Naturally Occurring Retirement Communities (NORCs) - A New Approach to Home Care in Ontario

In April 2024 the NORC Innovation Centre at University Health Network published A Home Care Model for Natrually Occuring Retirement Communities in Ontario. This is a summary of our key takeaways from that report.

With an aging population, the demand for home care services in Ontario is increasing, and the current system is straining to keep up. Naturally Occurring Retirement Communities (NORCs) are a new-ish concept designed to improve home care in Ontario, making it easier for older adults to receive the care they need while remaining in their homes.

What Are NORCs?

Naturally Occurring Retirement Communities, or NORCs, are residential areas where a large number of older adults live, even though these areas were not specifically designed for seniors. In Ontario, nearly 2,000 such communities have been identified, housing over 200,000 older adults. These communities provide a unique opportunity to improve home care delivery due to the high concentration of seniors living in close proximity.

Current State of Home Care in NORCs

Challenges Faced by Residents

Residents in NORCs face several challenges with the current home care system:

• Confusion and Frustration: Many older adults are confused about how the home care system works and what services they are eligible for. This leads to frustration with scheduling and coordinating care from multiple agencies.
• Underfunding: The home care sector is underfunded, which limits the ability to provide adequate compensation and training for staff.
• Fragmentation: Over one-third of NORC buildings in Ontario have four or more home care agencies providing services, leading to a lack of coordination and inefficiency.

Statistics

• Service Hours: Personal support workers (PSWs) delivered nearly 3.5 million hours of home care services in Ontario's NORCs in 2022-23, valued at over $120 million.

Proposed NORC-Based Home Care Model

The report suggests a new model for delivering home care in NORCs that is client-centered, efficient, and better for workers. Here are the key features:

• Single Lead Agency: Each NORC would have one lead home care agency responsible for coordinating and providing care. This would reduce fragmentation and improve coordination.
• Dedicated PSWs: Personal support workers would be dedicated to specific NORCs, allowing them to work full-time or part-time shifts with minimal travel. This would enable PSWs to provide more consistent and personalized care.
• Local Decision-Making: The lead home care agency would make day-to-day care scheduling decisions, making the system more responsive to the needs of residents.
• Population-Based Funding: Funding would be based on the population of the NORC rather than individual service episodes, providing more flexibility to meet the needs of residents.

Benefits of the New Model

Implementing this new model across all NORCs in Ontario could significantly improve home care services:

• Increased Efficiency: The model could provide an additional 754,976 hours of PSW services annually, worth $26.8 million, without requiring significant new funding.
• Improved Quality of Care: By having dedicated PSWs and a single coordinating agency, the quality and consistency of care would improve, leading to better health outcomes for residents.
• Better Working Conditions for PSWs: The new model would improve working conditions for PSWs by reducing travel time and providing more stable employment, which could help address the chronic shortage of home care workers.

Recommendations for Implementation

To implement this new model, the report makes several recommendations for the Government of Ontario:

1. Adopt and Promote the New Model: The government should adopt and promote the new NORC-based home care model.
2. Establish Thresholds: Criteria should be established to identify which NORCs are best suited for the new model.
3. Pilot the Model: The model should be piloted by selected Ontario Health Teams to refine and evaluate its effectiveness.
4. Develop Population-Based Funding: A funding formula based on the population of NORCs should be developed to support the new model.
5. Enable Staffing Model Changes: Home care agencies should be enabled to develop new staffing models that are place- and shift-based.

Conclusion

With the demand for home care expected to grow by 50% by 2031, it is crucial to find new ways to deliver these services effectively. The proposed NORC-based home care model offers a promising solution to improve the quality and efficiency of care for older adults in Ontario's naturally occurring retirement communities. By leveraging the natural densities of these communities, we can create a system that is better for both residents and workers, ultimately leading to a healthier and more sustainable home care system.

References

• NORC Innovation Centre (2024). A Home Care Model for Naturally Occurring Retirement Communities in Ontario. Toronto, ON: University Health Network.
• Statistics Canada (2023). Census Profile. 2021 Census of Population - Ontario.
• Canadian Institute for Health Information (2023). Wait times for home care services.

This article provides an overview of the proposed improvements to home care in NORCs, highlighting the benefits and recommendations for implementation. By adopting this new model, Ontario can ensure that its aging population receives the care they need in a more efficient and coordinated manner.