As people age, it may no longer be possible for them to live independently. Initially, your older clients may get by in their homes with part-time help. In time, they may move to a seniors’ residence in which they can live in their own units but purchase needed services. Eventually, however, they may go to a nursing home.

Barbara Carter, a seniors’ housing consultant in Toronto, says nursing homes and retirement residences are often confused: “Retirement residences — also called ‘care homes’ or ‘assisted-living homes’ — are usually privately owned and managed, and are not necessarily regulated under provincial guidelines.” Prices run from $1,000 to $6,000 a month, which may exclude meals and other services.

A nursing home is a long-term care facility. When an elderly person’s dependency grows to the point at which he or she requires 24-hour care, the next step is a nursing home. More than 200,000 Canadians currently live in nursing homes.

Nursing homes may be owned and operated by private, municipal or charitable groups, but they receive the majority of their funding from the provincial governments, which, in turn, regulate and license them. Carter, author of Where Will They Live? A guide to help your parents with their housing decisions (available by contacting Carter at; $15), notes that anyone who can foot the monthly bill can live in a retirement residence. But LTC residents must be “placed” by provincial health systems. These can be found on the Canadian government’s seniors policies and programs database at or through the provincial ministry responsible for health.

Nursing home rates and standards vary dramatically across Canada. The maximum daily resident’s rate (for a private room, determined by income) is $21 in the Northwest Territories, $66.69 in Ontario, $67.50 in British Columbia and $74.50 in Nova Scotia. In New Brunswick and Prince Edward Island, where there are no caps on rates, residents pay as much as $131 and $160 a day, respectively.

These prices may be just a start, warn Bill Gleberzon and Judy Cutler, co-directors of government and media relations at CARP, Canada’s association for the 50-plus, in Toronto. “Many people supplement their parents’ care by hiring help for feeding and bathing,” Gleberzon says.

In a recent study, CARP found that, although provincial laws cover staff training and nutrition, these areas are not always closely monitored. And other protections for the vulnerable people who live in nursing homes, such as minimum hours of care, hygiene standards, formal complaint systems, minimum number of annual visits by a physician and requirements to have a registered nurse on duty, vary within provinces or may not exist, Cutler says.

“There’s so much mobility today,” Gleberzon adds. “With the patchwork of standards, a person moving across the country to be closer to children has no idea what to expect.” In its brief to the House of Commons standing committee on finance on the 2004 federal budget, CARP called on the government to make LTC services, standards and fees uniform across Canada.

The sheer number of Canada’s nine million aging baby boomers may force changes, as well. “The baby boomers won’t want to be warehoused,” says Peter Silin, a social worker and principal of Diamond Geriatrics Inc. , a Vancouver-based care-management firm, and author of Nursing Homes: The family’s journey (Johns Hopkins Press, US$16.95). “We’ll be seeing more models of care in the future.”

The best thing families with elderly members can do is their homework — before an LTC facility is needed. Some provinces require families to submit a list of desired homes with their applications. The first opening on the list should be taken; a switch can be made later.

Here are some points to consider in choosing a nursing home:

> Look for the best fit. “The resident will probably want to live near his or her present community,” Silin says. “If the resident suffers from dementia, can he or she age in place? Is the location convenient for family caregivers who visit often?”

> Check inspection reports. Most provinces require annual or semi-annual inspections of nursing homes. Ask to see the most recent inspection report.

> Check accreditation. All nursing homes have to be licensed under provincial legislation, but they are not necessarily accredited. Accreditation is a process by which the Canadian Council on Health Services Accreditation, a national, non-profit, independent organization, goes through a facility and evaluates it. Ask if a home is accredited; if it is, ask to see the report.

@page_break@> Hygiene. Ask how many baths residents are given each week.

> Residents’ satisfaction. Ask whether the facility conducts a residents’ satisfaction survey. If it does, ask to see a copy of the results.

> Go on a tour. Visit the facility, eat lunch in the dining room and attend some activities. “How does the home make you feel?” Silin asks. “How does it look, sound and smell? How are staff members interacting with residents? How are the residents interacting with staff?”

> Staff. Ask about staff ratios, Silin suggests. How many are care aides who do day-to-day care, and how many are registered nurses? Lois Dent, president of non-profit lobby group Concerned Friends of Ontario Citizens in Care Facilities, says the biggest problem LTC facilities face is a shortage of trained staff to deal with residents with dementia.

> Elder abuse. “Most care aides and other staff are wonderful people who work under difficult conditions,” Silin says. “But the work can be stressful. The best way to prevent abuse is frequent visits by family. Get to know the staff, so they have a personal connection to you and the resident.”

> Listen to the buzz. Families looking at a LTC facility in Ontario can check with Concerned Friends ( If a relative is in the hospital before being discharged to a home, families should talk to the hospital’s discharge planner, Carter says: “These people hear the buzz about homes. Homes that have long waiting lists are probably better than the others.”

> The family. Going into a nursing home is an emotional process, for family as well as incipient residents. “The family has to let go and trust — with eyes open,” Silin says. “Staff may have many people under their care, but the family only has one. Family members have to become experts.” IE