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July 28, 2015

Aging in place

Take it with a grain of salt, but this is your future

According to the Chronicle-Herald, there are 7,821 Long Term Care beds in the province and 2,551 on the waitlist. That's 10,372.

Health and Wellness budgets $566,971,000 for its Long Term Care Program, a daily rate of $198.61 for the 7,821. That's quite a lot more than the $135 Ontario claims, so it probably includes a mix of Nursing Homes and Residential Care services. It's probably even more per bed, as some of the 7821 are self-pay

If there is a need for 2,551 more beds, that represents a further $184,930,702 or 32%

As a wheelchair user and Practical Pig, I'm very conscious of what will happen to me at the end of my life. I'm very lucky to have already considered accessibility issues. I have level access, wide doors, a roll-in shower and feel pretty confident that I can spend most of my remaining days here.

Both Health and Wellness and I are excited about this, as we won't be spending the $198.61 on me every day. In order to avoid that expense, Health and Wellness will provide in-home services at $12.65/hr, with some income-based subsidy available. For the $198.61, you'd get more than 15 hours of home care. This will work for me, hopefully for a while.  I'll need some help with the Activities of Daily Living, as they are called, but can easily see getting by on 4 hours/day or less.


  • The Province can save money if homes are retrofitted.  
  • Homeowners would prefer to stay home
  • Homebuilders can make money
Sounds like an opportunity.......


Suppose the province would subsidize your renovations (or new construction) up to, say, $6000 (30 days @ $200) on the certain bet that they will save money.  Capital and operating.  Your renovation would need to include a level entrance, a ground floor bath and bedroom, and 36" doors in between.  You'd have a good shot at doing that for $6000, and any extra would serve you well for nursing-home avoidance.

Some similar incentive can be imagined for landlords.

The Province would need to develop some minimum standards, but this is a no-brainer that will benefit the province, the construction industry, but most of all people who just want to stay at home.

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An employee at CHI Franciscan Health's telemedicine center monitors far-flung patients' vital signs in Tacoma, Wash. The New York Times
By 2015, a short 10 years, the internet will become an important, if not the dominant way of delivering primary health care.  The next generation of activity trackers like Fitbits will morph into health trackers.  Home video monitoring will become ubiquitous.   Here's a recent New York Times Article.

In their accessible homes, elders avoiding institutionalization will access a range of services, from simple check-in all the way to remote physician visits and diagnosis.  Your wrist-worn health tracker will call 911 when your heart rate is out of control, and your GPS will be aware of our location if you go wandering.

Cost pressures, wider availability of broadband, increased patient loads and the uneven distribution of specialists all make this inevitable.  There will be arguments back and forth about cost and outcomes, but the horse has already left the stable.

Rather than playing catch-up-ball, Health and Wellness, Doctors Nova Scotia and The College of Physicians and Surgeons should be ahead of this trend.  It'll save money and lives.


1 comment:

Gus Reed said...

My friend Claredon Robichau points to an existing program for Nova Scotians with disabilities. The problem is that we want to be proactive, and the concept is more a function of the desire to stay at home than present health. The province has a vested interest in making any home accessible.

http://housing.novascotia.ca/programs/financial-assistance-and-grant-programs-homeowners/disabled-residential-rehabilitation