Author: Grace (“Ace”) Ko
“My worst fear is growing old,” a friend says, and I can’t blame her. We are a group of nurses-in-training, doctors, with the occasional business student or engineer. Our discussions are often peppered with anecdotes from volunteering (“It’s so depressing”) to rumours (“It’s so sad.”).
Meanwhile, my grandmother dances on the table. She laughs and holds her alcohol, and shimmies and shakes, in front of a crowd of my several dozen family members. There are happy, squealing faces in the audience: A type of wildness. I found myself thinking: “This is it. This is the best of what it is to be human.”
My great-grandmother? I only knew her in a retirement home.
She smelt like soap.
That is all I can remember: That and the paper-white sheets, and the times she started to forget my name, and the time where I saw a colouring sheet but half-finished, and the time where I wanted to— I never ended up giving her the jar of origami I wanted to.
This would forever change how I saw long-term care homes: Was it a difference in age, or was it about the environment that led her to die when she did? She lived to over the age of one hundred years old, a feat so remarkable that the government (apparently) wrote her a letter about this.
But did she live well, near the end? She didn’t have friends, from what I could tell. Nor did she seem to be able to go outside. The care worker was often not there, and there seemed to be another elderly woman in the room as well, who we never knew the name of.
What would it mean to imagine a different way to retire?
What if we viewed retiring as an adventure, or as a way to pass down intergenerational knowledge?
What would it mean to age well?
As somebody who has seen multiple cases and has heard second-hand accounts from family, I will attempt to view this through the lens of my own experience. Granted, this will not be reflective of all Canadians’ experience; I only hope to share one particular perspective, backed up by available data.
Part 1: The Unseen Costs of Nursing Homes
But first, a question: Does anyone actually want to live in a retirement home?
One study in Frankfurt, Germany, showed that up to 30% of their nursing home residents suffer from major, or minor, depression (Tesky et al., 2019). One more pessimistic update suggests that this number, in Canada may be closer to 40% (CCSMH, 2024). Of course, it should be noted that there is a significant gap in literature available — many statistics are collected by non-profits (such as the previous source, the CCSMH), and so these numbers may not be the most academically rigorous.
However, this does not nullify the rather real impacts of nursing homes on the mental and physical health of patients. For example, the recent COVID-19 pandemic exposed many vulnerabilities in the long-term care system. In 2022, the operating expenses for Canadian private facilities reached $16.1 billion, while public facilities’ expenses reached $21.6 billion (StatsCan, 2024). The amount of expenses, in dollars, had risen at a 4.2% increase, reaching $39.1 billion dollars in total (StatsCan, 2024).
And, even without the data, there is the question: How many of you would want to send your loved ones to a retirement home? Would you want to visit one, to be in one?
A series of questions that Google auto-populates when searching up “nursing homes.” There is a sense of poetry here.
When it comes to the topic of retirement, it is generally agreed upon that seniors need far more additional healthcare. Where this agreement ends, however, is how this healthcare should be provided. Should it be in a long-term care facility? A live-in nurse? An apartment, with a few doctors on each floor?
For this blog post, due to the limited scope, I will focus on the issue of housing. However, I would highly encourage readers to do their own research about the topic of healthcare provision as it is also deeply important to this subject.
Part 2: Intergenerational Living
One solution, which resolves the issue of housing, is intergenerational living. Described by StatsCan (2022) as those where “at least one person who is both the grandparent of a person in the household and the parent of another person in the same household,” as well as “all households where there is at least one person who is both the child of a person in the household and the grandchild of another person in the same household.” In short: any household where multiple generations are living in the same place. With around 441,750 multigenerational families in Canada in 2022 (StatsCan, 2022), an increase from 406,645 in 2016, there has been a stable and steady increase of this arrangement in Canada.
One particularly optimistic CBC article follows several families, and discusses the many benefits, including a greater sense of community, more financial savings, and an increased ease of living (Braich, 2024). While one expert does hazard that this arrangement is not for everyone, it is overall a rather joyous picture of the living situation (Braich, 2024).
It would be short-sighted, however, to allow intergenerational living to become the only viable solution. As beautifully elaborated by Kevin Chong: although it offers a more human alternative, it can be physically and mentally exhausting for both parties. The writer describes the amount of emotional fatigue he often feels, living with his mother with his wife and children. However, he ends with an optimistic note about new alternatives. He concludes, “If the best thing about the new trend in multigenerational living is that it’s a choice, then the freedom to choose something that works better for you still remains vital.” [emphasis added].
Part 3: U City
A contrasting approach is that of U City, an experimental apartment in the city of Adelaide in Australia. It offers disability accommodation, retirement residences, as well as businesses and cafés (with a full bar on the first floor, which my grandmother would be happy to see) (U City, n.d.).
“I think the foyer is one of the real strengths of this building and community […] such a lively place, there is so much colour and art.” - A resident of U City (Barrie et al., 2023)
Instead of focusing on settling elders within the family, it allows for a full, metropolitan lifestyle within the heart of the city (Barrie et al., 2023). Furthermore, unlike intergenerational living, it has built-in services for physiotherapy, pharmacy pick-ups, meal preparation, and more (U City, n.d.).
While some may argue that this high-stress and busy environment may be detrimental to the health of seniors, I would argue that this complexity is exactly what makes this arrangement appealing. With loneliness linked significantly to the mortality of older adults by Barnes et al. (2022), the proximity to others could be considered a design benefit instead of a fault.
Regrettably, there is a lack of further literature about mixed-use developments for seniors. However, a cursory search reveals a startling amount of new projects: from Inspīr Senior Living in Manhattan, promising “luxury senior living” (Inspīr, 2022) to the village-like Merrill Gardens in Washington DC (Merrill Gardens, 2024). There are, at least, options.
That is not to say, however, that these are necessarily affordable or widely-adopted. The lack of academic rigour in the study of these homes, as well as the lack of general awareness about them, indicates a large barrier into making these more accessible to Canadians.
However, the very existence of them provides a glimmer of hope in an otherwise hostile market for retirement living (the question of whether it should be left to the market is another one altogether).
Of course, the aforementioned noise, and doubtless chaos of the city, are barriers for it becoming a strategy available to all. Not only that: These metropolitan homes seem to be billed as “luxury,” which creates a question of whether these are actually affordable to the general population.
Conclusion
While these two approaches seem different, they still revolve around one central tenant: allowing the fullest choice possible for elders within the community. I am inclined to agree with Chong — having multiple choices is more valuable than having one “perfect” plan. For those interested in other options, The National Initiative for the Care of the Elderly (NICE) is an excellent resource. It offers information about everything from aging in place to short-term and respite care.
Consider discussing these options with parents or loved ones in your life. If you are planning on retirement yourself, explore these alternate opportunities and communicate with your loved ones about how to implement these ideas.
All in all, there’s a beautiful future out there. Let’s make sure that we commit to making the best of it. _____________________________________________________________________________________________________________________
References
Barnes, T. L., et al. (2022). Loneliness, Social Isolation, and All-Cause Mortality in a Large Sample of Older Adults.
J Aging Health, 34(6-8), 883-892. https://pmc.ncbi.nlm.nih.gov/articles/PMC9483694/
Barrie, H., McDougall, K., Miller, K., & Faulkner (2023). The social value of public spaces in mixed-use high-rise
buildings. Buildings and Cities, 4(1), 669-689. https://doi.org/10.5334/bc.339
Braich, B. (2024, March 14). Why multi-generational living is becoming more common in Canada. CBC.
Canadian Coalition for Seniors Mental Health (2024). Depression. https://ccsmh.ca/areas-of-focus/depression/
Chong, K. (2024, January 3). Multigenerational Living Often Makes Sense. That Doesn’t Make It Easy. The Walrus.
Costa, A. (2023, September 23). Analysis: Are seniors being pressured into retirement homes by lack of community
services? McMaster University. https://brighterworld.mcmaster.ca/articles/analysis-are-seniors-being-pressured-into-retirement-homes-by-lack-of-community-services/
Inspīr (2023). Inspīr. https://inspirseniorliving.com/
Merrill Gardens (2024). Merrill Gardens. https://www.merrillgardens.com/senior-living/wa/seattle/merrill-gardens-at-
NICE (n.d.). Housing Options for Older Adults. https://www.nicenet.ca/articles/housing-options-for-older-adults
StatsCan (2024, March 19). The Daily: Nursing and residential care facilities, 2022. https://www.canada.ca/en/health-
StatsCan (2022, July 13). Household type including multigenerational households and structural type of dwelling:
Canada, provinces and territories, census metropolitan areas and census agglomerations. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=9810013801
Tesky, V. A. et al. (2019). Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the
effectiveness of a novel case management approach to improve treatment (the DAVOS project). Trials 20, 424. https://doi.org/10.1186/s13063-019-3534-x
U City (n.d.) About U City. https://www.ucity.com.au/about-u-city/
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