs that your family absorbed, these costs would have been transferred to the healthcare system. If all the caregiving families went on strike nationwide, the healthcare system would collapse. We need to think about what is a fair distribution of cost. Yes, there is a societal cost, and there is a personal cost. When families are willing and able to take responsibility, they may not realize the enormity of the responsibility, the level of scrutiny they may be subjected to, the risk impact of mistakes. We don't really know how much it is costing us until we sit down and to this kind of data collection and analysis. Without it, we have no idea what the costs are and who should be sharing in supporting caregiving households.

The family met and discussed anticipated needs for Material costs for the suite: moving my office out of the suite, installing necessary furnishings, providing housekeeping support.

CONCLUSIONS

We have no evidence-based data to support any conversations about the Material cost of operating long-term care beds. It doesn't matter if the beds are located in an institutional or a home-based setting, we do not know who much it costs to provide the material infrastructure for each bed.

It was surprising to me, the primary caregiver and homeowner, to learn how much it was costing our household to contribute a two bedroom suite for Mom's care. Our data shows that our family was expending $3,600 per month, or $118 per day to provide housing infrastructure to operate Mom's long-term care bed. Although we factored the cost of providing a spare bedroom for Mom's caregiver to stay overnight, we did not factor the extra food, laundry, entertainment, etc. for having that person on site.

We did not factor for the opportunity cost of what that suite would rent for, we only calculated for the actual property cost of that square footage.

When you look at a cost of $600k per new or repurposed long-term care bed, and then another $90,000 a year to operate each bed, it is entirely likely that there could be more opportunities to grow and support home-based caregiving infrastructure to meet projected needs and keep families in communities, where they would rather be living out their final days.

There is a compelling argument to study evidence-based cost accounting in long-term care, in particular, being able to compare the cost of institutional settings and home-based settings.