North East Local Health Integration Network Aging at Home Strategy. Seniors Residential/Housing Options Capacity Assessment and Projections

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1 Aging at Home Strategy Seniors Residential/Housing Options Capacity Assessment and Projections Final Report Revised March 16, 2009 Prepared by: In association with: Balance of Care Research Group, University of Toronto Led by Dr. A. Paul Williams, Professor of Health Policy, Management and Evaluation University of Toronto, with assistance from Kerry Kuluski and Jillian Watkins

2 Acknowledgements The Aging at Home Strategy Seniors Residential/Housing Options Capacity Assessment and Projections study was undertaken on behalf of the North East Local Health Integration Network (LHIN). This report was completed under the direction of Philip Kilbertus, Senior Consultant, Planning and Integration, North East LHIN. We would like to thank the study s Project Advisory Committee members for their input and assistance during the preparation of this report. These members include: Name Organization Rina Clark Community member Gary Champagne CAO, Manitoulin-Sudbury District Social Services Administration Board Gilbert Constant Huron Lodge Assisted Living & Community Support Services Liz DiTullio Canadian Mental Health Association Cochrane Timiskaming Branch Len Fabiano Lakeland Long Term Care Francine Gosselin Temiskaming Lodge Heather Ladouceur Canadian Red Cross Timmins and District Kim Lalonde Nipissing First Nation Health Services Brenda Loubert Cassellholme (East Nipissing District Home for the Aged) Fran McMillan The Westmount Retirement Residence Pat Montpetit Alzheimer Society Sudbury Manitoulin David Munch Sudbury Finnish Rest Home Society Inc. Terry Murray-Maeck North Bay General Hospital Dan O Mara CEO, MICs Group of Health Services Lily Petrus North East Community Care Access Centre Alice Radley Physically Handicapped Adults Rehabilitation Association Linda Toner Ministry of Health and Long-Term Care Francine Toulgoat North East Community Care Access Centre We also wish to thank representatives from various social service agencies, housing providers, municipal departments and the private sector for providing valuable input into key aspects of the study. Expert Panels were set up throughout the North East LHIN, and included the following groups: i

3 Algoma Appropriate Level of Care Working Group City of Sault Ste. Marie Community Social Services Department Representatives of Huron Lodge, Elliot Lake Retirement Living Inc., St. Joseph s General Hospital of Elliot Lake Appropriate Level of Care/Seniors Working Group (Timmins) Representatives of Golden Manor in Timmins and South Centennial Manor in Iroquois Falls District of Cochrane Social Services Administration Board Sudbury Appropriate Level of Care Working Group Representatives of Pioneer Manor, Finlandia Village, Westmount Retirement Residence and Extendicare/York (all in Sudbury) City of Greater Sudbury Housing Services Section Manitoulin-Sudbury District Social Services Administration Board Interim Strategies Group (Nipissing District) Representatives of Cassellholme and Au Chateau Home for the Aged Nipissing First Nation Health Services West Parry Sound Health and Social Services Support Network Parry Sound Health System CEO Round Table Timiskaming Health System CEO Roudn Table Timiskaming Appropriate Level of Care Working Group Finally, we would like to thank all the individuals who completed a survey, participated in telephone interviews or otherwise assisted in the collection of the most recent and most accurate data available. ii

4 The Aging at Home Strategy Seniors Residential/Housing Options Capacity Assessment and Projections was prepared by: The SHS Consulting team for this study was comprised of: Ed Starr, Principal Adene Kuchera, Research and Policy Analyst Cassandra Vink, Senior Research and Policy Analyst The study was prepared in association with: Balance of Care Research Group, University of Toronto Led by Dr. A. Paul Williams, Professor of Health Policy, Management and Evaluation University of Toronto Assisted by Kerry Kuluski and Jillian Watkins iii

5 Table of Contents Acknowledgements... i Table of Contents...iv Table of Contents...iv List of Tables... vii List of Figures...ix Executive Summary Introduction Study Background Study Goals and Objectives Study Approach and Methodology Study Format Study Area Sources of Information Current Demographic Context Population Characteristics Trends in Population Growth Trends in Age Distribution Population Projections Income Analysis Household Income Individual Income Incidence of Low Income Housing Analysis Trends in Dwelling Types Trends in Tenure Housing Affordability Housing Condition Health Characteristics Activity Limitations Cultural and Language Characteristics Summary Analysis of Current Capacity of Seniors Residential / Housing Options Current Seniors Housing Supply Long-Term Care Beds Retirement Home / Assisted Living Units Seniors Supportive Housing Units Convalescent Care Beds Residential Hospice Beds Other Seniors Social Housing iv

6 3.1.7 Summary of Current Seniors Housing Supply Current Seniors Housing Demand Long-Term Care Beds Retirement Home / Assisted Living Units Seniors Supportive Housing Units Convalescent Care Beds Residential Hospice Beds Other Seniors Housing Gaps in Current Seniors Housing Capacity A Profile of Long-Term Care in the North East LHIN Long-Term Care Facilities Long-Term Care Home Residents Projections of Future Capacity of Seniors Residential / Housing Options Status Quo Scenario Future Seniors Housing Demand Methodology Assumptions and Limitations Status Quo Projections Long-Term Care Beds Retirement Home / Assisted Living Units Seniors Supportive Housing Units Convalescent Care Beds Residential Hospice Beds Projections of Future Capacity of Seniors Residential / Housing Options Balance of Care Scenario Balance of Care Model Key Findings from Previous Balance of Care Projects in Ontario Data and Methods Overall Findings CCAC Long-Term Care Waitlist Clients Vignettes and Home and Community Care Packages The Potential for Supportive Housing Supportive Housing Care Packages and Cost Estimates Summary of Diversion Rates for Home and Community Care Packages and Supportive Housing Equivalents General Conclusions from the Balance of Care Project Balance of Care Projections Long-Term Care Beds Seniors Supportive Housing Units Summary of Balance of Care Projections v

7 6.0 Future Challenges and Opportunities for Service Development Challenges and Barriers to Meeting Seniors Housing Needs Bricks and Mortar Challenges Program and Operating Challenges Demographic Challenges Health Challenges Lack of Awareness and Understanding About Programs and Services Lack of Communication and Co-ordination Between Agencies The Role of Prevention Often Overlooked Hospice and Convalescent Care Needs Opportunities for Service Development Formalize a Seniors Supportive Housing Program Advocate for Increased Capital Funding and On-going Support Service Funding Examine the Feasibility of Converting Surplus Schools into Supportive Housing Promote Cluster Developments / Continuing Care Communities Pilot the Abbeyfield Form of Seniors Supportive Housing Promote More Specialized Long-Term Care Homes Promote Seniors Housing Initiatives in Aboriginal Communities Encourage Expansion of Federal Housing Assistance Programs Expand Funding for Hospices and Convalescent Care Facilities Expand Funding for Preventative Programs Explore Portable Rent Subsidies/Housing Allowances for Seniors Expand Training Programs for Personal Support Workers Promote Volunteering Improve Linkages with Retirement Homes Launch Public Education Program for Seniors Next Steps and Recommendations Appendix A Appendix B vi

8 List of Tables Table 1: Population Trends by Planning Area in the North East LHIN, Table 2: Population Trends by Age by Planning Area in the North East LHIN, Table 3: Population Projections by Planning Area for the North East LHIN, Table 4: Percentage Change in Projected Population by Planning Area in the North East LHIN, Table 5: Projected Population by Age, North East LHIN, Table 6: Summary of Supply of Long-Stay Long-Term Care Beds by Planning Area in the North East LHIN, Table 7: Number of Individuals Aged 65 Years and Older Per Long-Stay Long- Term Care Bed by Planning Area in the North East LHIN...38 Table 8: Number of Individuals Aged 75 Years and Older Per Long-Stay Long- Term Care Bed by Planning Area in the North East LHIN...38 Table 9: Percentage of Interim Beds by Planning Area in the North East LHIN, Table 10: Percentage of ELDCAP Beds by Planning Area in the North East LHIN, Table 11: Summary of Supply of Retirement Home Beds/Suites by Planning Area in the North East LHIN, Table 12: Summary of Supply of Seniors Supportive Housing Units by Planning Area in the North East LHIN, Table 13: Summary of Supply of Convalescent Care Beds by Planning Area in the North East LHIN, Table 14: Summary of Supply of Residential Hospice Beds by Planning Area in the North East LHIN, Table 15: Summary of Supply of Seniors' Social Housing Units by Planning Area in the North East LHIN, Table 16: Summary of Supply of Various Forms of Seniors Housing in the North East LHIN, Table 17: Number of Clients in the Community or Hospital Awaiting Placement into a Long-Stay Long-Term Care Bed by Planning Area in the North East LHIN, October Table 18: Number of Individuals or Couples on Waiting Lists for Retirement Homes by Planning Area in the North East LHIN, October Table 19: Summary of Waiting Lists for Seniors Supportive Housing by Planning Area in the North East LHIN, October Table 20: Demand for Non-Residential Hospice Services by Planning Area in the North East LHIN, October Table 21: Summary of Waiting Lists for Seniors Social Housing by Planning Area in the North East LHIN, October vii

9 Table 22: Summary of Estimated Current Gap in Supply of Various Seniors' Housing Forms in the North East LHIN, Table 23: Percentage of Long-Term Care Homes Who Responded to Survey...53 Table 24: Occupancy Rates for Long-Term Care Homes by Planning Area in the North East LHIN, Table 25: Long-Term Care Home Placements by Planning Area in the North East LHIN, Table 26: Summary of Long-Stay Long-Term Care Projections by Sub-Planning Area in the North East LHIN, Status Quo Scenario, Table 27: Summary of Retirement Home Bed/Suite Projections by Planning Area in the North East LHIN, Table 28: Summary of Seniors Supportive Housing Demand by Planning Area in the North East LHIN, Status Quo Scenario, Table 29: Summary of Convalescent Care Projections by Sub-Planning Area in the North East LHIN, Table 30: Summary of Hospice Bed Projections by Sub-Planning Area in the North East LHIN, Table 31: Summary of Measures of Needs for Long-Term Care Applicants in the North East LHIN, October Table 32: Summary of "High Needs" and "Low Needs" Long-Term Care Applicants in the North East LHIN, October Table 33: Summary of Costs and Diversion Rates for Home and Community Care Services and Supportive Housing Providers in the North East LHIN...89 Table 34: Summary of Long-Stay Long-Term Care Bed Projections by Sub- Planning Area in the North East LHIN, Balance of Care - High Diversion Scenario, Table 35: Summary of Long-Stay Long-Term Care Bed Projections by Sub- Planning Area in the North East LHIN, Balance of Care - Medium Diversion Scenario, Table 36: Summary of Long-Stay Long-Term Care Bed Projections by Sub- Planning Area in the North East LHIN, Balance of Care - Low Diversion Scenario, Table 37: Diversion Rates for the Balance of Care Scenario by Planning Areas in the North East LHIN...96 Table 38: Summary of Seniors' Supportive Housing Unit Projections by Planning Area in the North East LHIN, Balance of Care - High Diversion Scenario, Table 39: Summary of Seniors' Supportive Housing Unit Projections by Planning Area in the North East LHIN, Balance of Care - Medium Diversion Scenario, Table 40: Summary of Seniors Supportive Housing Unit Projections by Planning Area in the North East LHIN, Balance of Care - Low Diversion Scenario, Table 41: Summary of Beds/Units Required, Balance of Care Scenario, viii

10 List of Figures Figure 1: Seniors Housing Continuum... 6 Figure 2: Map of the North East LHIN and its Planning Areas... 9 Figure 3: Trends in Age Distribution in the North East LHIN, Figure 4: Comparison of Age Distributions by Planning Area in the North East LHIN, Figure 5: Projected Age Distribution in the North East LHIN, Figure 6: Comparison of Projected Age Distributions by Planning Area in the North East LHIN, Figure 7: Trends in Average and Median Household Income the North East LHIN, Figure 8: Trends in Distribution of Household Income in the North East LHIN, Figure 9: Comparison of Average and Median Individual Income by Planning Area in the North East LHIN, Figure 10: Comparison of Average and Median Individual Income by Age Group in the North East LHIN, Figure 11: Trends in Distribution of Individual Income in the North East LHIN, Figure 12: Trends in Individual Income of Seniors by Income Range in the North East LHIN, Figure 13: Trends in Low Income Population by Age in the North East LHIN, Figure 14: Trends in Percent Incidence of Low Income in the North East LHIN, Figure 15: Distribution of Dwelling Types by Age of Individual in the North East LHIN, Figure 16: Tenure by Age of Individual in the North East LHIN, Figure 17: Proportion of Income Spent on Housing by Age of Individual in the North East LHIN, Figure 18: Percentage of Dwellings in Need of Repair by Age of Individual in the North East LHIN, Figure 19: Percentage of Dwellings in Need of Repair by Planning Area in the North East LHIN, Figure 20: Percentage of Persons with Activity Limitations by Age of Individual in the North East LHIN Figure 21: Distribution of Aboriginal and Non-Aboriginal Identity Population by Age in the North East LHIN, Figure 22: Distribution of Aboriginal and Non-Aboriginal Identity Population by Planning Area in the North East LHIN, Figure 23: Official Language Spoken by Individuals 55 Years of Age and Older by Planning Area in the North East LHIN, Figure 24: Bed Type Distribution in Long-Term Care Homes by Planning Area in the North East LHIN, ix

11 Figure 25: Age Distribution in Long-Term Care Homes by Planning Area in the North East LHIN, Figure 26: Relationship Status of Long-Term Care Home Residents by Planning Area in the North East LHIN, Figure 27: Percentage of Long-Term Care Residents Receiving Rate Reductions by Planning Area in the North East LHIN, Figure 28: Average CMI of Long-Term Care Homes by Planning Area in the North East LHIN, Figure 29: Trends in the Proportion of Seniors Living in Institutions, , and Projections for x

12 Executive Summary The Aging at Home Strategy Seniors Residential/Housing Options Capacity Assessment and Projections study has been carried out by the (North East LHIN) to look at the current and future need of seniors for longterm care, retirement or assisted living, and supportive housing. As an introduction to the report, Section 1 outlines the study s background and objectives, and its approach and methodology. Following this, Section 2 provides an extensive examination of demographic characteristics of the seniors population in the North East LHIN service area. The data contained in this section demonstrate that seniors comprise a rapidly growing segment of the population in the North East LHIN. The analysis shows that there are currently 90,985 persons age 65 and over in the area, representing 16.5% of total population. Ministry of Finance projections indicate that this population is expected to increase by 78% over the next 25 years to 162,260 by the year At the same time, the remaining and younger segments of the population are expected to decline by more than 60,000 persons. While some minor differences were observed among the Planning Areas comprising the North East LHIN service area, in general these trends were consistent across the entire area. The projections mean that persons 65 years of age or older are expected to represent 29.1% of the total population by 2031, or nearly one in every three persons. Furthermore, the most rapidly growing portion of the seniors population is those who are 75 years of age or older. This age category is expected to increase by 84% during the next 25 years and nearly double its share of total population from 7.2% in 2006 to 13.2% in The anticipated rapid increase in the seniors population means that ongoing efforts are needed to increase the supply of housing options that are most suited to the needs of this growing population, and especially those in the more elderly age groups. A particular concern is ensuring that the range of housing options available to the seniors population is affordable for the many seniors of modest means across the North East LHIN is vital. The data on activity limitations highlight the fact that a substantial number of seniors may be able to continue to live in their existing home, provided a suitable range of supportive services are available, and that these services are able to keep pace with the forecasted growth in the seniors population. As described in Section 3, an analysis of the supply of seniors housing options with various levels of support finds a total of 7,245 beds or units across the North East LHIN, as is shown in the table below. 1

13 Given the current population of persons aged 65 years or more, this total means that there is one bed or unit for every 12.6 Housing Form Long-term care beds Supply 4,766 seniors in the North East LHIN service area. Retirement home beds/suites 1,896 In terms of individuals 75 years or more, Supportive housing units 533 there is one bed or unit for every 5.4 individuals. Convalescent care beds 30 Residential hospice beds 20 This figure does not account for current Total Supply 7,245 gaps such as the number of individuals or couples on the waiting list for each form of accommodation. When these figures are taken into account, the overall need for seniors housing options grows, as detailed in the table below. Housing Form Current (2008) Demand Estimate Current (2008) Gap Estimate Long-term care beds 6,599 1,833 Retirement home beds/suites 2, Supportive housing units Convalescent care beds Residential hospice beds Total Demand 9,379 2,134 In order for the supply of seniors housing to simply keep pace with projected growth in the seniors population, an increase of 8,409 beds or units over the next 25 years, or an average addition of 336 per year, would be required across the North East LHIN s Planning Areas. These Status Quo projections based on current patterns of eligibility and placement are explored in Section 4 of the report, and are summarized in the table below. Projected (2031) Demand Estimate, Status Quo Scenario Additional Beds/Units Required By 2031, Status Quo Scenario Current (2008) Housing Form Supply Long-term care beds 4,766 10,821 6,055 Retirement home beds/suites 1,896 3,575 1,679 Supportive housing units 533 1, Convalescent care beds Residential hospice beds Total Demand 7,245 15,654 8,409 2

14 Given the predominance of long-term care beds within the current supply, maintaining current practices would give rise to projections calling for the bulk of the need to be met through expansions to the supply of long-term care beds an additional 6,055 beds by As investigated in Section 5 of the report however, a Balance of Care analysis illustrates how a considerable portion of future need for long-term care could potentially be met through the addition of supportive housing units. More specifically, between 32% and 69% of individuals awaiting placement in a longterm care home could have their housing needs met through a supportive housing setting. The table below summarizes the number of beds or units that would be required by 2031 based on the Balance of Care high, medium and low diversion scenarios. Projected (2031) Demand Estimate, Balance of Care Scenario High Diversion Projected (2031) Demand Estimate, Balance of Care Scenario Medium Diversion Projected (2031) Demand Estimate, Balance of Care Scenario Low Diversion Current (2008) Housing Form Supply Long-term care beds 4,766 3,433 4,407 7,358 Retirement home beds/suites 1,896 3,575 3,575 3,575 Supportive housing units 533 8,488 7,514 4,563 Convalescent care beds Residential hospice beds Total Demand 7,245 15,654 15,654 15,654 Expanding the supportive housing supply would both provide a living environment preferred by most seniors and also enable needs to be met at a significantly reduced operating cost compared to the cost of expanding the supply of a similar number of long-term care beds. Current clusters of seniors housing units could be the location for future seniors supportive housing units. The report concludes in Section 6 by looking both at the wide range of challenges and barriers to be addressed in meeting the seniors housing needs as outlined in the report, and at a variety of opportunities and approaches that could be attempted to meet the seniors housing requirements of the future. 3

15 1.0 Introduction 1.1 Study Background The (North East LHIN) was established in March 2006 with a mandate to locally lead the transformation of the health system. It has the responsibility of planning, funding and coordinating over 200 health care services in the North East, a geographic area covering some 400,000 square kilometres with a population of more than 551,000 individuals. More than 60% of the people living in the North East LHIN are located within the boundaries of the urban areas of the City of Greater Sudbury, Sault Ste. Marie, North Bay and Timmins. The remaining 38% are spread out in small towns and in rural and isolated communities through the vast area encompassed by the North East LHIN. With the highest number of French-speaking communities in the province, and with Aboriginal and First Nations communities comprising a significant proportion of the population, the North East LHIN is culturally and linguistically distinct and vibrant. That said, it is also faced with a number of challenges when compared to the province as a whole, including higher rates of unemployment, fewer high school graduates, and more families living below the low-income cut-off. The population of the North East LHIN also has an older age structure than most areas of Ontario, and similar to LHINs across the province this elderly population is growing at a significant rate. The care and accommodation of this increasingly aged population today, and even more so in the future, is a key focus for all LHINs. The North East LHIN s ALC Task Force Report (December 2007), ALC Action Plan (December 2007) and Aging at Home Strategy Direction Place (October 2007), specifically point to the need for adequate and appropriate housing options for seniors across the North East. Correspondingly, this report was commissioned by the North East LHIN to look at the current and future need of seniors in terms of their need for long-term care, retirement or assisted living, and supportive housing. Although only one section of the overall spectrum of housing needs of a community, it is a critical gap in the current range of options for a growing portion of the population and significantly affects the functioning of the health care system and need for health resources. 4

16 1.2 Study Goals and Objectives The overall purpose of the study is to present a report that assesses current seniors housing needs and options within the North East LHIN, and which outlines future requirements at the local level for the range of services needed. The overall key objectives include the following: Inventory of current seniors housing capacity Analysis of current and future long-term care bed requirements Assessment of the potential for expanding the role of seniors supportive housing in meeting the residential and care needs of the seniors population Identification of local challenges and opportunities for the range of seniors housing development required in the future 1.3 Study Approach and Methodology This study provides a comprehensive review of the residential options for seniors in the North East LHIN currently, and provides seniors housing demand projections. Informing the study is an understanding of seniors housing as an integral part of the overall housing continuum for a community, as well as a belief that seniors housing options on their own should be seen within the context of a continuum as well. This is demonstrated in the following diagram, which takes a general housing continuum for a population or community that is organized from left to right based on affordability, and transposes the relevant portions of it into a continuum of housing for seniors that is based on the level of care required. 5

17 Figure 1: Seniors Housing Continuum Sources: Adapted from Steve Pomeroy, Leaks in the Roof, Cracks in the Floor: Identifying Gaps in Canada s Housing System, 2004; adapted from Mawby, 2004; modified by D. Plumstead, Nipissing DSSAB. Seniors Housing Continuum adapted from a model developed by Allison Jones, The Role of Supportive Housing for Low-Income Seniors in Ontario, This Seniors Housing Continuum incorporates the range of housing options for seniors in the North East LHIN and depicts an integration of social housing, health care and community supports. Although the Seniors Housing Continuum demonstrates a progression based on level of care generally, it is not necessarily the case that individuals experience each housing option. For instance, some seniors particularly low-income seniors may move from supportive housing directly into long-term care. 6

18 1.3.1 Study Format This study involves the collection and analysis of various forms of information about the people and communities of the North East, with a particular focus on the portion of the population that is 55 years of age or older along with their housing needs and opportunities. The report is correspondingly organized as follows: Current Demographic Context: o This section is broken down to provide details about the current demographic context of the North East LHIN, including its population characteristics, an analysis of household and individual income, an analysis of current housing, health characteristics, and cultural and language characteristics. These areas of analysis are examined with a focus on the senior population. Analysis of Current Capacity of Seniors Residential/Housing Options: o This section takes a detailed look at the current seniors housing supply including long-term care beds, retirement home/assisted living units, seniors supportive housing, convalescent care beds and residential hospice care beds. It also takes a look at the waiting lists for each of these housing types, and highlights the gaps in the current seniors housing capacity. Projections of Future Capacity of Seniors Residential/Housing Options: o This section of the report examines how the North East LHIN can meet the needs for seniors housing in the coming years. It does this in two ways: in the first place, it looks at the need for longterm care beds, retirement home/assisted living units, seniors supportive housing units and convalescent care beds, within a status quo scenario. More significantly, however, it provides an in-depth analysis into looking at future seniors housing needs in a Balance of Care scenario whereby projections will show the potential for diversion of individuals from long-term care to supportive housing if the services were available. Future Challenges and Opportunities for Service Development: o This final section highlights the North East LHIN s challenges and barriers that need to be overcome in order to achieve the goal of providing adequate seniors housing options, and explores the opportunities for service development in this area. Much of this section was informed by the Expert Panel, or key informant, consultation sessions. 7

19 1.3.2 Study Area The study area for this report is the North East Local Health Integration Network. Findings and recommendations are presented at the overall North East LHIN area and at the level of the LHIN s Planning Areas. These Planning Areas generally correspond to Statistics Canada s Census Division areas, and include: Algoma Planning Area Cochrane Planning Area James and Hudson Bay Coasts Planning Area Manitoulin-Sudbury Planning Area 1 Nipissing Planning Area Parry Sound Planning Area Timiskaming Planning Area Due to limited availability of data for communities in the James and Hudson Bay Coasts Planning Area, it has not been possible to present any detailed findings or analysis of this Planning Area. 2 In addition to analysis at the Planning Area level, details are also provided at the sub-planning Area level, so as to capture both similarities and disparities within the large area. It also allows for comparison between the urban centres across the LHIN and less populated areas. The Planning Areas are sub-divided as follows: Algoma: o Sault Ste. Marie Census Agglomeration Includes Laird Township, Macdonald, Meredith and Aberdeen Additional Township, Prince Township, City of Sault Ste. Marie, Garden River 14 Indian Reserve, and Rankin Location 15D Indian Reserve o City of Elliot Lake o Other Parts of Algoma Cochrane: o Timmins Census Agglomeration o Other Parts of Cochrane 1 Unlike the other Planning Areas which are aligned with Statistics Canada Census Divisions, the Manitoulin-Sudbury Planning Areas is actually composed of three: Manitoulin District, Greater Sudbury Census Division, and Sudbury District. 2 See Appendix Table 1 for population figures for the communities within the James and Hudson Bay Coasts Planning Area. Note, however, that the data for the Cochrane District or Planning Area includes the town of Moosonee and Moose Factory First Nation. The portion that is in the Kenora District is not included. 8

20 Manitoulin-Sudbury: o City of Greater Sudbury o Other Parts of Manitoulin-Sudbury Nipissing: o North Bay Census Agglomeration Includes the Townships of Bondfield and East Ferris, the City of North Bay and the Municipality of Callander 3 o Other Parts of Nipissing Parry Sound: o Town of Parry Sound o Other Parts of Parry Sound Timiskaming: This Planning Area is not sub-divided The following figure illustrates the study area. Figure 2: Map of the North East LHIN and its Planning Areas Source: 3 It should be noted that although the Municipality of Callander is included in the North Bay Census Agglomeration, it is located within the Parry Sound Planning Area. The data for Other Parts of Nipissing in the figures and tables in the report that are based on Statistics Canada data, have been calculated as the Nipissing Planning Area minus the North Bay Census Agglomeration. As a result of this inclusion, the total numbers in these figures and tables for Other Parts of Nipissing are lower than in reality. 9

21 1.3.3 Sources of Information In preparing the Capacity Assessment and Projections Report, a range of data and research resources were consulted, including the following: Surveys to long-term care homes, retirement homes, supportive housing service agencies Focus group or interview sessions with Expert Panels within each Planning Area 4 Review of data and reports identified by the North East LHIN and key stakeholders In depth analysis of Statistics Canada Census, Community Profile data from 1996, 2001 and 2006 In depth analysis of additional Statistics Canada custom tabulated data for 1996, 2001 and 2006 Consultation with the North East LHIN Seniors Housing Project Advisory Committee for the study 4 Expert Panels included Alternate Level of Care Working Groups, long-term care and retirement home administrators, District of Social Service Administration Boards staff, and others familiar with seniors housing needs. 10

22 2.0 Current Demographic Context The need for various forms of seniors housing across the North East LHIN service area is largely a function of current and future demographic trends within this segment of the population 5. Below we review these trends and comment on their impact on the need for senior citizen housing across the North East LHIN. The section highlights some of the key data relied upon for observations and conclusions. More detailed data is provided in Appendix A. 2.1 Population Characteristics The size and characteristics of the seniors population form the basic foundation in determining the demand for various forms of senior citizen housing. Below we describe these characteristics in the communities comprising the North East LHIN Trends in Population Growth Table 1 below outlines overall population trends across the North East LHIN service area from 1991 to The table shows that overall population declined by some 30,000 individuals (5.3%) during this time period. The decline occurred almost entirely from 1996 to 2001, then levelled off between 2001 and The latter time period, in fact, has seen some modest upswings in population in some of the larger urban centres, such as Sault Ste. Marie, Greater Sudbury and North Bay. Discussions with key informants indicate that the declines in population across the area in the mid-to-late 1990s were the result of both demographic factors, such as declining birth rates, and economic factors, such as the outmigration of youth due to a lack of local job opportunities. A rebounding economy, especially in the resource sector, has contributed to slight upswings in population in many urban centres since that time, with the exception of Timmins, Elliot Lake and Parry Sound, which have continued to decline. Interestingly, while most rural areas and smaller urban centres have experienced declines in population since 1991, those in the Nipissing and Parry Sound Planning Areas have actually experienced growth. Discussions with key informants indicate that much of this growth may be attributable to the growing reputation of these areas as retirement communities, which is attracting many seniors from outside the area. 5 For the purposes of this section of the study, senior citizens are considered to be individuals aged 65 years or older. 11

23 Table 1: Population Trends by Planning Area in the North East LHIN, Population Location Sault Ste. Marie 85,008 83,619 78,908 80,098 Elliot Lake 14,089 13,588 11,956 11,549 Other Parts of Algoma 28,172 28,248 27,703 25,814 Algoma Planning Area 127, , , ,461 Timmins 47,461 47,499 43,686 42,997 Other Parts of Cochrane 46,456 45,741 41,561 39,506 Cochrane Planning Area 93,917 93,240 85,247 82,503 Greater Sudbury 161, , ,909 Other Parts of Manitoulin-Sudbury 37,370 35,578 35,573 34,482 Manitoulin-Sudbury Planning Area 198, , , ,391 North Bay 65,222 64,785 62,303 63,424 Other Parts of Nipissing 19,501 20,047 20,607 21,264 Nipissing Planning Area 84,723 84,832 82,910 84,688 Town of Parry Sound 6, ,124 5,818 Other Parts of Parry Sound 32,298 33,559 33,541 35,100 Parry Sound Planning Area 38,423 39,885 39,665 40,918 Timiskaming Planning Area 38,983 37,807 34,442 33,283 North East LHIN 581, , , ,244 Percentage Increase Location Sault Ste. Marie -1.6% -5.6% 1.5% -4.2% Elliot Lake -3.6% -12.0% -3.4% -15.0% Other Parts of Algoma 0.3% -1.9% -6.8% -8.6% Algoma Planning Area -1.4% -5.5% -0.9% -6.4% Timmins 0.1% -8.0% -1.6% -9.5% Other Parts of Cochrane -1.5% -9.1% -4.9% -13.6% Cochrane Planning Area -0.7% -8.6% -3.2% -11.5% Greater Sudbury 2.6% -6.1% 1.7% -4.5% Other Parts of Manitoulin-Sudbury -4.8% 0.0% -3.1% -3.1% Manitoulin-Sudbury Planning Area 1.2% -5.0% 0.8% -4.3% North Bay -0.7% -3.8% 1.8% -2.1% Other Parts of Nipissing 2.8% 2.8% 3.2% 6.1% Nipissing Planning Area 0.1% -2.3% 2.1% -0.2% Town of Parry Sound 3.3% -3.2% -5.0% -8.0% Other Parts of Parry Sound 3.9% -0.1% 4.6% 4.6% Parry Sound Planning Area 3.8% -0.6% 3.2% 2.6% Timiskaming Planning Area -3.0% -8.9% -3.4% -12.0% North East LHIN 0.0% -5.2% -0.1% -5.3% 12

24 Source: Statistics Canada, Community Profiles, 1996, 2001, and 2006 An examination of senior citizen population trends finds patters that are much different. Custom Census tabulations provided by Statistics Canada for this study provide a breakdown of population trends among individuals age 55 and over in each Planning Area from 1996 to 2006, as shown in Table 2 below. 13

25 Table 2: Population Trends by Age by Planning Area in the North East LHIN, Location Age Range # % Change # % Change # % Change , % 14, % 16, % Algoma Planning Area Cochrane Planning Area Manitoulin- Sudbury Planning Area Nipissing Planning Area Parry Sound Planning Area Timiskaming Planning Area North East LHIN , % 11, % 12, % 75 years and over 6, % 7, % 9, % Total 30, % 33, % 38, % , % 8, % 9, % , % 6, % 6, % 75 years and over 3, % 4, % 5, % Total 17, % 18, % 21, % , % 20, % 24, % , % 15, % 16, % 75 years and over 8, % 10, % 12, % Total 43, % 47, % 54, % , % 9, % 10, % , % 7, % 7, % 75 years and over 4, % 5, % 5, % Total 19, % 21, % 24, % , % 5, % 6, % , % 4, % 4, % 75 years and over 2, % 3, % 3, % Total 12, % 13, % 15, % , % 3, % 4, % , % 3, % 3, % 75 years and over 2, % 2, % 2, % Total 9, % 9, % 10, % , % 61, % 73, % , % 48, % 51, % 75 years and over 28, % 33, % 39, % Total 132, % 143, % 164, % Source: Statistics Canada, Census 1996, 2001, and 2006 Table 2 shows that population age 55 and over has been increasing steadily over time. In particular, the Table shows that total population age 65 and over in the North East LHIN increased from 74,495 in 1996 to 90,985 in 2006, an increase of 16,490, or 22.1%, as compared to the overall population decline of 5.3% observed across the LHIN during this time period. 14

26 A closer look at these trends finds that individuals age 75 and over are, in fact, the most rapidly growing segment of the population. While the population age increased by 11.0% from 1996 to 2006 (an increase of 5,060 individuals), population age 75 and over increased by 40.1% (an increase of 11,430 individuals). This rapid increase in the more elderly segment of the seniors population is highly significant in terms of a rapidly growing need to expand the supply of housing where supports are provided, as the need for support services for the seniors population increases significantly with age. Table 2 also shows that these trends are consistent in virtually all Planning Areas, with some exceptions. The Algoma Planning Area (which contains Elliot Lake) saw an increase of 31.0% in population age 65 and over from by far the highest of any Planning Area. Population age 75 and over in the Algoma Planning Area increased by 56.7% during this time period also the most rapid growth of any area. This rapid growth of more elderly seniors points to the particular need within Algoma (especially in Elliot Lake) to ensure the range of supports required by a more elderly seniors population expands quickly to keep pace with growth. Conversely, the Timiskaming Planning Area experienced only an 8.1% increase in population age 65 and over during this time period. This slower growth in seniors population may be due to the movement of many seniors to other areas with more seniors housing options. Discussions with key informants found that there were extensive waiting lists for seniors housing in the Timiskaming Planning Area, leaving seniors with few suitable local housing options Trends in Age Distribution The growth of seniors population in virtually all areas of the North East LHIN over time has led to an increasing proportion of elderly persons throughout the area. Figure 3 below shows that the proportion of population age increased from 7.9% in 1996 to 9.3% in 2006 and the proportion age 75+ increased from 4.9% to 7.2% during this time period. Accordingly, persons age 65 and over now comprise 16.5% of the total population of the North East LHIN (one in every six persons) a significant growth from the 12.5% figure found in This growth is giving rise to increasing pressure on a range of services for seniors, particularly housing. 15

27 Figure 3: Trends in Age Distribution in the North East LHIN, Percent of Population 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 27.6% 25.7% 23.2% 20.5% 16.7% 16.2% 16.1% 16.5% 14.1% 13.0% 15.2% 16.6% 9.9% 11.2% 13.4% 7.9% 8.8% 9.3% 4.9% 6.1% 7.2% 0.0% Age Groups Source: Statistics Canada, Community Profiles, 1996, 2001, 2006 Note: Further details are provided in Appendix Table 2. While the growing proportion of seniors is evident in all Planning Areas, there are some differences from area to area. The Planning Area with the greatest proportion of persons age 65+ is Parry Sound, where seniors comprise 21.0% of the total population (more than one out of every five persons). This observation confirms the growing role of the Parry Sound area as a retirement community. The Algoma Planning Area, at 19.0%, is also much higher than the North East LHIN average (which is largely a function of the presence of Elliot Lake within this Planning Area). The two Planning Areas with the lowest proportions of population age 65 and over are Cochrane, at 13.7%, and Manitoulin-Sudbury, at 15.0%. 16

28 Figure 4: Comparison of Age Distributions by Planning Area in the North East LHIN, % 8.4% 6.1% 6.5% 6.9% 8.9% 7.9% 7.1% 90% 7.6% 8.5% 10.6% 9.0% 12.1% 10.2% 9.3% 80% 11.9% 13.0% 13.0% 14.1% 14.5% 13.4% 70% 16.9% Percent of Population 60% 50% 40% 74.4% 67.0% 72.1% 71.1% 30% 62.0% 67.4% 70.2% 20% 10% 0% Population Projections Location Less than and over Source: Statistics Canada, Census, 2006 Note: Further details are provided in Appendix Table 3 While recent trends have seen an increase in the population age 65 and over across the North East LHIN, forecasts prepared by the Ontario Ministry of Finance 6 indicate that these trends are expected to intensify over time. Table 3, Table 4 and Table 5 below show that, while the total population of the North East LHIN service area is projected to remain virtually constant over the next 25 years (projected to grow from 551,280 in 2006 to 556,390 in 2031 a 0.9% total increase), the population age 65 and over is projected to increase from 90,985 to 162,260 an increase of 71,275 seniors, or 78.3%. Of particular significance is the projection that population in the more elderly age group (75 and over) is expected to grow from 39,905 in 2006 to 73,710 an increase of 84.7%. As noted previously, the need for specialized forms of accommodation and supports increases significantly with age, so this rapid growth in more elderly population will place particular pressure on such resources across the North East LHIN. This projection also finds that the population within the age groups below 65 is actually expected to decline by 66,165 during this time period. Accordingly, by 6 Ontario Ministry of Finance Population Projections by Age,

29 2031, it is projected that persons age 65 and over will comprise 29.1% of the total North East LHIN population almost one of every three persons and almost double the 2006 level of 16.5%. The impact on housing needs of this pronounced shift in age distribution across the North East LHIN will be profound. The magnitude of this shift points to the urgency of moving to address these impacts as soon as possible. Table 3: Population Projections by Planning Area for the North East LHIN, Population Location Sault Ste. Marie 80,095 80,583 79,498 78,728 78,128 77,432 Elliot Lake 11,535 11,605 11,449 11,338 11,252 11,152 Other Parts of Algoma 25,835 25,992 25,643 25,394 25,200 24,976 Algoma Planning Area 117, , , , , ,560 Timmins 42,980 42,152 40,720 39,568 38,506 37,485 Other Parts of Cochrane 39,540 38,778 37,460 36,402 35,424 34,485 Cochrane Planning Area 82,520 80,930 78,180 75,970 73,930 71,970 Greater Sudbury 157, , , , , ,240 Other Parts of Manitoulin-Sudbury 34,490 35,210 34,980 34,940 35,020 35,010 Manitoulin-Sudbury Planning Area 192, , , , , ,250 North Bay 63,425 63,964 64,930 65,866 66,772 67,461 Other Parts of Nipissing 21,275 21,456 21,780 22,094 22,398 22,629 Nipissing Planning Area 84,700 85,420 86,710 87,960 89,170 90,090 Town of Parry Sound 5,820 6,239 6,476 6,747 7,006 7,212 Other Parts of Parry Sound 35,095 37,621 39,054 40,683 42,244 43,488 Parry Sound Planning Area 40,915 43,860 45,530 47,430 49,250 50,700 Timiskiming Planning Area 33,275 32,310 31,450 30,830 30,340 29,820 North East LHIN 551, , , , , ,390 Source: Ontario Ministry of Finance Population Projections, 2007, based on original data from Statistics Canada Population Estimates for

30 Table 4: Percentage Change in Projected Population by Planning Area in the North East LHIN, Location Sault Ste. Marie 0.6% -1.3% -1.0% -0.8% -0.9% -3.3% Elliot Lake 0.6% -1.3% -1.0% -0.8% -0.9% -3.3% Other Parts of Algoma 0.6% -1.3% -1.0% -0.8% -0.9% -3.3% Algoma Planning Area 0.6% -1.3% -1.0% -0.8% -0.9% -3.3% Timmins -1.9% -3.4% -2.8% -2.7% -2.7% -12.8% Other Parts of Cochrane -1.9% -3.4% -2.8% -2.7% -2.7% -12.8% Cochrane Planning Area -1.9% -3.4% -2.8% -2.7% -2.7% -12.8% Greater Sudbury 3.0% 0.5% 0.5% 0.4% 0.1% 4.6% Other Parts of Manitoulin-Sudbury 2.1% -0.7% -0.1% 0.2% 0.0% 1.5% Manitoulin-Sudbury Planning Area 2.8% 0.3% 0.4% 0.4% 0.1% 4.1% North Bay 0.9% 1.5% 1.4% 1.4% 1.0% 6.4% Other Parts of Nipissing 0.9% 1.5% 1.4% 1.4% 1.0% 6.4% Nipissing Planning Area 0.9% 1.5% 1.4% 1.4% 1.0% 6.4% Town of Parry Sound 7.2% 3.8% 4.2% 3.8% 2.9% 23.9% Other Parts of Parry Sound 7.2% 3.8% 4.2% 3.8% 2.9% 23.9% Parry Sound Planning Area 7.2% 3.8% 4.2% 3.8% 2.9% 23.9% Timiskiming Planning Area -2.9% -2.7% -2.0% -1.6% -1.7% -10.4% North East LHIN 1.3% -0.3% 0.0% 0.1% -0.2% 0.9% Source: Ontario Ministry of Finance Population Projections, 2007, based on original data from Statistics Canada Population Estimates for 2007 Table 5: Projected Population by Age, North East LHIN, Age Group # % # % , % 377, % 354, % 327, % 320, % , % 81, % 88, % 87, % 73, % , % 55, % 66, % 81, % 88, % 75 years and over 39, % 43, % 47, % 61, % 73, % Total 551, % 558, % 556, % 557, % 556, % Sources: Statistics Canada, Census 2006, estimates, 2007, and projections of Ontario Ministry of Finance Figure 5 below shows the distribution of projected population by age over time and highlights the projection that over 42% of total North East LHIN population is expected to be age 55 and over in 2031, with 29.1% age 65 and over. 19

31 Figure 5: Projected Age Distribution in the North East LHIN, % 70% 60% 70.1% 63.7% 58.8% 57.7% Percentage 50% 40% 30% 20% 10% 13.4% 16.0% 15.6% 13.2% 9.3% 11.9% 14.5% 15.9% 7.2% 8.5% 11.1% 13.2% 0% and Over Age Group Source: Ontario Ministry of Finance Population Projections, 2007 based on original data from Statistics Canada Population Estimates for 2007 Note: Further details are provided in Appendix Table 4 As with current population trends, projected population shows somewhat different patterns among the Planning Areas comprising the North East LHIN. Whereas the population age 65 and over is projected to grow by 78.3% in the North East LHIN overall from 2006 to 2031, it is projected to grow by 99.0% in the Parry Sound Planning Area during this time period. Other areas where the seniors population is projected to grow more quickly than the North East LHIN overall are the Nipissing Planning Area (82.0%) and the Manitoulin-Sudbury Planning Area (81.8%). Conversely, the seniors population in the Timiskaming Planning Area is projected to grow by 56.0%, the least of any Planning Area. Interestingly, the growth of seniors population in the Algoma Planning Area is expected to be below the rate for the North East LHIN as a whole at 72.1%, despite the presence of Elliot Lake in that Planning Area. While the above observations show some differences from area to area, the implication of these projections is quite clear extensive growth in seniors population is expected in all parts of the North East LHIN and significant expansion in the supply of housing options for seniors will be required. 20

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