One of the primary effects of successful aging-in-place programs here in Alberta is that we've had a very aggressive aging-in-place set of policies as early as 2006 to 2008 to keep people in their homes, in the community, or in alternative living, to keep people out of long-term care as long as possible. That's been quite successful.
One of the challenges with that is that it's meant that the women, primarily, who go to long-term care in a nursing home go very much later in the trajectory of their life, their dementia and their other chronic conditions. It's not that it has increased the chronic conditions themselves, but as you get older and closer to death, within the last year or two of your life, if you have advancing dementia, in particular, your needs become much more demanding—“acute” is not the right word in long-term care—with a heavier workload. Moreover, they're more complex. They're not just complex medically, requiring the management of symptoms, which we don't always do very well in long-term care, but socially as well. There are now longitudinal data that show us unacceptable levels of symptom burden in the last year of life in many places, and their social needs are more complex because as your dementia gets to those stages, you have difficulty communicating.
Things like a pandemic where you're isolated are catastrophic for a person with dementia, both in the community and especially in the nursing home. Even if you have staff coming in, they're dressed in masks and clothing, so they can't hear well, they can't see their faces, and they're afraid. These people that we see in many jurisdictions—