SPOR EA - Cost Accounting for Long-term Care Beds - Conclusions - Research Priority

INTRODUCTION

This article is the ninth 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 our conclusions resulting from attempting to compare costs between operating a long-term care bed in an institutional and a home-based setting.

In this article we argue it is time to make evidence-based cost accounting research in long-term care a priority in research programs across Canada.

1. SCOPING REVIEW

The Scoping Review revealed that there has been no evidence-based cost accounting research into operating long-term care beds published since 2014.

There was no cost accounting data available to understand the cost of operating a long-term care bed in either an institutional or a home-based setting. There was no data to support any claims as to the comparative cost of operating a long-term care bed in an institutional or home-based setting.

There was no data to examine the flow of funds to institutional long-term care beds, in particular, the efficacy and efficiency of operating long-term care beds in institutional settings. There was no data to support any legislative initiatives to rationalize funding support for home-based long-term care operations.

There was no data showing how any amount of funding to support home-based long-term care operations could be qualified and quantified for efficacy and efficiency.

2. FAMILY CAREGIVING

Our autoethnographic case study of one home-based family caregiving operation showed that there is a method available that can produce evidence-based cost accounting data.

The results of our study show promise for informing research design in long-term care to enable cost comparisons between institutional and home-based settings.

Most importantly, our study showed that home-based long-term care operations are incurring significant costs that are largely invisible to health system economics because of a lack of research priority and historical attitudes toward work done by women in home-based settings.

Our study shows that it is possible to measure, account, and report costs to operating a home-based long-term care bed.

3. GROUP DISCUSSION

As a society we need to discuss research priority-setting with regards to long-term care and how we distribute the cost of caregiving between our social interest and our personal interest. We need to engage with the issues of what it costs to provide long-term care, what it costs when there aren't enough institutional long-term care beds, and what it means to be able to live comfortably in home-based long-term care settings.

At the same time, we need to understand what existing systems can do to alleviate pressure that is causing burnout in family caregiving households. In the absence of cost accounting data and a rationalized flow of resources to support family caregiving households, what can we do with existing resources to maximize efficacy and efficient uses of resources.

One other point arising from the discussion was the idea that we might have more resources available if we become more innovative with how we think about building up our infrastructure of long-term care beds - either in institutional settings or home-based settings. As we showed in the family caregiving study, the difference between a family household going into deficit or maintaining family resources is likely less than the cost of building new long-term care institutional beds, including the cost of operating those beds.

In addition to research priorities to study the cost and cost accounting methodologies for producing evidence-based cost accounting data to compare institutional and home-based long-term care operations, there is a research priority to study the societal and social cost of long-term care.

CONCLUSION

We are in a state of increasing pressure across the health system as the baby boom generation enters their life stage of advanced age. Everyday there are more Canadians who are being diagnosed with diseases and conditions associated with advanced age, everyday there are more Canadians who require support to manage their activities of daily living. Many Canadians in this age group are actively searching for solutions to ensure their comfort, health and well being through this stage of life, whether it is creating multi-generational housing, community support networks, or applying for assisted living residency.

As of today our healthcare system is depending on home-based long-term care operations provided by unpaid family caregivers. If these family caregivers were unable to do this work, the health system would collapse. At the same time, the work family caregivers are providing is putting their households in socio-economic jeopardy. The healthcare system is relying on household resources that are in increasing deficit conditions.

At present we have no cost accounting data to help legislators, health professionals, social scientists, seniors advocates, or senior citizens and their families to make a realistic plan for the future.

These are the research priorities this study indicates as necessary, important and urgent:

Establish a research centre to coordinate long-term care studies across Canada, with a specific focus on cost accounting and societal responsibility;
Initiate a pilot study to look into cost accounting in an institutional and a home-based study, with a goal of comparing costs between the two settings;
Initiate a pilot study to discuss the social cost of long-term care in terms of societal and personal responsibility - use the results of this study to write a position paper to support innovation and relief for family caregiving households.