Aging in Place

EYET’s Community Conversation: Aging in Place, Featuring the Steering Committee on Aging in Place, Toronto 

People living with mental illness and addictions have complex health and social needs, are at higher risk of experiencing poverty, homelessness, and housing instability, and are at a higher risk of experiencing the effects of aging prematurely. People aging prematurely – before the age of 65 – are unable to access supports and services, including supportive housing, that is reserved for seniors in the community.  

In 2019, the Aging in Place Project, funded by Mainstay Housing and supported by the Aging in Place multi-stakeholder Steering Committee, produced Aging in Place: Current and Emerging Needs of a Vulnerable Population.  

On September 15, 2021, EYET invited the Steering Committee on Aging in Place, Toronto, to participate in a Community Conversation focused on engaging with housing professionals about how to better support the unique housing needs of a prematurely aging population. 

During this Community Conversation, members of the Aging in Place Steering Committee spoke to key findings from that report, identified some of the unique needs of an early aging population, and offered some insights into the systemic barriers to housing stability that are faced by this community.  

Using facilitated small-group conversations, housing professionals discussed the challenges experienced related to housing stability and evection prevention for clients who are aging prematurely, shared strategies that they and their organizations use to manage those challenges, discussed resources that exist – or are missing – that would be helpful for housing professionals, and identified some of the system changes that would be required to support stable housing for people who are aging prematurely.  

Key Challenges Identified: 

Access to Suitable Housing Options  

• Waitlists through Access Point is extremely long, leaving many people waiting until the end of their loves  
• There are some housing options that can be accessed at age 55, but there are not enough spaces for seniors, let along options for younger people who exhibit the signs of aging early 
• Buildings with elevators – and program services and housing with elevators – is limited, and accommodation requests will frequently leave people with mobility limitations unhoused or rejected from applications  
• There are some congregate living houses that are agency-operated, but they often have stairs and are not physically accessible, and there is not enough funding allocated to those upgrades by funders  
• There is a severe limitation of available long-term care for people who are not seniors  

Available Supports 

• Clients that experience premature aging often need connection to supports that are targeted and available to seniors. Because this population do not meet the age eligibility requirements, they are left without access, creating a gap in needs-to-services 
• Medication costs can be extremely high, and there are no income supports committed to prescription coverage for a prematurely aging population 
• Many clients need a case management approach to providing supports, but service agencies are limited and there are not enough case managers to support their needs, help them manage their health and wellbeing, and maintain their housing 

Eligibility Limitations  

• Some services are eligible to very specific, severe cases and people whose health is deteriorating rapidly are unable to apply until their condition meets eligibility, even though there is a clear trajectory in place  
• Income supports are limited, ODSP does not cover enough for housing and clients are ineligible for other seniors-specific funding and income supports, despite sharing many of the same barriers, challenges, and needs 
• Seniors’ waitlists are long, and clients are not able to apply to those waitlists early, which would allow less wait time after into eligibility 

Isolation  

• A lack of social connection and access pathways to community engagement has left many prematurely aging community members isolated, and the ongoing COVID-19 pandemic only exasperated that isolation 
• People need to feel safe to access resources in their area, it’s challenging when people have to move outside of their current communities in order to find affordable or supportive housing, which increases isolation 

Cultural and Language Differences 

• Many clients – especially immigrant and refugee populations – have cultural expectations around aging (ie. family support) that are different from the Canadian cultural context which puts pressure on family dynamics, and on workers who may be faced with language barriers and risks of breeching confidentiality when communicating to family members on behalf of clients  
• Language barriers can prohibit clients from communicating their needs, from accessing appropriate medical services that could support access to services (ie: communicating medical experiences to physicians, workers, and others)  

Disabilities 

• Individuals with developmental disabilities age faster, and premature aging is not encapsulated within the services and financial supports available for people with disabilities  
• People with developmental disabilities have shorter life expectancies, and systems were set up with this expectation, but people who are living longer than expected are falling through the cracks 

Transition Supports  

• When circumstances change, often abruptly, there is no clear, easeful pathway to transition to different types of supports 
• For example, when people with disabilities who have been living independently experiencing a medical crisis that results in a sudden need for supportive living are left in limbo: they can’t be discharged to their independent living situations, and a new process of resource identification, application, and wait lists must begin 

Strategies to Meet Challenges: 

Group Homes for Living and Aging Together  

• New buildings designed with accessibility and B3 Care Standards enable aging in place, as they are specifically constructed to be able to add in door openers, lifts, and other things that may be needed as a person ages 
• Apartment approach is easier to support aging in place than houses, as there are often physical accessibility considerations constructed into the buildings, and residents may have more access to a sense of community that could combat isolation 

Supportive Housing and My Access to Housing  

• Supporting clients in their application for Supportive Housing and My Access to Housing is helpful, and ensuring clients understand how the priority waitlist operated so that there is clarity on the wait times 
• Advocating for clients to be moved up the waitlist if they are exhibiting signs of progressive illness, in anticipation of them needing supportive housing after independent living 

Case Management 

• Eliminating a time limit on case management for clients who are exhibiting early signs of aging, ensuring they have case managers through to end-of-life care 

Medical Support  

• Including medical support to meet the added challenge of clients not trusting the medical system due to experiences of dismissal and judgement 
• Referring clients to Community Health Centres to find medical treatment, which are quite knowledgeable and empathetic to early aging populations 
• Accompanying clients to medical appointments to ensure their symptoms of early aging are being communicated and addressed 

Community Education and Outreach  

• It would be helpful to collaboratively create a guideline for people who are experiencing early signs of aging so that they can understand their medical needs, create a plan for self-advocacy, and access the supports they can anticipate needing 
• This guide should include information and education about different medical conditions that can arise with early aging, common treatments, and expectations for treatment and healing journeys 

Helpful Resources 

Community Resources and Referrals  

• Supports for hoarding behaviours, including hiring specialized Hoarding Support Workers and finding additional help with the Toronto Hoarding Network, has been helpful for some clients 
• Finding cleaning and home care support from VHA Home Healthcare 
• Seeking interpretation and translation from Toronto Central listing of Translation and Interpretation Services  

Resource Gaps 

Coalition or Alliance  

• An association or central organization that focuses on this specific issue would be helpful, and organizations could work together to share experiences, lobby for changes, and create a stronger voice about the needs of this population 
• A central organization could also provide literature and information in multiple languages about premature aging, targeted to the population itself 

Training 

• Specialized training available for service providers that is dedicated to premature aging, including strategies for support, eligibility and programming, and advocacy  

Technical Support  

• Access to devices, and skill development training for use 
• Access to devices that are outside the home to support the needs of community members who are residing with abusers  
• Supports for creating email addresses and learning how to update digital files  
• Access to, and training on, scanners and file uploading requirements for My Access to Housing Toronto 

Resources within the Shelter System  

• Training for staff dedicated to building trust and improving shelter staff and community member relationships, to push back on perceptions of being policed or over-regulated  
• Resources within the shelter system for transitional housing options for prematurely aging populations  

System Change 

Advocacy  

• Pressure on the City to put in place more supportive housing and in-house services  
• Education in the Medical Field about the impacts that the Social Determinants of Health have on aging, specifically  
• More case managers and case planning with realistic expectations about the length of client-facing appointments
• Computer and tech provision to accompany the My Access to Housing changes and system expectations 

Record Keeping and Data Sharing  

• Centralized file keeping and updating to avoid the need to re-upload information to multiple channels  
• Centralized computer stations through My Access to Housing, where service users can access their centrally kept files  

Education, Training, Guidance  

• Guidance for workers on how to access necessary services faster, before medical conditions escalate  
• Resources and training on how to address the question of premature aging  
• Centralized information on resources and referral options 

Eligibility Re-Definition, “Senior” Redefined   

• Better definition of “senior” is needed, based on development and health condition; this has been acknowledged in the National Seniors Strategy 
• Leverage the re-definition of “Senior” from National Dementia Strategy  
• Re-define eligibility requirements for government programs and supports around specific health conditions rather than age 
• Open long-term care to health-based eligibility 
• If age-based eligibility persists, allow early applications for people who are anticipating aging, to reduce wait times once eligible  

Funding Priorities  

• Realistic, service-provider directed needs assessment from all funders  
• Language and interpretation support, and free translation and interpretation from all government agencies, including My Access to Housing and Income Supports
• Technology access funding to ensure access for clients to computers, internet, phones, data, etc.  
• Transition supports for life changes that easefully shift someone from one type of programming/support to another, without having to re-apply or do a new application procedure  

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