‘Almost like part of the family’
Senior’s ‘cluster care’ community keeps her out of hospital and long-term care
Susan Vickberg has what many do not.
At the age of 71, living with multiple sclerosis, Vickberg has a private room inside a “cluster-care” household for older adults at WoodGreen Community Services on Queen Street East with — and this is the important part — an inhouse supervisor plus 24-hour-aday help from the same personalsupport workers (PSW) she has known for years.
“It’s almost like having a mother,” Vickberg said. “Somebody cares about you and that is an emotionally positive experience — you lose that sense of loneliness.”
Familiarity with workers, she believes, keeps her safe, strong and out of long-term care or hospitals. The not-for-profit WoodGreen says 75 per cent of its older renters in six sites across Toronto remain in cluster care until the end of life, avoiding nursing homes.
And while WoodGreen’s purposebuilt households are not the Naturally Occurring Retirement Communities (NORCs) increasingly found in condos and apartments, their in-house supports offer a prototype for new NORC-focused home care services, said Dr. Samir Sinha, director of geriatrics for Sinai Health and University Health Network (UHN.)
“Most people living in the thousands of (NORC) buildings don’t have anything like this, but imagine if we could take the governmentfunded home care and offer something similar to cluster care in these buildings,” Sinha said.
A new report released Tuesday by the NORC Innovation Centre at UHN is calling on the province to modernize its home-care delivery by streamlining services in the population-dense NORCs, which are multi-generational buildings where many people have, naturally, aged in place.
Ontario has nearly 2,000 buildings defined as NORCs — home to 217,000 older adults, according to data from the NORC Innovation Centre (NIC.) And that, the NIC says, offers the opportunity to give better care, especially preventative care. Using one service provider in a NORC or a group of neighbouring NORC buildings can simplify the process and better meet the needs of residents and staff, the report said.
While the NIC analysis found NORC residents received nearly 3.5 million hours of home care services valued at more than $120 million in 2022-23, the report also said the system’s confusing and outdated approach could be modernized to reach more people. By the early 2030s, when one in four Canadians is over the age of 65, home-care demands are expected to jump by 50 per cent.
“Ontario’s current home-care system is underfunded, disjointed and not working for the many older adults who rely on it the most,” said the report, called “A Home Care Model for Naturally Occurring Retirement Communities in Ontario.”
Front-line staff also struggle with the current system, the report said.
“Services are still mostly delivered as though all clients live in suburban homes, often requiring extensive travel from client-to-client, performing piecemeal work that is neither satisfying for them nor their clients.”
Older adults living in NORCs told researchers that access to home care services — such as help with eating, dressing, bathing, housekeeping or end-of-life care — seemed confounding.
Noting that some problems can be attributed to Ontario’s underfunded home-care system, researchers’ data analysis found that over a third of NORC buildings in Ontario have four or more home-care agencies coming into the same building each day to care for different clients.
The struggle with a confusing system can exacerbate health problems, said Melissa Chang, the NIC’s director of operations and sustainability and a co-author of the report.
“You can’t go in and manage existing conditions, so those conditions grow worse if we don’t catch them in time,” said Chang. “It will increase demand on emergency departments and hospital stays. The need for long-term care … will start to increase.
“We are already seeing burnout in our community-care providers. They can’t continue to be spreading themselves that thin and we are seeing people leave the industry because of the stress,” she said.
If Ontario NORCs followed the NIC’s recommendations for a dedicated provider and consistent staff, more clients could be seen each day without compromising service delivery, which would improve productivity, the report said. Researchers found it would add an additional 754,976 hours of PSW services, worth $26,756,331.
“Given the chronic shortage of PSWs working in home care, and the rising demand for services within Ontario’s rapidly aging population, a NORC-based home-care model can make a positive difference not just for those living in NORCs, but also for home-care workers and the health care system more broadly,” the report said.
“Best of all, transitioning to the model would not require significant new funding; it would simply represent a different and more efficient way to organize and deliver services where natural population densities already exist.”
Researchers proposed that the Ontario government, “make use of the natural densities of NORCs” by upturning the traditional system through a series of changes that include: Adopting and promoting a new home-care model for those living in NORCs; piloting a NORCbased home-care model, and creating a population-based funding formula for home-care agencies responsible for NORC buildings.
In New York City, where long-established NORC programs get state and municipal funding, services are offered by an in-house provider with an executive director, staff social workers and nurses who help residents navigate health care and social activities that range from dinners to yoga, art classes for people with dementia or current affairs discussion groups.
A key piece of the NORC philosophy centres on the goals and interests of the residents living in the building. If they want dinners that appeal to certain cultures, they might have paella or biryani chicken. If they want a Clark Gable movie-night series, it will happen.
One of the most recent proponents of that NORC community spirit, so to speak, is federal Seniors Minister Seamus O’Regan.
“That’s just friggin’ great to me,” said O’Regan, minutes after an early March visit to a York Region supported housing building in Newmarket, where older residents have a say in services and activities.
O’Regan joined a discussion on activities between the residents and the not-for-profit service provider, Community & Home Assistance to Seniors (CHATS.)
“You see people who have dignity, who are respected and are overcoming,” he said. “I think one of the worst things that can happen to you when you’re older is loneliness. And what I saw there … the loneliness and isolation … all these things were being combated one suggestion at a time. It was really great to see.”
While O’Regan’s visit focused on community activities, in Toronto, WoodGreen leaders say their cluster-care households give people a normal, family-style approach to everyday life.
Vickberg takes the Wheel-Trans every week from her WoodGreen home on Queen Street East, to another WoodGreen building on Broadview Avenue, a “seniors active living centre,” for a creative writing workshop.
In her home, she lives in a household of about 10 people, with private units that include a bedroom, washroom and a tiny kitchenette. Residents also share a lounge, full kitchen and dining room table for communal meals. The PSWs prepare her medication and breakfast every morning.
It’s a model that works, for its social connections, health-care services, affordable housing and success in keeping low-income people out of institutional settings, said WoodGreen’s director of public affairs, Eric Mariglia.
Instead of spending more than $700 a day (in government funding) on an alternate level of care hospital bed or roughly $200 a day in a nursing home, the cluster care rooms cost $99, Mariglia said. Residents also pay geared-to-income rent and a $550 monthly fee for services.
With two new WoodGreen developments in the works, creating another 27 cluster care beds, (one at 1080 Queen St. E. and the other at 60 Bowden St.,) Mariglia said WoodGreen is hoping to add more cluster care households in Toronto.
While they’re not NORCs, said Sinha, WoodGreen’s in-house supports create relationships that are beneficial, not just to residents, but also to front-line staff.
“They’re familiar faces,” he said. “They know the building, they know the culture. They’re almost like part of the family.”
‘‘
Ontario’s current home-care system is underfunded, disjointed and not working for the many older adults who rely on it the most. REPORT RELEASED TUESDAY BY UNIVERSITY
HEALTH NETWORK