Too many seniors in our province struggle to find publicly subsidized assisted living where they can be supported as they age. Amidst an affordable housing crisis felt across generations, the need to significantly boost the supply of subsidized assisted living is more urgent than ever before.
Assisted living is a type of supportive housing for people with moderate levels of disability who need daily personal assistance to live independently (meals, help with bathing, or taking medications, etc.). Publicly subsidized assisted living is part of B.C.’s larger home and community care system. There is also a large private-pay assisted living sector, where seniors pay entirely out-of-pocket and fees are completely unregulated. For-profit corporations provide the vast majority of private-pay units, while non-profits provide the majority of publicly subsidized units.
In a new study published by the Canadian Centre for Policy Alternatives, my research found a number of concerning trends.
Access to publicly subsidized assisted living units in B.C. dropped significantly — by 17 per cent — between 2008 and 2017. (Access is measured as the number of units for every 1,000 seniors age 75 and older).
Perhaps not surprisingly, the private-pay assisted living market has benefited as a result, as seniors and their families look for other options when subsidized care is unavailable. Between 2010 and 2017, 1,130 private-pay units were added throughout the province, while a mere 105 publicly subsidized units were added.
Private-pay care may be an option for some, but it is beyond the means of most low- and moderate-income seniors. Senior couples at the median (middle) income of $61,900 can scarcely afford a one-bedroom assisted living unit, which would eat up 58 per cent of their income. For seniors living alone, even a bachelor suite would require over 80 per cent of their income.
Without access to subsidized assisted living, seniors who can’t afford to pay privately may go without care altogether or wait until their health deteriorates to the point of requiring a nursing home or hospitalization. This situation does not serve seniors or our public health system well at all.
Over the last two decades, the provincial government has not made the public investments needed for health authorities and non-profits to develop new assisted living spaces, which means very few new subsidized facilities are being built.
At the same time, skyrocketing real estate prices have led to a growing financialization of seniors’ care, where real estate assets are bought and sold as commodities on international markets. But allowing assisted living facilities to be treated this way is fundamentally at odds with the basic social purpose of providing care to vulnerable seniors.
It is clear that B.C.’s policy approach is not working. Access to publicly subsidized units has fallen and yet we know that the for-profit sector is more likely to build private assisted living units because the rate of return on capital invested is higher.
What is the solution?
B.C. currently relies on private-sector financing of assisted living, which is more expensive than the provincial government financing new construction. This approach is a relic of the early 2000s when government refused to take on debt in order to build critical social infrastructure.
Aside from an initial injection of federal and provincial capital funding in the early 2000s, the provincial government has provided very little ongoing direct capital funding to expand subsidized assisted living. In fact, over nearly 10 years (2009-10 to 2017-18) the B.C. government provided a mere $3.3 million in capital funding. To put this into perspective, this represents 0.04 per cent of total capital investments in the health sector over this period.
The B.C. government should provide new capital and operating funding to non-profit organizations and health authorities to increase the supply of publicly subsidized assisted living units as part of a provincial seniors’ care capital funding plan. Seniors and their families deserve no less.
Andrew Longhurst is a research associate with the Canadian Centre for Policy Alternatives and author of the just-released report Assisted Living in British Columbia: Trends in access, affordability and ownership.