Thank you very much.
I have never had the opportunity to give a brief before such a committee, and I am really honoured.
Just to give you a little bit of background, Neighbourhood Link Support Services is a multi-service social agency providing service in the east end of Toronto. We serve approximately 20,000 clients every year; of that, about 2,600 are seniors.
We only have 80 supportive housing units and we have 80 clients living in those units. The remaining 2,515 clients live in their own homes, whether houses or apartments, in the community. We are not an institution in any way, shape, or form.
We say we serve the oldest, the loneliest, the sickest, and the poorest. To go to the oldest, 50% of our seniors are over 75, and 20% are over 85. We have 64 clients over 95 and 10 over 100. The average age for people in nursing homes is about 79. In our case, the average age of our clients is 80.
Let us look now to the loneliest. These are people without families. Ninety percent of our supportive housing clients live alone, and 70% of our community clients live either alone or in a situation that is not with family, whether they have shared accommodation, roommates, or something such as that. Most of them are simply alone.
They are the poorest. A third have incomes of less than $12,000, and another third have incomes of less than $25,000.
And they are the sickest: 75% or more have two or more medical conditions that compromise their independence and their mobility, and yet these people are living independently in their own community.
As you can imagine, seniors are typically women, and we have the classic split: 75% of our clients are women. This is a statistic from a U.S. study, but it showed that women are almost three times as likely to go into nursing homes as are men. They didn't go on and elaborate as to why, but I can well imagine the reason women are more likely to go into nursing homes is that they don't have the financial security to purchase those services they require to stay at home.
In Ontario, and I gather for most of the country, the most common community support is the community care access centre or something comparable to that, which brokers hours of professional or semi-professional care, whether it's occupational therapy, nursing, personal support, or what have you. Typically, they order hours for people who are coming out of hospital. For seniors or people with chronic ailments, they have to report that they require personal support to get any care at all. Personal support is things like help with bathing, toileting, feeding, and things of that nature.
The way they make that judgment is that the stranger goes in with the clipboard and asks very personal questions about bowel function, and very often the senior is too proud to admit the level of need they have.
If a client gets service through the CCAC, if they do qualify, the average is 1.4 hours a week, which means that the vast majority gets one hour a week. What can you do in an hour? You can have a bath, maybe. I'm not sure that my 93-year-old mother could be bathed and redressed in an hour.
If you are only getting an hour a week, then your house becomes messier. If you get groceries they're from the corner store, where it's more expensive, or you're paying the delivery fee to have them brought from the grocery store. Maybe you can't get out to visit your doctor. You can't go to the pharmacy to get your prescription filled, so you don't follow up the medical regime and you're back in hospital, probably using an ambulance to get there. You don't want to invite people in because your house is a mess, so you become more and more isolated.
If you do have groceries, the trouble of making your meal is so great. Who wants to eat alone? So you start to subsist on tea and toast and pretty soon your health deteriorates and you're back in hospital.
Somebody somewhere along the line suggests to you that you'd better go to a nursing home for your own good, and when you look around and you say that if this is all the service I can get, is the only support I have to stay at home, I had better get to that nursing home.
A community support service agency intervenes to provide all of those practical services that aren't traditionally considered health care. That means drives to essential appointments, social-recreational things, changing a light bulb, cleaning up, or doing the laundry. There are a myriad of things—whatever it is that a client requires.
If a client is institutionalized, the human cost is incalculable. Institutions are very good for people who genuinely choose to go there, or who can't rationally make a choice—people with such severe dementia that they really can't make a choice. But if your infirmity is macular degeneration, which causes your blindness, or arthritis, and 42% of the people in that nursing home with you have dementia and another 33% have had recent documented episodes of depression, that's not the right place for you. You know you are stuck there. You can't leave because probably you don't have a home any more on the outside, and if you did, you wouldn't be able to care for yourself. You know you're there to die.
The best nursing home in the world is still an institution, and we know that institutions are not good for people. You can see I'm not a fan.
As health care costs escalate, the health dollars are more and more specific to acute care. The cost of a nursing home is $700 a week, approximately. It's hard to assign a sensible number to the cost of community support services. In our agency, we expend $3 million a year on senior services, and we have 2,600 clients. Divide that by 52 weeks and it comes up to $22 a week. So it's $22 a week versus $700 a week.
The problem is, who gets to pay for that? What silo should that money come out of? Is it housing? Is it community and social services? Is it health care? Is it a federal problem? Is it a provincial problem? And since nobody really knows, it ends up being given very short shrift, indeed.
In Ontario, I know there are quite comprehensive community supports in Ottawa and in Toronto. Everywhere else in the province, they are sketchy, if they exist at all.
What I believe is necessary as a sort of national initiative to support seniors, and in particular senior women, is to develop local agencies to provide senior services. You could use the mature agencies such as Neighbourhood Link to mentor those agencies that don't have experience giving senior care. Existing agencies also need to be funded to enhance the services they're already providing.
This should not be a big, heavy bureaucratic kind of undertaking. We don't need another broker like a CCAC. If the neighbourhood agencies can remain flexible and responsive to need, that's clearly the better way to go.
Thank you very much.