Canada is a laggard in long-term care insurance, trailing numerous jurisdictions that prepared for their aging population with benefits that help older adults pay for private home care or nursing home fees, says a new white paper from the National Institute on Ageing.
The problem is that even if the federal government acts quickly to launch a nation-wide plan – funded by a range of options from paycheque deductions to taxes – its impact on the eldest of boomers would be minimal because of limited contributions, said Dr. Samir Sinha, director of the NIA’s health policy research.
But that doesn’t mean the country shouldn’t get ready for its future seniors.
National long-term-care insurance, said Sinha, is a necessary “social contract” that will especially help Gen Xers, the eldest of whom are marching toward 60, and the massive cohort of millennials, who start turning 50 in the early 2030s.
“More people are living paycheck to paycheck and so they aren’t really doing a great job saving for their retirement,” said Sinha, director of geriatrics at Sinai Health and University Health Network.
“And the biggest thing that can really threaten anyone’s retirement or how they live in retirement will be if they all of a sudden have long-term-care needs.”
A public — not private — long-term-care insurance program could help pay for costly and unexpected expenses due to ill health or fragility that can be financially devastating, said the NIA report, called “Could a National Long-Term Care Insurance Program be a Feasible Solution to Address Canada’s Growing Long-Term Care Crisis?” (The paper said the private-paid long-term-care insurance, which is currently available in Canada, is often very expensive.)
Nation-wide long-term-care insurance, it said, could “greatly reduce fragmentation and lead to more equitable service coverage and financial protection.”
The NIA’s white paper defines “long-term care” not as the traditional nursing home depiction, but as a mix of supports or health care services from public or private care providers across a range of settings, including institutions, the community and individual homes.
Many will one day need extra help, with bathing or getting dressed; or from physiotherapists or occupational therapists. It’s not just the potential vulnerability of old age, many will be living with disabilities. Some coverage is provided currently by a patchwork of provincial systems across Canada, the paper said, but often expenses are paid by the individual, if they can afford it.
Pat Armstrong, editor emeritus at York University and long-term-care expert, said the assumption that care will be provided by family, especially women, often leads to an unhappy awakening, given that many caregivers are not qualified to provide the support needed.
It takes medical training that many don’t have, whether it’s looking after a partner with dementia or a chronic disease, said Armstrong. And that leaves many families struggling, she said, particularly when an ill individual is sent home from hospital.
“It’s especially the case now when you have people with catheters and kidney failure and all kinds of other equipment they go home with,” she said.
“That requires an incredible amount of training and skill. And the recognition that those skills mean you have to pay for them.”
The paper examined long-term-care insurance programs offered by Germany; Japan; the Netherlands; South Korea; Taiwan and Washington State all of which provide individuals with dedicated funding for extra care.
Germany’s insurance program, which started in 1996, offers coverage for care in homes, or institutions, offering cash for informal help at home or direct payments to nursing homes, the paper said. In 2026, when Washington State’s benefits become available, individuals can use their benefits for a range of services, along with changes in homes that support aging in place.
There is no “one size fits all” approach, the paper noted, with programs in those six jurisdictions funded a combination of ways, including taxes or “social contributions” from employees and employers.
Without long-term-care insurance, many will spend their later years living on a basic retirement income that likely won’t cover the thousands of dollars needed for health-related services, such as home care from private-pay personal support workers or nursing home “accommodation” co-payment fees.
In nursing homes, those co-payment fees cost more than $33,000 a year for a private room and $28,000 for a semi-private room. In-home services, the paper said, can range from $1,000 to $3,500 dollars per month while the cost of complex home care in Ontario can cost as much as $25,000 a month.
It won’t be long before those expenses will hit an increasingly vulnerable and, as the report calls it, “super-aged” population.
In the early 2030s, nearly one-quarter of Canadians will be over the age of 65 and by 2048 — the eldest of the gen-Xers will be in their early 80s and the massive demographic of millennials will officially reach their senior years. In the same period, the number of Canadians aged 85 and older is expected to triple, to as many as 2.8 million, the paper noted.
While the paper acknowledged that private long-term-care insurance plans exist, it said their affordability and sustainability are “challenging” because the small pool of contributors and high likelihood of payouts means the premiums are expensive. Only seven per cent of home care recipients of all ages have services covered solely by insurance, the report said.
To assess the options, the NIA looked at the six jurisdictions that have long-term-care insurance but did not recommend a specific approach.
“As a first step, high-quality economic evidence and insights are needed within the Canadian context,” the paper said.
Laura Tamblyn Watts, a lawyer and CEO of CanAge, an advocacy group for older adults, said many Canadians mistakenly believe they will have far more health coverage than exists in their later years.
That’s why the concept of a national long-term-care insurance program, Tamblyn Watts said, could resonate.
“It’s intriguing. And so I think it’s a really interesting public opportunity that Canada has never really looked at, I think, to any degree of seriousness,” she said.
“I think Canada requires a political climate where it’s open to looking at solutions for its aging population in a holistic and concentrated way.”
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