“In Denmark, they started planning for folks getting older in 1986 and they developed a wonderful system of caring in the community. We kind of started three years ago.” – Dr. Peter Zalan, president of the medical staff at Health Sciences North (Sudbury), in response overcrowding and long waits in the ER. (CBC News)
In 1987 Denmark decided to build no new nursing homes, and since then, the number of beds has dropped dramatically.
However, that does not mean there are no residential facilities for seniors that provide around the clock care in the country of 5.5 million. In 2007 about 41,000 Danes received permanent help in either a nursing home or a “nursing dwelling.” By comparison, Ontario with a population of more than 13 million people has about 76,000 people in long-term care homes.
What Denmark does do is provide a lot more home care.
Denmark is not doing it on the cheap – in 2005 Denmark spent $4.04 billion Euros on home care – about $5.27 billion in Canadian dollars. This represents almost 2 per cent of their GDP. By contrast, Ontario, with a much larger population, spends about $2 billion on home care out of a GDP of about $650 billion – or about one-sixth of what Denmark spends comparatively.
The problem is in the most recent budget Ontario expects to increase home care by 4 per cent AND hold the line on new long-term care beds despite a waiting list of 30,000 for nursing homes and another 10,000 for home care.
Even with its rule of no new nursing homes, on a per capita basis, Denmark still has more residential beds with around the clock care than does Ontario.
Whereas couples wait long periods to be reunited in Ontario long-term care homes, in Denmark accommodation offered must be suitable for two persons. If the recipient dies, the surviving partner or spouse is entitled to stay on.
A significant feature of Danish home care is the emphasis on support services. Many Danes receive home support without needing nursing care. If one really wants to keep seniors in their homes for as long as possible – as is the objective in Denmark – then it makes sense to have what the Danes call “home helpers,” to assist with acts of daily living.
In Ontario Community Care Access Centres used to contract for housekeeping services to similarly assist seniors to stay in their homes. As budgets got tight under the Harris regime, these services were quietly eroded.
Given most of the 100,000 Danish home care workforce are public employees – about 5 per cent is private sector – there is considerable coordination of services. A 2010 paper by the German Institute for Economic Research notes “home nursing services, personal home care services and practical home care workers cooperate and coordinate their services.” They further state that “many local authorities cooperate on measures of prevention and rehabilitation for the elderly.”
If this is where Ontario truly wants to go, clearly it has a lot of work to do.
While Ontario may want to hold the line on long-term care beds, the Danish experience would suggest they need to make major investments in both home care and other residential alternatives.
In the present atmosphere of funding restraint, this is not likely to happen any time soon.
Like many other attempts at reform, Ontario will likely want to reap the benefits of such a system long before they put in place the enablers for such a system.
We saw it mental health. We are now witnessing it in hospitals, where services are being wedged out in favour of largely fictitious community care providers.
Now we’re seeing the government hold the line on long-term care beds while they fail to make any real significant progress on home care.
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