Long term care options for seniors: How much will you pay?

Sheryl Smolkin (SherylSmolkin.com)

By Sheryl Smolkin,

Special to the Financial Independence Hub

Whether you are considering a move to an assisted living facility for yourself or an elderly member of the family, the options available and how much they cost may come as a surprise to you.

The rules vary considerably across Canada, but a series of informative bulletin from Sun Life Financial covering each province and territory describe the three main alternatives, how much they cost and the level of government subsidy, if any. In this blog I refer to the situation in Ontario, because that’s where I live. Generally care for seniors can take place in one of three settings:

  • At home
  • Retirement homes
  • Nursing homes

Home care

Government-subsidized home care for seniors in Ontario is administered by the local Community Care Access Centre. If you contact CCAC in your area a case manager will be sent out to conduct an assessment and develop a care plan.

To be eligible, the person must be frail without needing medical care; not sick enough to be in the hospital; or possibly waiting for a place in long-term care. Categories of support include visiting health professional services; personal care and support; homemaking services and community support programs.

Available home care support form CCAC is limited and continuing family support is required. Private home care without government subsidy can be arranged with an individual caregiver or an agency for in-home meal preparation or personal care. You can expect to pay between $13/hour and $32/hr. [See note at end.]

We pay $25/hr. plus HST and mileage to an agency that sends us a part-time caregiver (she drives her own car) for my Mom. One reason to apply for CCAC care is if they give you any subsidized care you don’t have to pay HST on additional private care.

Retirement home

A retirement home is a private facility offering residential living in private rooms or suites for multiple residents. Each retirement home has its own admission procedures, waiting list and fees. Two or three meals a day, housekeeping and various recreational activities are usually included.

There is no government subsidy and depending on the age, design, quality of services and location of the residence, the monthly cost can vary from $1,200 – $6475 for a single room or from $1,900 – $11,000 for suites of different sizes.

As individuals lose physical or mental capacity but before they are ready for a nursing home, you may also have to employ a privately-paid attendant for several hours/week (see home care rates above).

In my experience, the decision to move from a private home or apartment to a retirement home is often very difficult for seniors. They are still feeling relatively well. They have to downsize dramatically. They have to give up their privacy. And even fairly well-off people are both shocked at the cost and worried about how long their money will last.

Long-term care

Nursing homeIn order to be placed in a long term care home an individual must meet certain eligibility criteria as defined by regulation and assessed by the local CCAC:

  • Be 18 years-of-age or older
  • Have a valid Ontario Health Card
  • Have health care needs that cannot be met with any combination of care giving in the home or community, and
  • Have health care needs that can be met in a long term care home

Your local CCAC is responsible for assessing long term care home applications. If the CCAC determines that the applicant is eligible for admission to a long term care home, up to five home choices can be selected.

There is no guarantee seniors will get their first or second choice particularly if a sudden move is necessary due to a health or personal crisis. This can be problematic for family members who have to travel long distances on public transit to visit elderly residents or provide additional support. In some cases when a room later comes up in a more desired facility, the patient can be relocated.

To make the choice of home(s) easier for you, you are encouraged to visit various long term care homes, take a tour of their facilities, speak with staff and residents, and learn about the services they provide.

The basic monthly fee paid by residents in homes is $56.14 per day or $1,707.59 per month (may be less for residents who are unable to pay) for standard accommodation (usually a three-bed ward). A preferred or semi-private room costs $2,011.76/month and the cost of a private room is $2,361.55 for the same period (2013 rates).

If an individual can’t pay for the basic accommodation, a subsidy is available. However, the subsidy is not available for private or semi-private accommodation. The CCAC will assess whether an individual’s income can cover the cost of the nursing home based on their income tax returns. The monthly income of the individual, less $100, is taken to cover the basic accommodation cost and the rest is covered by the provincial government.

Deciding to move directly from a private home or apartment or from a retirement home to a nursing home is also a difficult decision for seniors and their relatives or other caregivers. The accommodation, quality of care and available facilities may vary dramatically between facilities and waiting lists for the most desirable places can be long. There is a further loss of privacy and autonomy and low-income seniors who are fully subsidized are left with a discretionary monthly allowance of only $100.

* Prices effective 2013. Updated costs for 2014/15 can be found by contacting the appropriate governing ministry in each province.

 Sheryl Smolkin is a lawyer and journalist. You can find her work on sherylsmolkin.com and retirementredux.com. You can contact her through either website.

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