Report of the Dementia Task Force
The Community and Neighbourhood Services Committee recommends the adoption of the following report (March
9, 1998) from the Commissioner of Community and Neighbourhood Services:
Purpose:
To summarize the findings and recommendations from the Dementia Task Force, which was comprised of staff from the
municipalities of Toronto, Hamilton-Wentworth, Halton, Peel, Niagara, York, and Durham.
To provide facts related to dementia projections specific to the population of the City of Toronto, and to detail additional
recommendations based on assessed potential impact relevant to the City of Toronto.
Funding Sources, Financial Implications and Impact Statement:
There is no net impact as a result of the recommendations contained in this report. Rather, the report sets out the urgent
need for the Ministry of Health to make immediate and future investments in care and service for individuals with
dementia. Without significant new and sustained financial investment in this area of health care delivery, there will be a
growing and unacceptable gap in service for individuals suffering from Alzheimer's Disease and related dementias, and
their families. As a result, these individuals will be placed at significant risk.
Recommendations:
It is recommended that:
(1)City Council support the recommendations detailed in the report of the Dementia Task Force, namely:
(a)that the Province formally recognize the current and future funding shortfall for long-term care service in the "seven
regions" including long-term care facilities and community services, by immediately allocating additional resources for
these areas of need;
(b)that the Minister of Health allocate financial resources for specific research into the prevention, cause, cure, and
management of Alzheimer's Disease and related dementias; and
(c)that a copy of the report be sent to the Premier of Ontario, Minister of Health, Minister without Portfolio responsible
for Seniors Issues, local MPPs, Opposition Leaders and Health Critics, District Health Council, Alzheimer Association,
Association of Municipalities of Ontario, Ontario Association of Non-Profit Homes and Services for Seniors, Health
Services Restructuring Commission, Ontario Public Health Association, Association of Local Public Health Agencies, and
Ontario Community Support Association;
(2)City Council advocate for the enhancement of funding and resources to provide care and service for individuals with
dementia and their families within the City of Toronto which focus on supporting the individual in an environment that is
as normalized as possible, and includes both facility and community options, and:
(a)support the Health Services Restructuring Commission's (HSRC) recommendation that an additional 5,207 new
long-term care beds be added by 2003;
(b)support the HSRC's recommendation that an additional 4,181 new long-term care spaces be added by 2003; and
(c)encourage the Ministry of Health's adoption of a resident classification system that captures the care and service needs
of a population with dementia;
(3)future care and service delivery for those with dementia within the City of Toronto be planned and implemented with
recognition of unique needs encountered as a result of the multicultural and linguistic diversity of the City's population;
(4)future financial investments by the Ministry of Health include dedicated enhanced funding for the provision of
(short-term) respite services, in both facilities and the community; and
(5)the appropriate City officials be authorized and directed to take the necessary action to give effect thereto.
Background:
In April 1997, Dr. Robert Hopkins, Ph.D., Psychogeriatric Unit, Kingston Psychiatric Hospital, shared his clinical research
bulletin, "Dementia Projections for the Counties, Regional Municipalities and Districts of Ontario", at a panel presentation
hosted by the Alzheimer Society of Durham Region.
Dr. Hopkins' projections were based on population projections prepared by the Province of Ontario and dementia
prevalence rates validated in clinical research. His dementia rates focused on "severe and moderate" dementia only,
identifying that these are the individuals who will require support from the health care system. As a result, Dr. Hopkins'
projections should be seen as conservative, at best.
Persons with dementia are defined as having "severely impaired memory and reasoning ability, usually with disturbed
behaviour, and associated with damaged brain tissue." Individuals with "severe to moderate" dementia require 24-hour
supervision, assistance with daily functions such as eating and dressing, and experience a range of behavioural problems,
including hallucinations, depression, paranoia, aggression, etc.
Based on the significance of the data shared by Dr. Hopkins at the abovementioned conference, Durham Regional Council
initiated an invitation to the Regional Chairs from the seven regions in the Greater Toronto Area to have staff
knowledgable in the care of individuals with dementia participate on a Task Force mandated to study and respond to this
serious issue. Two staff from the Homes for the Aged Division participated on the resultant "Dementia Task Force," on
behalf of the former Municipality of Metropolitan Toronto. In addition, staff from the Regional Municipalities of Durham,
Peel, Halton, Niagara, York, and Hamilton-Wentworth participated in the initiative.
The Task Force met on a number of occasions over the period of April 1997 until December 1997, and finalized and
released its report to the relevant Mayors/Chairs of the participating municipalities in January 1998.
This report attempts to provide members of the Community and Neighbourhood Services Committee with an
understanding of the significance of Dr. Hopkins' findings, in terms of the capacity of the current health delivery system to
respond to the growing dementia rates; to summarize the findings and recommendations of the Dementia Task Force; to
outline the significance of the demographic projections specific to the City of Toronto; and to comment on the
enhancements that will be required in the current health delivery system to ensure that it is adequately prepared to meet the
needs of individuals with dementia residing within the City of Toronto who will require care and service now and in the
future.
Discussion:
Both population projections and dementia projections are critical in determining the health care needs of a future
population and the health delivery system's capacity to meet these needs. First, Dr. Hopkins' clinical work identifies that the
elderly population (i.e., over the age of 65) will increase 53 percent by the year 2010, and by nearly 120 percent by the year
2021. This growth will result in a significant increase in age-related medical disorders and an expanded demand for
services to seniors in a variety of areas, including social and recreational programming, transportation, assistance with
financial management, safety and security, home help, and personal support.
Second, there is evidence that the prevalence of dementia in society is increasing, as our capacity to successfully treat
physical illnesses improves. Dr. Hopkins' clinical research studies detail a projected increase in Ontario's dementia rate of
85 percent by the year 2010 and 150 percent by the year 2021. In terms of numbers of individuals with dementia, statistics
show that Ontario was caring for 82,000 persons with dementia in 1992; this number swelled by over 15,000 by 1997; by
2021, there will be 206,000 persons with dementia who will require care and support.
Dr. Hopkins' data indicated that these problems will be especially dramatic in the municipalities across the Province which
have grown rapidly during the 1970s and 1980s. As an example, the dementia rate in Durham Region will grow by 209
percent. The average increase in the combined municipalities of Durham, Halton, Hamilton-Wentworth, Niagara, Peel,
Toronto, and York is 124 percent. The increases in individual communities within this group range from 80 percent in
Niagara to a 250 percent increase in Peel Region. The projected increase for Toronto is 81 percent. Appendix 1 illustrates
the projections in dementia cases in each region.
In terms of numbers of individuals with dementia dependent on Toronto's health delivery system for care, there were
20,367 individuals with dementia in 1992, and 22,315 in 1995. Based on projection rates, there will be 35,988 individuals
with dementia by the year 2011 and 44,251 by the year 2021.
(a)Work of the Dementia Task Force:
It is clear that these increases will present a significant challenge to the respective communities' ability to service the
health, social, and economic needs of this target population. The public and private costs to society as the number of
individuals with dementia increases will be high, given the nature of the care and service that they will require.
Due to the nature of dementia, there is a need for enhancement in the full range of services, from community-based options
to long-term care facilities, specifically designed to meet the unique needs of a population with severe dementia. It is
imperative for planners to realize that physical environments in both existing and future long-term care facilities will
require appropriate design and structural changes to effectively care for the dementia population. Funding to support
augmented staffing levels will be required; staff will require additional training with respect to the specialized care that
individuals with dementia require.
Next, there is a need to address this serious and complex issue within a framework of health policy planning. Early
intervention from all levels of government is crucial in order to adequately prepare, plan, and fund organizations to meet
the needs of this target population. Significant investment is required in both research and service delivery. Health research
is a key initiative in the development of prevention and treatment for dementias. Current health care deliverers must work
collaboratively to improve co-ordination of information, care and service.
Consideration must also be given to reinvesting a substantial portion of the savings realized from hospital restructuring in
order for the overall health system to be able to adequately respond to the future demands for dementia care; reinvestment
is required in both community-based care and long-term care facilities.
Last, legislation regarding financial (e.g., tax) incentives to assist caregivers in the community, on both the provincial and
federal levels, should be considered to alleviate some of the financial burden associated with the challenge of providing
care at home.
(b)Other Issues Relevant to the City of Toronto:
There are 68 long-term care facilities within the City of Toronto (including nursing homes and homes for the aged),
offering a total of approximately 11,850 beds. There are currently 5,020 individuals on the waiting list for placement in
these long-term care facilities. The City of Toronto owns and operates 10 of these facilities; there are 2,641 beds within the
City's 10 Homes for the Aged (i.e., 22 percent of the total number of beds); and 1,050 persons are currently awaiting
admission in one of the City's homes (30 percent of the total waiting list). Currently, 65 percent of the residents living in the
City's homes suffer from cognitive impairment, mental health problems, and/or dementia. In addition, the severity of
dementia is evidenced to have increased amongst both applicants/residents of the Homes for the Aged and clients of the
Division's supportive housing and homemakers programs.
Within the Homes for the Aged, a total of 19 beds have been approved by the Ministry of Health to offer short-term
(respite) admissions; a significant number of the admissions done to these beds are for individuals with dementia whose
caregivers require short-term relief in order to continue coping with the day-to-day pressures of providing care. In addition
to the 19 short-term beds within our own Homes for the Aged, there are an additional 64 short-stay beds in the other 58
long-term care facilities within the City boundaries. This level of resource will be grossly insufficient to respond to the
projected future need.
Although the Division operates five Adult Day Centres and provides service to a number of individuals with dementia in
these Centres, none of the Centres receive the higher level of funding set aside for designated Alzheimer's Day Programs.
In addition to the care and service directly provided by the Homes for the Aged Division, the Community Services
Department funds a number of community-based organizations that deliver service to this client group. There are 15
Alzheimer's Day Centres within the City of Toronto; in addition, there are six Day Centres which specialize in services to
the frail elderly, and five integrated Day Centres which provide service to both cognitively impaired and cognitively intact
clients. The Community Services Department also provides a grant to the Alzheimer's Society.
Notwithstanding the levels of service currently provided within Toronto, and the commitment of the City's service
providers to respond to the specialized needs of individuals with dementia, there will be substantial gaps in future service
delivery if provincial planning and investment does not occur now. First, the huge increase in individuals with dementia
will place extra significant demands on the hospital system. Already, the decrease in emergency room capacity is having a
negative effect on the elderly; individuals are waiting long periods of time for admission, or are being turned away; this
introduces significant risk as individuals with dementia require comprehensive assessment for possible acute medical
problems, as they do not have the communication skills to detail their own complaints. The frail, confused elderly do not
have the capacity to cope with long waits in emergency departments, and their health may be further compromised when
emergency department staff have other legitimate priorities.
Second, there are no funded Regional Geriatric Programs (RGP) in the municipalities that surround Toronto. Without the
creation and funding of such programs in the broad Greater Toronto Area, all individuals with dementia from the GTA will
rely on the RGP in Toronto, for the specialized assessment and treatment available for this target group. This reliance and
gravitation to the larger urban centre will increase the health care costs in Toronto, and negatively impact the system's
ability to care for its own citizens.
Next, the long-term care facilities within Toronto are not universally designed to care for a dementia population. The
Ministry of Health must commit to making an investment in retrofitting a number of existing physical plants to meet the
specialized needs of this growing target group. It is worthy of note that a number of individuals with dementia currently
residing in our facilities are below the age of 65; younger persons with dementia are able-bodied, have high energy levels,
and present a number of challenges with respect to designing their care programs. Specific design features should be built
into new construction to meet the needs of this special group.
Next, there is a marked need for a major increase in the number of long-term care "spaces" available for community care.
Short-stay/respite programs must be increased and funded adequately. Adult Day Centres must be designed and staffed to
provide quality programming to individuals with dementia.
The Health Services Restructuring Commission (HSRC) recognized the growing need for enhanced long-term care
services and recommended that 5,207 new long-term care beds be added within the City of Toronto; the Commission also
recommended that 4,181 non-institutional spaces be added, including attendant care, respite care, and supportive housing.
This expansion is a critical step to ensure that hospital restructuring does not totally incapacitate the already over-burdened
and under-resourced long-term care system.
Last, the cultural diversity of the City of Toronto poses a number of issues related to dementia care not generally seen in
other communities. For example, 19 percent of the residents in our Homes for the Aged speak a language other than
English; 9 percent speak no English at all. These statistics are approximately double the provincial average. This profile
presents a unique challenge to staff, that is further exacerbated when the individual also suffers from dementia. Many
individuals with dementia lose the ability to speak English, especially if it is a second language. Loss of culture and
language familiar to the individual has the impact of adding to anxiety and exacerbated behavioural problems. In turn, these
issues place higher demands on the staff providing care and service.
Conclusions:
The prevalence of dementia and its associated health care costs are staggering; Dr. Hopkins notes that the estimated costs
of treating individuals with dementia throughout Canada in 1991 was over $3.9 billion. Dr. Hopkins' dementia projections
provide evidence that unless significant changes are made in the level and type of resource available to this population in
the future there will be a crisis in health care which will result in a heavy burden on their communities and on society as a
whole.
There is an urgent need for proactive action at the provincial level. The Dementia Task Force has made a number of
recommendations, which are fully endorsed by staff, in order to respond to this growing crisis. In addition, the health
delivery system within the City of Toronto could be improved by enhanced planning and co-ordination, and by advocating
for and securing much needed funding, in order to meet the needs of our future population.
Contact Name:
Sandra Pitters, General Manager, Homes for the Aged Division
Tel: 392-8907; Fax: 392-4180; E-mail: sandra_pitters@metrodesk.metrotor.on.ca
The Community and Neighbourhood Services submits the following communication (March 4, 1998) from Mr.
John Daly, Legislative Co-ordinator, Regional Municipality of Peel:
I am writing to advise that Regional Council approved the following recommendation at its meeting held on February 26,
1998:
Recommendation HS-15-98:
AThat Regional Council support the recommendations contained in the report from the Dementia Task Force, dated
January 29, 1998, comprised of representatives from the Region of Durham, the Region of Halton, the Region of
Hamilton-Wentworth, the Region of Niagara, the Region of Peel, the City of Toronto and the Region of York;
and further, that the Minister of Health formally recognize the current and future short-falls for Long-Term Care Services
in the ASeven Regions@, including Long-Term Care Facilities and Community Services, by immediately allocating
additional resources for these areas of need;
and further, that a copy of the report of the Commissioner of Social Services, dated February 5, 1998, titled ADementia
Task Force,@ be forwarded to all area MPPs, the Peel District Health Council, Peel Community Care Access Centre
(CCAC), the Alzheimer=s Society of Peel, Peel=s Area Hospitals, the Region of Durham, the Region of Halton, the Region
of Hamilton-Wentworth, the Region of Niagara, the Region of York, and the City of Toronto;
and further, that a copy of the subject report be forwarded to the Federal Minister of Health for a response;
and further, that the Regional Chair request a meeting with the Provincial Minister of Health to seek approval for
additional Long-Term Care Beds in the Region of Peel.@
(A copy of the Report of the Dementia Task Force, referred to in the aforementioned communication, was forwarded to all
Members of Council with the agenda of the Community and Neighbourhood Services Committee for its meeting on March
26 and 27, 1998, and a copy thereof is on file in the office of the City Clerk.)