Alberta urged to move ahead with publicly funded small care homes

There are calls for Alberta to make good on its plans to pave the way for publicly funded small care homes as the population ages and demand for long-term care grows.

A new report from the National Institute on Ageing recommends provinces urgently prioritize the small care home model, which provides housing for 10 to 12 residents and represents a shift away from large, hospital-like institutions.

"What we're really calling for is governments like Alberta — that have actually taken an interest in small care homes — to actually get on with it," said Dr. Samir Sinha, a geriatrician and director of health policy research at the National Institute on Ageing. 

"Move this forward so that it's not just an option available for people who can pay in private facilities. But that this is something that the public system can offer." 

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Small care homes can be built in neighbourhoods and designed to look like other houses on the street. They have individual bedrooms and bathrooms with shared living spaces, including kitchens, living rooms and dining rooms.

Staff provide a range of support from personal and medical care to meal preparation and laundry.

"With a smaller number of staff taking on a larger variety of roles, they can actually spend more face time with the residents, they can build stronger relationships," said Sinha, adding staff turnover is lower.

The model can also be adopted within larger facilities by creating small, individual households within the building, he said.

"It's like living in your own home," said Davida Thompson–Upton, whose 92-year-old mother has dementia and moved into a private small care home in Edmonton in April 2024.

"You become a friend with the [licensed practical nurse], for instance, that looks after you. There's so much more personable interaction than there is if they're in a publicly funded residence with maybe 400 residents." 

Waiting for grants

A  2021 report on facility-based continuing care in Alberta recommended funding for more resident-centred living options, including the development of 1,600 small care home spaces by 2030.

Following the release of that report, the province offered a capital grant program in 2023 to spur the development of small, stand-alone care homes that would house between four and 14 residents. 

Dawn Harsch, who has been pushing for Alberta to adopt this model for years, applied for grants to build eight publicly funded small care homes in rural parts of central and northern Alberta, where the need is high.

She already runs three private small care homes in Edmonton, including the dementia-centred home where Thompson-Upton's mother lives.

More than a year after applying, she's still waiting.

"I think if the government of Alberta would announce those capital grants and let us start building these small homes, we could help address the need within about 18 months," said Harsch, founder and president of Exquisicare Senior Living.

"Once we are notified that we can start building and getting our permits, it's really about a 12-month build for small homes. And we can build them all concurrently. So we can start to make a difference very, very quickly."

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Launched by Alberta Health, the grant program was open between April and November 2023 and 74 applications were received from 33 different applicants.

The Alberta government, which is restructuring the province's health system, told CBC News the program is being reviewed now that continuing care has moved to a new ministry.

"The Continuing Care portfolio moved to Seniors Community and Social Services in January and Minister [Jason] Nixon is taking time to review the portfolio and become familiar with the program. We will provide an update when more information is available," a spokesperson for Nixon's office said in an emailed statement.

The minister's office says $654 million has been allocated over three years to its overarching continuing care capital program to develop new spaces or modernize existing homes.

How much of that funding will go to small care homes is contingent on what projects are approved, according to the statement.

Harsch, who previously worked as a nurse in large facilities, said she's seen a number of benefits to providing care on a smaller scale.

"Because we get better clinical outcomes — such as fewer falls, better nutrition, fewer trips to the emergency department — we are saving the system money on a whole, not to mention just better quality of life for seniors who deserve it."

Meanwhile, Sinha said Alberta was a leader in Canada when it launched the grant program and he hopes that doesn't change. 

"I'm hoping this report is going to support the Alberta government and the ministry itself to say, 'Wow, there actually is a lot of evidence to support this and this is where the future of care should be going.'"