October 11, 2023 | Hosted by Leanne Kaufman
Learn about the potential costs of care as we age and ways to ensure your wealth plan can support your care plan
“Start thinking about what you want and discuss it with your significant family and others… We don't like to talk about our health and many of us don't want to for sure talk about death, but there's a lot between today and tomorrow, so we have to start thinking about those things.”
Hello, and welcome to Matters Beyond Wealth with your host, Leanne Kaufman, president and CEO of RBC Royal Trust. For most of us, talking about subjects like aging, late life, and estate planning isn’t easy. That’s why we’re going to help get the conversation started on this podcast while benefiting from the insights and expertise of some of the country’s top experts. We want to bring you information today that will help to protect you and your family in the future. Now, here’s your host, Leanne.
Canada’s seniors’ population, meaning those 65 and over, is expected to rise 68 percent over the next 20 years. This will have a multitude of social, economic and healthcare system implications. Caregiving is one of the industries that is already under significant demand, but demand will further expand with these shifting demographics. The cost of care can have a major impact on personal finances. For our aging population and for those who are or will be caregivers, it is increasingly important to have a care plan in place to help manage our own lives and those of our loved ones.
Hello, I’m Leanne Kaufman, and welcome to RBC Wealth Management Canada’s Matters Beyond Wealth. With me today is Audrey Miller, a registered social worker and Canadian Life Care Planner, with over 30 years of experience in counseling individuals and families on health and rehabilitation. She’s the founder and managing director of Elder Caring Inc., a consulting firm that provides direct care management services to seniors, their caregivers and families. Audrey also educates professionals in the legal and financial communities about aging issues and the needs of caregivers. She’s the author of hundreds of articles and blogs and is a partner to us at RBC.
Audrey joined us in an earlier episode to discuss aging at home safely and securely, and I’m delighted to welcome her back. Audrey, thanks for being here with me today to talk about the cost of care and why this matters beyond wealth.
Thanks so much, Leanne. I’m very happy to be back with you.
When you’re starting conversations with clients that you see about living and their caregiving options, as they, or maybe they’re talking about their parents, age, what are the top three questions that you might get asked?
Great place to start. I get asked lots of different things, but I would say the question that I get asked the most is, “How can I plan ahead to remain in my own home?” Many of us say, “I’m only leaving feet first.” So the question is, how do we keep them staying upright and alive and well in their own home?
Usually I start with prevention. I’m talking about things such as safety-proofing the home, exploring accessibility, ensuring good lighting. Talking about falls prevention, those little tripping hazards for example that can be removed. I’m also talking about the access to resources and community support because it can be lonely living in one’s own home, so we have to really look at the community at large. Who is their social support network? Who could step in if there was a problem, and provide both emotional and practical support?
I’m also talking to them about financial requirements, and always referring back to an advisor so they can look at what it’s going to cost to stay at home. I also suggest that they start educating themselves about their own illness progression. If they have one, and understanding what that might look like as their situation changes or their health deteriorates over time both from an emotional perspective as well as from a financial and practical perspective.
The second question I get asked is from the adult children. The first obviously was from the seniors who were wanting to remain at home in their own, and this is from the adult children. Many children start the conversation with, “My parents are very private, they don’t tell me anything. I’m so worried about them, but help. I know nothing. What can I do?” That’s very common, our parents tend to be private and many times they don’t want to share their concerns or their finances, or even what’s going on, on a day-to-day basis.
My response to them is about starting the conversation. I would say there’s always a good time to start the conversation. It might even be after listening to this podcast, where it triggers a couple of things to think about. Or you might say, “I’ve started to think about my own aging journey and I’d like to chat with you about some of the things I’m thinking about. Would you like to maybe share with me a little bit about some of your thoughts about how you want to live your life and how I can support you better in this?” It’s an opportunity, I think, to have them share their concerns and try and open the door.
I might also ask that they ask about paperwork. “I understand that you’ve asked me to be your attorney for personal care and I’m so thrilled, but where is that paperwork? What if I need it? What if something was to happen, where would I find that? Or more importantly, let’s have a conversation about your wishes. I know you want to stay at home, but how do I know when things aren’t going well for you?” So really try to open the door and have a little greater communication. I might even talk to them about the Wellness Binder, which is an information-keeping tool and allows the conversation to go back and forth for all the information to be recorded.
The third question that I get asked, and I’m asked this by both the seniors themselves and by the adult children, is about wait lists. “Tell me what wait lists look like.” People are always worried about having to get on a list. I think most times that’s not quite understanding what is the list. So the conversation might be a fuller explanation about what’s a retirement residence, for example, and why there might be a waitlist, but that might be only a few weeks or a month if you’re waiting for the corner suite. As compared to applying for long-term care, where for sure there’s very lengthy wait lists. So, there’s an education piece about understanding what is a waitlist, why do we want to be on a waitlist, and a waitlist for what exactly.
So education’s a big piece of the conversation. There are a few questions that I start my wellness consults with, or responses to their questions that I get asked pretty regularly.
Well, that’s great and I think we’ll be able to dive a little deeper into some of those topics as we continue to chat here. But before we do that, what do the demographics and your own observations from the clients you see say about how all of this is impacting women versus men, and what advice might you give to couples with that in mind?
Well, you’re right. Women typically outlive their male partners. Women are living to age 84, according to Stats Can, and men to age 80. So there could be a few years where we’re aging on our own. I guess the main thing is we don’t all age the same. We age differently and we have different needs. In my own family, my dad died at 69 after a very unpleasant, lengthy demise of his own health, yet my mom lived a good life until age 87. So, I think it’s important for couples to recognize they have different health needs, and certainly, I see lots of couples who have an age range between them. The 10-year difference between a man and a woman may not seem much in your 30s, 40s, or 50s, but as you enter your 70s and your 80s, and 80s and 90s, those 10 years make a big, big difference. And usually I see that for the gentleman living or being older than his [fe]male partner.
With couples I will have the “what if” conversation. If something happens to one of you, how will the other manage? Last week I met with a lovely couple, and she was 10 years younger than her husband and was a caregiver to him and was struggling with that. It was really the conversation about appreciating we’re at different needs, but how can both of you have your needs met. Where she may not have seen herself in a full-time caregiving role, so how can I help her deal with the emotional aspect of being a full-time caregiver, but also look at respite for her and other caregiving resources so perhaps she can have a regular break, or not have to take it on to the degree that she was feeling so overwhelmed by. So, really [it’s] about appreciating that we age differently, and that we both need to have our care needs met throughout the aging journey.
And then what about—I know you use the phrase “solo senior,” so either those who have lost a partner or maybe were never in that kind of a relationship, and maybe don’t have children or other close families to support them. Maybe they have children, but they’re at a distance. How are the considerations for those solo seniors different?
I think that’s a great question, Leanne. Certainly I’m seeing more and more solo seniors. Meaning exactly as you’ve described: those who by choice or circumstance find themselves on their own, and may have children but don’t have children living close by, or people who are involved in their lives, and are choosing to be on their own.
I think it’s really about understanding what makes you happy, and the distinction between being alone and being lonely. So, building a community. And I think women are usually better [at] this than men: [women are] happy to talk with their girlfriends in terms of what retirement or accommodation might look like for them. Many may not be seeing themselves going into regular retirement residences or long-term care and have a different vision, but its including the community. So, what are the supports available to you? I’ve seen many women start by having a phone tree—the, “Good morning, how are you? Oh, I didn’t hear from Mary. Let’s go check on Mary.” So we have to build this in if we don’t have it naturally.
And looking at your own community, we are in a generation today, [where] much is available online and that’s fantastic. Yet the other side of that is we don’t have a lot of interaction with people up close and personal. So what do we need? Really for each of us to think about what makes us happy. I read a beautiful article just this week in the newspaper, and it was a gentleman who lived by himself, but was talking about the love that he had in reading his books and listening to his music and not feeling lonely, by having these wonderful memories and then being able to share some of these memories with those who he chose to share it with.
But I think it’s really about moving towards more of an interdependent connectedness rather than being on our own all the time. We are social beings. We need people around us. Really it’s about ensuring that we have what makes us happy available to us, wherever that is. And for everybody, it’s different, but it’s thinking about it while we’re able to think about it, and ensuring that we build the community around us as we get older because these things do become more difficult.
Yeah, and it’s an important distinction between being alone and being lonely because we know how damaging being lonely can be, but just because someone’s alone, it doesn’t mean that they’re lonely.
Let’s talk about the cost of some of these different care options and living arrangements that you’ve touched on already. Earlier you were talking about people wanting to stay in their own homes and that might involve some accommodations or some maybe even remodeling. Then you’ve got further down the spectrum, retirement homes, before you get to something more like a long-term care. Can you just give us the Cook’s tour of some of the costs that could be expected?
Sure, and we’re looking a lot at people wanting to stay at home, and as I started this conversation, it’s about prevention and accessibility. So I’ll start with things like grab bars, safety in the bathroom. Grab bars, for example, no longer have to look like the industrial version, the metal bar. They’re really now beautifully decorated and they can match with your bathroom decor. They can really be very important so you’re not grabbing onto a towel rack when you lose your balance and ugh, the towel rack has now come out. There are companies who provide grab bars. Many of the home health divisions will provide grab bars, including the building stores. But two grab bars, for example, plus installation, I just received a quote for $375 for someone to come in and know where to put the grab bars—I think that’s an important piece. You might want to consider having an occupational therapist come in to assess your needs. If you’re of a very petite stature, for example, or if you’re very tall, the grab bar’s going to be in a different point to be able to support you as you’re trying to raise yourself off the toilet or hold onto something getting in and out of the shower. So grab bars are one simple one.
A bathtub conversion to a shower. Many of the falls occur in the bathroom, so one of the things we look at is ease of getting in and out of a bathtub or replacing the bathtub altogether. A survey says, national average was about $7,000 to actually do a bathtub to shower conversion. Big range there from 2,000 to 12,000 but that’s looking across Canada, and depending on if you’re cutting out a ledge or if you’re replacing it completely. You’re talking to a builder and you want your builder to ensure that they have knowledge in working with seniors so that it’s non-slip tread and all of those factors that have to be considered. So, I would say national average is $7,000 for a bathtub to shower conversion.
One of the other things that we often look at are stairs. Stairs can be a real detriment for people with mobility challenges, and many of the older homes don’t have a bathroom on the main floor. You might consider a stair glide, and a straight stair glide installed can run around $3,000, and can certainly increase from there if it’s curved or anything more fancy than that. Some of the curved indoor stair lifts, I’ve seen quotes about $9,500. Again, it will depend on what you’re after, what you like. Stair glide is one, certainly people could put in elevators, and I can’t even give you a ballpark on that. You’ve got to deal with a builder who’s knowledgeable in these areas.
Even changing the handles on the door so they’re easy to be opened. If one has challenges with their hands and fine motor [skills], then turning a handle is difficult, where you may want a different lever. So there’s certainly different things in building stores, and having a consultation with an occupational therapist to look at your ease of access and safety of getting in and out of the home are certainly important components of being able to make sure your home is safe for you. That’s the first, the physical look and safety of the home.
The other thing we would then look at is if you need assistance with your activities of daily living or instrumental activities of daily living. So from eating to bathing to doing the laundry or doing the cooking, then one might want to bring in either a companion or a personal support worker or a healthcare aid. Across Canada, we’re looking at an average of about $35 an hour, and I would say that’s at the low-end today. It’s going up certainly, but some provinces are lower and [are] able to keep that price lower. But in most major downtown busy cities, we’re probably closer to $40 an hour. And agencies will have a shift—two, three or four hours. This is all private pay, and I should really go back and say, start with your own provincial health authority, see what you might be eligible for and each province is different. You can access that information online, Google it, and find out who your provincial health authority is, put in your postal code and you’ll get the appropriate office. Then speak to them, see what you might be eligible for. That’s always the starting point.
But if you’re adding and wanting to supplement, then we’re looking at the cost of a private caregiver, which, as I say is, about $35 upwards per hour, going all the way up to 24 hours. It can be very costly. So, there may be a live-in option, some agencies will have an asleep option. Others, through the Temporary Foreign Workers Program, might be able to live in and do a sponsorship. It has to work for you, and that’s part of the exploration, so costs can vary. So that’s staying at home, Leanne, as option one, aging in place, living at home and bringing in care.
The next piece is what if I can’t stay at home? What if my care needs exceed what I can afford? Or I cannot put in that stair glide, it makes no sense for me to put in a stair glide for a year or two and not have access or whatever it might be. The resale value may be impacted, and you might decide, “No, I don’t want to do that $30,000 renovation now,” or whatever it might be. Then we might explore retirement residences, which are privately owned and operated, and most times you are signing a monthly tenant agreement and you have an opportunity from renting a bachelor to a two-bedroom. Some have kitchenettes, some have full kitchens. They will all have access to personal support workers on staff. They will all have activities and socialization. Most have meal plans from one to three meals a day. They have visiting doctors, some have bistros, hair salons, they have podiatrists who come in. So a full range can be made available from independent—where you’re just paying your monthly cost, which might also include housekeeping or daily tidying—all the way up to full care and might even include a specialized floor for those with memory impairment that is secure so no one can get off the floor unauthorized or on their own, to obviously prevent the risk of someone getting lost, with specialized activities for those with dementia.
So prices vary, again, location, location and amenities, and we have a beautiful big country so prices certainly vary from east to west. I would say on average, if we’re looking at a number, starting point might be $3,500 a month to the most expensive that I’ve seen today is $15,000 a month, and that’s for exclusive memory care. So a big range in there, and some of these retirement residences might be for-profit or they may be not-for-profit, run by a charitable organization. Some even offer shared space, which would be under the $3,500. If you’re on a lower income and you are more social and maybe like to have a shared accommodation, that too may be possible. So there’s lots of options out there.
Yeah, and I think just briefly, because this isn’t a topic we can really delve into with any…do it to any justice in the time we have left today, but paying for this isn’t something that we’ve historically considered when we’re doing our retirement planning or our financial planning. So, if you could just quickly give your thoughts on what kind of conversations should people be having with their financial professionals when they’re giving consideration to these issues for themselves or for their parents?
You’re right, traditionally banks haven’t looked at this, so I certainly applaud and support the Healthy Aging initiative and the ability to be able to sit down with your clients and explore what the next stage of life might look like. And that can be done in 10-year increments. The first parts of retirement, where we’re feeling great, we’ve got our health and we want to travel. And then maybe we look at the next 10 years, where maybe our health isn’t so good, we’re starting to see some issues. Or maybe our mobility’s impacted and we need a little bit more care.
Then certainly looking at the later stages, 80s and 90s, and we do know many are living into their 100s. I don’t know how well people are living who are in their 100s, some great and others need full-time care. So being able to sit down with your advisor or your counselor to be able to say, “Well, what are the different stages of life going to look like for me?” Can help focus on staying at home, bringing in care, or downsizing, selling, and then wanting to explore retirement residents. Or if your health really changes, then perhaps looking at or considering long-term care through the Provincial Ministries of Health as a way to ensure coverage.
I think it’s a conversation and a very important one. For me, paperwork, powers of attorney, living Wills, advanced directives, are always the cornerstone of every conversation, as is communicating that with family. But as we said, for those solo seniors who may not have a complete close network, being able to have these conversations with your advisors is also very helpful, so they can ensure that your money’s going to last throughout your lifetime and work for you the way you want it to. So I think that’s very important as well.
Yeah, and as we said, not something that we’ve traditionally planned for, but Audrey, so much that we could continue to go deeper on here. But if you hope listeners just take one thing away from our conversation today, what would that one thing be?
I think it’s starting the process. Start thinking about what you want and discuss it with your significant family and others. It makes me think of Mr. Rogers and he says, “If it’s mentionable, it is manageable.” We don’t like to talk about our health and many of us don’t want to for sure talk about death, but there’s a lot between today and tomorrow, so we have to start thinking about those things. So my one thing would be start the process.
That’s great. Well, thank you so much, Audrey, for joining me today to talk about these proactive steps and planning for your future care, ensuring that it serves you today and well into the future, to our 100 years, and why all this matters beyond wealth.
Thank you very much, Leanne.
You can find out more about Audrey at eldercaring.ca, as well as follow her Twitter account @ElderCareExpert, and LinkedIn at Audrey Miller.
If you enjoyed this episode and you’d like to help support the podcast, please share it with others, post about it on social media, or leave a rating and review. Until next time, I’m Leanne Kaufman. Thank you for joining us.
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