I'm considering a lot of things in talking about this.
One of the first things that we need to understand is that the nursing home today is not the nursing home of 15 years ago, which provided an awful lot of social care, and was there for the frail elderly, mostly people who were quite old and needed some medical support. The nursing home of today is really an alternate for hospital care, so you have people going there who would have been in hospital 15 years ago. We find an increasing medical complexity, people going into nursing homes at the very end of their lives. That's in Canada. That's not necessarily the case in the Nordic countries or the rest of Europe where nursing homes are there to do more social care.
When I talk about the care gap, I'm talking about the gap between the care we are able to provide with public funding and how it's filled. It's filled with families in nursing homes, with student work, with the work of volunteers, or we're expecting the paid staff to volunteer their own time so they're working overtime. Also, families are hiring privately paid companions. They're paying out-of-pocket to have private care in publicly funded nursing homes. These care workers are doing work that's identical to that of the paid staff, so it's creating tons and tons of risks for the staff, for residents, and for families.
Families are also finding that they are under incredible pressure and burden. Maybe mom has become a bit aggressive with her dementia and the nursing home is saying they can't keep their mom there unless they pay to have someone to watch her around the clock.
Families are facing these sorts of burdens and it's an increasing and incredibly difficult challenge and it creates difficulties all the way round.
If we think about the role of the federal government, the Romanow commission talked about home care, and they didn't talk about nursing homes at all. Nursing homes are practically invisible. These are extended health services, so as you know, the federal government sends money to the provinces and they don't necessarily look at how much the provinces are funding nursing home care.
If the federal government wants to make a big impact, they should be thinking not only about home care, but also about nursing home care. While it is true that people want to remain at home, that's if they have a good home to remain in, and that's if they have sufficient supports to keep them in that home—community supports like Meals on Wheels and transportation, and help with their housing. Some people have no choice but to get round-the-clock nursing care, and they really do need nursing homes. I think by not concentrating on this need, we're neglecting the over 200,000 people who are using these services every year. By understaffing in this area, we're also putting great risks and burdens on the women who mostly provide this work.