Abstract

Although recent data show that population aging is not a major driver of rising health care costs, fears persist that a "grey tsunami" of older persons living longer with multiple chronic needs will overwhelm already floundering health care systems in a period of global economic downturn and shrinking public expenditures. As part of our overall program of research, we consider policy responses to an aging population in Ontario (Canada's largest and most populous province) over the past decade and a half, placing particular emphasis on "aging at home."

In part a push back against what has been seen by some as an historical tendency to abandon older persons to their own means, to “warehouse” them in long-term care (LTC) institutions, or to treat aging as a medical condition to be “cured” in hospitals, “aging at home” strategies typically aim to maintain older persons and their informal caregivers as independently as possible, for as long as possible, in their own homes and communities through coordinated access to a range of community-based health and social supports. Such strategies respond to the increasingly vocal demands of older persons to age in familiar settings; they also respond to a growing perception among policy-makers that “lower-cost” community-based care can substitute for more costly and often inappropriate care in hospitals and institutions.

Nevertheless, “ageing at home” strategies have proved difficult to implement and sustain in Ontario. Much of this difficulty is due to an embedded logic of shifting older individuals at the back end of the care continuum, out of hospitals and typically into institutional settings. This logic conflicts with attempts to shift the balance of care to the prevention and maintenance of individuals at the front end of the continuum living in community settings.

In this presentation we discuss how a legacy of ED/ALC logic has dominated "aging at home" in Ontario. We provide a summary of our analyses of the costs and consequences of policies which have failed to build sufficient community-based care capacity to avoid unnecessary hospitalization and institutionalization by maintaining individuals in the community. The presentation will conclude with a discussion of the way forward, drawing on lessons learned from Ontario for other jurisdictions facing similar challenges.

Slides