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The Commission heard that elder care is a growing need, and largely provided in the community by family members. As well, the gendered nature of elder care and the disproportionate burden that women face in caring for aging relatives was noted. Consultees described the stress caused by caring for older persons and the need for efforts to address caregiver stress. Finally, the Commission heard that issues relating to elder care require creative responses by government in terms of legislation, programming and funding and by employers in terms of workplace flexibility to ensure that caregivers are supported in their provision of care. The message presented to the Commission was that caregivers are fulfilling an important societal role and should not have to bear the responsibility alone. Society should be supportive of their efforts.

“Informal caregivers are...silent victims in a silent system...they have inherited unfair burden and responsibility without enough support in the downloading of responsibility [as a result of] hospital closures.”
(Canada’s Association for the Fifty-Plus (CARP))

The Squeeze in Elder Care

A number of organizations told the Commission that that there is mounting pressure in the area of elder care: as the population continues to age, hospitals continue to discharge patients at a faster rate and inadequate provincial funding is provided to community based health care providers. These factors together make it difficult for home care providers to provide adequate care (The Council on Aging). This means that families will increasingly be required to provide care for their aging relatives. Submissions by the Council on Aging and others highlighted that in this context, older persons themselves will become the victims of an inadequate system, particularly those older persons who do not have family or the capacity to access private health care.

The Gendered Nature of Elder Care

A report submitted by CARP noted that in 1999, 46% of all working Canadians provided general eldercare.[42] The Older Women’s Network told the Commission that the care of older persons is most often performed by women; 90% of paid caregivers are women and a significant proportion of informal caregivers are also women. This is supported by a recent report by the Ontario Community Support Association.[43] Canadian Pensioners Concerned told the Commission that the role of women as primary caregivers has existed as a “norm” within society, requiring women to place caregiving responsibilities above their own aspirations. They noted, “because of family responsibilities, lower salaries, and fewer opportunities for education and job promotions, [women] have been unable to amass sufficient retirement income through pensions and savings”. The gendered nature of elder care therefore has repercussions for women in other areas, likely to last far into their later lives.

Caregiver Stress

Caregiver stress has been identified as a significant and increasingly important issue as the number of older persons requiring care in the community grows. One individual told the Commission that caregiving places a significant burden upon families, particularly when family members do not have the necessary training to provide appropriate care for their aging relative. The Chatham-Kent CCAC noted that particular expertise is required in the care of older persons given that elder care often requires knowledge of polypharmacy and diseases related to aging, and the know-how to deal with consent and capacity issues. Without such expertise, stress can be further compounded. A number of submissions emphasized that the burden experienced by the family can also cause stress for the older person because it can cause the older person to feel like a burden. The Ottawa-Carleton CCAC and others stated that for older people who are caring for another older person, this burden can be exacerbated by their own care needs.

Accommodating Caregiving

The Consultation Paper asked for comments on the extent of an employer’s duty to accommodate employees who care for older persons. A number of organizations responded with creative suggestions that could apply in the workplace and beyond. ESAC told the Commission that support for caregiving in the form of job flexibility is necessary. They stated that the ten days of emergency leave to care for family members, as prescribed by Subsection 50(5) of the Employment Standards Act, 2000[44], is not enough in most cases. ESAC suggested that leave to care for family members should be flexible, similar to the current provisions for maternity leave. The Ottawa-Carleton CCAC suggested that temporary leaves and reassignments are possible options to help employees address caregiving obligations. The Alzheimer Society of Ontario added that, “there is a need for employers to offer provisions such as a leave of absence, benefits or other support for those who care for a family member with Alzheimer Disease that are at least comparable to benefits that exist to address childcare needs”. While a number of the consultees recognized that employers do not have unlimited resources, consultees also suggested that employers should be willing to accommodate reasonable requests for care leave.

The fact that the significant costs associated with elder care have not been formally recognized by current policies is causing many caregivers some degree of financial hardship...There is a need [to] review related policy to ensure that equal value is placed on elder care as is placed on caring for adults and children with disabilities and to financially assist caregivers to provide the type of support that older care recipients need.
(The Alzheimer Society of Ontario)

A number of concrete recommendations were offered for the manner in which governments can respond to the needs of caregivers in Ontario. The Ottawa-Carleton CCAC emphasized that legislation is required to ensure that persons providing care are supported and not punished. CARP recommended that support for informal caregivers in the form of CPP benefits and retraining programs should be made available. The Alzheimer Society of Ontario emphasized that caregivers should be offered a “caregiver tax-credit” similar to credits available for caregivers of persons with disabilities. Furthermore, extended health benefits, such as those available for dependent children, should be available for dependent adults. Union Culturelle des Franco-Ontariennes told the Commission that guaranteed remuneration should be available to people who stay at home to care for sick family members.

Alternative Care Options

The Commission heard that to relieve caregiver stress, caregivers need a break from their duties. Day programs, respite programs and home care programs were discussed. The Chatham-Kent CCAC noted that day programs and short stay beds are options for caregiver relief but that they often have limited value. They are useful in the sense that they provide caregivers a break, however, such programs can be difficult to access due to issues regarding transportation to and from such programs. With respect to respite care, they told the Commission that many of the forms of respite care are not flexible enough to address the various needs of caregivers. They suggested that respite care in the home often presents a better option for families. The Ontario Association of Senior Citizens’ Organizations told the Commission that universal services, such as long-term care facilities and home care programs, should be in place with adequate funding to ensure that real alternatives to family care are available.

Recommendations for Government & Community Action

28. THAT the Ministry of Labour extend the new leave provisions of the Employment Standards Act, 2000, to smaller workplaces (including those of less than fifty employees).

29. THAT all levels of government and employers consider providing various forms of support to caregivers. Options for consideration include program support (e.g. programs for caregiver relief), financial support (e.g. tax credits) and flexible work options.

Commission Commitments

9. The Commission will develop a policy statement on elder care that identifies the related human rights issues.

10. The Commission will consider complaints where employees, who care for aging or ailing parents, spouses or same-sex partners, face discrimination on the basis of "family status", "marital status" and "same-sex partnership status".

[42] Canada’s Association for the Fifty-Plus (CARP), Putting a Face on Homecare: CARP’s National Forum on Homecare – Focusing on the Informal Caregiver (Toronto: CARP, June 1999), at 2.
[43] Ontario Community Support Association, In 20 Short Years: A Discussion Paper on Demographics and Aging (Toronto: Ontario Community Support Association, February 2001) at 9.
[44] Employment Standards Act, 2000, S.O. 2000, c. 41.

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