Speaker 1:
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Jordan:
Even before the pandemic. Nobody’s aging parents were actively hoping to spend their final days in a long-term care facility. And then Covid struck and we realized very quickly just how poorly many of these homes were serving their residents today with an aging population. Even if every one of those long-term care homes was providing wonderful world-class service to every single resident, there still wouldn’t be nearly enough spaces in them for what we need. It’s not news that governments across the country are scrambling to find ways to fix this crunch on the healthcare system, which will only get worse as more and more boomers see their health decline. So far we haven’t made much progress there, but what if there was a better way, a solution that would actually deliver on the promise that we all want to make to our aging loved ones that yes, they can stay in their own home and still get the care they need. That solution is out there, you just have to look for it. I’m Jordan Heath-Rawlings. This is The Big Story. Cathrin Bradbury is a longtime Toronto based journalist, author of The Bright Side and the author of this piece, which appeared in The Walrus. Hey Cathrin.
Cathrin Bradbury:
Hi. How are you?
Jordan:
I’m doing very well. Thanks for joining us again.
Cathrin Bradbury:
Thank you for inviting me.
Jordan:
I want to ask a bit of an open question to start. I guess before we get into specifics. When is it that we change from thinking about where we’ll live when we are old as a theoretical thing to a practical matter we need to start looking into? Has that happened to you yet? Is there a time when it shifts?
Cathrin Bradbury:
That’s such a good question. It hasn’t happened to me yet. I’ve just turned 69, but I have siblings who are my focus group on aging who are between eight and six years older than I am, and I’m watching some of them and their friends in their mid to late seventies begin to make this decision. And these are people who said, you’ll have to carry me out of my house. I’ll never leave. I’m going to stay here. And then with my sister, for example, one day she said she was never moving and the next day she was looking for apartments to move into. I think it just comes over you that you’ve had enough of home ownership and looking after a big pile that you have to worry about and go up and down stairs in and you want a streamlined life.
Jordan:
And when we talk about what’s next for people who are aging, seniors, not wanting to go to a long-term care facility or a nursing home or whatever, that is not a new phenomenon, but the pandemic seems to have supercharged it. Can you give us a brief explanation of what happened?
Cathrin Bradbury:
Well, I think we all watched the nightly news footage of older Canadians in nursing homes behind glass, waving at their family, standing on the other side of the glass. And these were people who didn’t get to see family members for years. It was terrible, not only the separation, but the daily, weekly toll on life that we started to hear from overworked, understaffed, nursing homes and old people dying. That took us inside nursing homes in a way a lot of us hadn’t been. And it took us inside nursing homes during a health crisis
Jordan:
And also outside of the commercials that we often see for those facilities which look very different.
Cathrin Bradbury:
Right, right, exactly.
Jordan:
Can we quantify in any way how much older people hate nursing homes, don’t want to go into a retirement home, and why do we have surveys of their preferred options and what they are?
Cathrin Bradbury:
There was a big study, it’s a bit of a mouthful, done by the National Institute on Aging and the Canadian Medical Association, and they surveyed a huge number of Canadian 65 and over about where they wanted to age. And the numbers were overwhelmingly anywhere but a nursing home. People said, and I quote, they will do anything they can to avoid being housed in an institutional setting. So I think that the studies bear it out and so do conversations I’ve had with people who are getting older,
Jordan:
And this is a really important conversation to have now obviously because as I’m sure and many people know, the long-term care space in especially preferred residences is at a huge premium. There isn’t much of it. And while one of the reasons that you are doing reporting on aging and you have this focus group is because there’s a massive number of Canadians entering this stage of life. And I guess my question from all that is if there’s not enough long-term care facilities and residents really don’t want to go into them anyway, what are the alternatives?
Cathrin Bradbury:
Yeah, so right now it’s something like close to 3 million Canadians who are moving into their peak care years. So that’s a lot of us. And as you say, there aren’t enough beds. Ontario premiers Doug Ford, he has this more beds, better Care Act, and that would allow hospitals to move patients to nursing homes as far as 150 kilometers away. And that’s pretty horrifying right there. So alternatives need to be found. And one of them are these what are being called NORCs, which are naturally occurring retirement communities. And that’s what I’ve written about for The Walrus Magazine.
Jordan:
Explain maybe just basically what those are and wherever did the concept come from? Where did it emerge?
Cathrin Bradbury:
Well, NORC started in New York City as far as I know from my research in the 1980s. And basically they started to look at buildings in New York City where a lot of people over 60 were already living. And then they decided instead of having to go out for services to start to designate these buildings that had a very high percentage of older citizens in them, as buildings where you could bring care in. And it was so successful in New York that these NORC buildings, they’re all rentals are almost impossible to get into. They’re so well known there and they’re thriving. And in fact, they now are subsidized by the government in New York. In Canada, they’re very little known. I hadn’t heard of them in Toronto right now, which is kind of the center of where NORCs exist. There are 23 operational NORCs, and with the data mapping being done out of UHN here in Toronto, they know that there are at least 53 buildings that would qualify for a NORC program. They’ve done data maps of the potential NORC buildings in Toronto, and there are 500 of them around the city.
Jordan:
How do these places work practically? You mentioned bringing in services. What else is there? What kinds of things happen in a NORC that wouldn’t happen in a regular condo or a co-op that had a lot of elderly residents?
Cathrin Bradbury:
It’s a bit complex because there are many different kinds of NORCs. You have to have 30%, only 30% of people who are over 65 to qualify as a NORC. So say you’re in such a building and every time say you need some kind of healthcare access or some kind of information, everybody’s on a different line. Calling a different place is really difficult to navigate the healthcare system in Ontario, if you’ve ever had to navigate your parents or anyone else through it, you know how exhausting and time consuming that is. With NORC, it’s one number, with certain kinds of NORCs, they actually come and work in the building. That’s a kind of mid-level NORC. So there’s a team of people who work in the building part-time with a very high level of NORC involvement. There’s people working in the building and then with a fairly light touch.
The building runs it completely themselves. They call them NORC ambassadors, and they just use NORC as a resource. You bring in paramedic services, paramedic talks, you have all kinds of clinics. You might have vaccine clinics come in, you might have foot doctors come in, you might have art shows and lunches and social outings. It’s really what the building decides the building wants. There’s two important things. One is that you bring the services to where people already are instead of pulling people out of their environment. That’s really important. And the other is that you build a community so people get to know the people who are living in the unit next to them, and you start to get involved in each other’s lives and the needs of each other. And isn’t that the way to get old?
Jordan:
Well, tell me more about that then, because you’ve just discussed it practically, but you also visited one in Toronto and spent some time there. Just tell me about what it was like and what you took away from it.
Cathrin Bradbury:
Well, I was invited to what was called a soup social, and there’s a part of me that hears soup social, and I think, oh my God, do not ever want to be at a soup social.
Jordan:
Like a church picnic?
Cathrin Bradbury:
Yeah, that kind of thing. But you know what, it was a nice light filled room. It was packed with people. The volume level was incredibly loud. Everybody was sharing pictures on their iPhone. There were a couple of guys mounting a TV over in the corner. It was a very warm, open, loud gathering, and not only a social gathering, but you would hear things like, who needs a ride tomorrow to the grocery store? Or, let me help you with my flashlight with that TV people were very warm and actively involved with each other. I did talk to one woman there who said a NORC probably made the difference between her being able to stay in her place and being sent to a nursing home. She had fallen in her kitchen and fractured her pelvis and the NORC support convinced her she wouldn’t have done it otherwise. To go and get an X-ray immediately, they helped her get into bridgepoint. When she came home, there was support there to help her make sure her apartment was safe, and to help her get the services she needed to stay at home. Without NORC, she might’ve ended up in a nursing home, and as she said to me, it’s the thing we all fear the most. She was 83, and I would share that fear of hers.
Jordan:
This soul sounds really positive, and as you mentioned, community is important, and bringing services to where people are at that age can be critical. Who pays for all of this? Where does the money come from? How much does it cost?
Cathrin Bradbury:
Yeah, good question. Right now it’s being funded by a very generous, farsighted anonymous donor, and that’s all I know about it. That’s how NORC is being funded. But the people who run it through UHN, again, as I mentioned, are very hopeful that what’s happening in Toronto can A, start to move right across Canada and B, be integrated into the healthcare system. That’s their ambition. I think step one is for people to know more about it, but yeah, private donor.
Jordan:
That’s really interesting because that makes it officially, I guess, not a part of Ontario’s healthcare system then.
Cathrin Bradbury:
Correct.
Jordan:
So from an individual economic point of view, how much does a spot in a NORC cost? Is it the same as an apartment? How does it compare to the cost of a long-term care facility and that kind of stuff?
Cathrin Bradbury:
Oh, there’s no cost.
Jordan:
Oh, wow. This is all funded through the extremely wealthy donor then? Yes,
Cathrin Bradbury:
There’s no cost at all. And so I live in the Annex, and theoretically you could have a horizontal NORC. So right now, the NORCs that have been identified and are up and running, the 23 that are up and running are an apartment building, so they’re called vertical NORCs. But if I say got together with a group of neighbors and we found out that a four block radius, 30% of us were over 65, and I’m sure that wouldn’t be true in the Annex, then we could apply to be the first horizontal NORC in the city. And I don’t think that would look like getting someone to come full-time to work with us. I don’t think we would need that, but it could certainly help us organize community healthcare events and talks and social events. So yeah, that’s the remarkable thing about it is that there’s no cost, not to the individuals.
Jordan:
Where else are these in Canada, or is Toronto really the only place?
Cathrin Bradbury:
There’s one in Kingston that was very early on. There are similar types of things that I’m told in Vancouver, not nearly as organized as Toronto. So it is really Toronto right now. I mean, as I say, the people are very ambitious. One of the doctors I spoke to has been an internist at Mount Sinai his whole career. He’s now at the age of a lot of the people in the NORC programs, and he said he just one too many times saw people in our hospitals with nowhere to go and no family coming to help them or see them or take them home. And he knew that there had to be a better way, and he really worked hard to think with people and talk with people about what those better ways could look like. And they discovered that Newark was already happening somewhere and they started to create something similar here.
Jordan:
You mentioned a couple of times in this chat already how a community is the basis for it and how important that can be, but then are you also right in your piece that you’re not exactly a communal person? Talk to me a little bit about whether or not we might think ourselves, communal people, how important that becomes to us as we get into those later years.
Cathrin Bradbury:
Yeah, that’s a good question and a big question, and I’ve been thinking about that since I wrote this piece. A lot of my friends and myself talk all the time about what the next stage of life could look like, and maybe we should all buy something together. Maybe we should get a building together. Maybe we should all move into the same apartment building. And then when it comes right down to it, it’s almost impossible to coordinate that with people. Like that kind of community. I would love if I took the community we already had and moved in together. That’s kind of my dream. But practically speaking, I think it’s very hard to pull off. People will have different situations. People have different lives, people have different health levels, people have different mortgage deadlines. I guess it’s really hard to make it happen. I will tell you a story about my family.
My two brothers and my one brother’s son and another family are building a family commune compound in Fonthill, Ontario. So they all decided to put everything together, and the ages range from 76 to I think 30. And there’s a couple babies too, and they are all going to live communally. And for them, that means everyone has their own space, but they’ll have common kitchen and living areas. And I think it’s brilliant. I think it’s a miracle they pulled it off. And I know that they did talk to many, many people who had always said, that’s what I want to move to, but when it came right down to it, people were like, no, I can’t do that. I can’t sell now. I’ve got this or that. So it’s a wonderful idea, but to actually make it practically happen has to be more than an idea. It has to be a lot of will and change and decision-making.
Jordan:
Last question I’ll ask is just a practical one, and I guess it’s mostly for listeners in and around Toronto, but if somebody listening is at that age, they don’t live in a building right now that could be turned into a NORC, but they are fascinated by this idea and desperate to avoid ending up in a long-term care home and they want to get involved here, what are the next steps? How do you apply to get in here or get in touch to be perhaps selected for a spot in one or what?
Cathrin Bradbury:
Yeah, I wish I could say there was an application process. There isn’t, but what the people did at the place where I went to the lunch social was they by word of mouth, heard about NORC and then one of the women went online and she just ferreted through and found the right way to contact them and to get it into her building. There is a do it yourself NORC kit. I don’t know what the link is to that, but I think if you Google NORC do it yourself kit, it’ll probably come up. I think once you’re in touch with them, then I think things can move along pretty quickly. And as I say, there are these very different tiered types of NORCs. So in certain buildings in Toronto, they have full-time, NORC people working there, and in other buildings, part-time and in other buildings, no one working there at all. It’s just a focal point for people to come together and decide what they want as a group. So it’s more community building in that case. But I think it sounds really cool. I think it sounds like a good option for the future for Canadians.
Jordan:
Cathrin, thank you for writing about it. Thank you for taking the time to talk to us and I did just check while we’re speaking, we will put the link to the do it Yourself guide to NORCs in the show notes for anyone who is interested, and thanks again for joining us.
Cathrin Bradbury:
Fantastic. Thank you.
Jordan:
Cathrin Bradbury writing in The Walrus. That was The Big Story. For more from us, you can head to TheBigStorypodcast.ca. You can also, of course send us your feedback. We’d love to hear from you. The way to do that is via email. Hello@TheBigStorypodcast.ca is the address or by leaving a voicemail at 416-935-5935. You can listen to The Big Story wherever you listen to podcasts. We would be very grateful if wherever you do that, you throw us a rating or even better write out a review if the app lets you do that. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.
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