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"We need to do better as a nation to prepare for the growing needs of our seniors in long-term care," said Candace Chartier, Chair of CALTC. "Too often the answer we hear from governments across Canada is that 'we'll invest in home care or prevention strategies.' The reality is that our seniors who live in long-term care homes require care 24 hours a day. They can no longer live at home."

91% are concerned or somewhat concerned that there won't be enough long term care beds to the meet the future needs.

"All of the long-term care leaders meeting today are frustrated that none of the political parties in the middle of this election campaign are talking about the challenges facing our seniors in long-term care," said Chartier. "We're calling on them to start talking about what's important to Canadians."

93% are concerned or somewhat concerned that patients are waiting too long for placement in a long-term care home.

91% are concerned or somewhat concerned that homes are not being properly staffed to meet the needs of seniors;

When asked to choose between delaying additional investments until government's budget woes improve or to invest now, almost 80% believe that due to the aging population that we need to invest immediately.

Only 2 in 10 believe there will enough staff to provide care to seniors when they need it.

Less than 2 in 10 are confident that hospitals and long-term care homes will be to handle the needs of Canada's aging population.

1.5 in 10 are confident that long-term care homes will be prepared for the rising number of Canadians living with dementia.

93% believe for the federal government to work with the provinces to ensure that Canadians have access to the same level and quality of long term care regardless of where they live in Canada.

92% believe the federal government should ensure that long-term care homes are prepared for the rising number of seniors with dementia.

89% believe the federal government should lead a national long term care strategy with benchmarks to address inequities in access and funding for long term care.

85% believe the federal government should lead the development of a comprehensive, national dementia strategy.

Combined with other savings and income, that amount might provide some retirees with all they need for decades. But everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Plans that looked solid on paper are no match for their bills. "Within the first year most people are tapped out," said Joe Caldwell, director of long-term services at the National Council on Aging. "Middle-class families just aren't prepared for these costs." Many who can afford it buy insurance to help pay for long-term care years in advance, when insurers are less likely to reject them. But even those with insurance, like Ranzman, come up short. Forced to improvise, they sell the house and lean on family. They move in with their adult children, or arrange for their children to move in with them.

Some can save money by switching to different facilities. On average, a shared room in a nursing home runs nearly $11,000 a year less than a private room, and a room in an adult-family home runs cheaper still. Still, there's not a lot of room for creativity, said Liz Taylor, a self-employed geriatric care manager in Lopez Island, Washington. "The amount of care you need dictates the price," she said, "and there aren't that many ways around it." Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid $20 an hour in some parts of the country. But hiring them to work around the clock is often the most expensive, Taylor said. "Needing help to get out of bed to use the bathroom in the middle of the night means you need a nursing home," she said.

EVICTED To Roslyn Duffy, it seemed that her mother, Evelyn Nappa, had everything she needed. After a stroke made it difficult to live alone, Nappa moved from Arizona to Seattle to be near her daughter and soon settled into The Stratford, an assisted-living facility, where she quickly made friends of fellow residents and the staff. "The care was great," Duffy said. "We loved that facility." With the sale of the house in Arizona, Nappa's savings appeared sufficient to cover 10 years at The Stratford, enough to last until she reached 100. Duffy said that the home's directors told her not to worry about her mother running out of money and winding up on Medicaid, even though the government program pays just a portion of what many facilities charge. After all, many of the same homes that refuse to admit seniors on Medicaid will keep those who spend all their savings and wind up on the program. "'We will keep her here' - that's what they said," Duffy recalls. "But I didn't get that in writing." A representative from the nursing home declined to comment.

As Nappa's dementia progressed, she needed more attention. That meant moving her from an independent unit that cost $3,000 a month, to a dementia unit that cost $6,000. Trips to the emergency room, hearing aids and other costs that Medicare didn't cover added up. Soon enough, the money that was supposed to last 10 years was gone in two. Duffy enrolled her mother in Medicaid, confident that The Stratford's management would keep its promises. Two months later, she received a letter saying her mother had 30 days to find a new home. Duffy protested, writing letters to the management and local newspapers, and succeeded in keeping her mother at the Stratford for two months until social workers helped line up an adult family home willing to take Medicaid payments.

But the stress and the change of surroundings strained her mother's health, Duffy said. Six weeks after moving, she was dead. "She declined so quickly," Duffy said. "Being in familiar surroundings is hugely important for dementia patients. There's no doubt in my mind that the move hastened her death. It was devastating, just devastating." NEW HOME Ranzman's story has a happier ending. Her daughter pulled her out of the Amsterdam Nursing Home and rented a house in Smithtown, Long Island, with a patio and a backyard full of azaleas and trees. It was Ranzman's own space. She had round-the-clock aides, a large window and plenty of sunlight. Her daughter, Goldblum, noticed that Ranzman's memory improved quickly. Her mother seemed happier and more alert. "It was less than half the cost of a nursing home and a million times nicer," Goldblum said. "She showed such improvement." Goldblum paid $36,000 a year for the house and her mother's long-term care insurance paid the home-health aides. The move saved around $250,000 a year in expenses. What's more important to Goldblum is that her mother seemed content when she died in April at age 86, lying in bed and surrounded by family. "It was a wonderful ending," she said.

The Public Health Agency of Canada says publicly funded research on dementia has increased by more than 67 per cent since 2006, totalling about $220 million. In October health minister Rona Ambrose announced that Ottawa would work together with provinces and territories to develop a national strategy.

more than 17 percent of nursing home residents in 2010 were given daily doses of antipsychotics in excess of recommended levels.

Participation in the program to reduce use of antipsychotics is voluntary

Last week, three US senators filed a proposal that would require federal regulators to issue standardized rules for nursing homes to follow in seeking permission from patients, or their designated health care agents, such as a family member, before administering antipsychotics for so-called off-label use.

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said that there are already strong rules against overmedicating nursing home residents but that regulators too often fail to enforce them.

Lisa Levin, chair, Ontario Caregiver Coalition The HQO report on caregiver distress backs up what we see every day: caring for someone with dementia plus other health conditions causes extraordinary caregiver distress, anger and depression. The report says that distress has doubled in the last four years.

Alzheimer Societies in Ontario are deeply immersed in this issue. Through our First Link program, which has reached 60,000 new clients over the past five years, as well as our ongoing caregiver education, counselling and support groups, we hear every day the need for a responsive, co-ordinated home-care service with a workforce specially trained in dementia care.

The report underscores the importance of putting in place an Ontario dementia strategy, an initiative currently being led through the Ministry of Health and Long-term Care. We want to ensure that the strategy enables the voice of caregivers and people with dementia to be heard and to influence how programs can better serve them. Chris Dennis, CEO, Alzheimer Society of Ontario

possible to reduce or withdraw the drugs from more than 60 per cent of patients

possibly violent.

Daycare has mandated staffing levels for children in care but that isn’t the case for seniors in nursing homes.

Instead, administrators of B.C.’s 331 long-term care facilities can decide their own staffing needs and can choose or not choose to follow Ministry of Health guidelines.

Vancouver Coastal Health, for instance, follows the industry standard of one care aide at night for every 25 residents.

Nick Whittle, administrator of Inglewood Care Centre, said the facility is not in contravention of the industry standard. He said that besides the two care aides for the 50 residents on the dementia ward at night, there are other staff nearby should they be needed, including a registered nurse and a licensed practical nurse.

The Hospital Employees Union, which represents 15,000 care aides in British Columbia, said the standard being used in the industry is not enough, and chronic understaffing has reached dangerous proportions.

“We hear from our members routinely that they are not backfilled when they are on vacation or sick. Our members are literally rushed off their feet to the point where safety is compromised — both their safety and the safety of residents,” said the HEU’s Jennifer Whiteside.

Whiteside said seniors who have dementia, which sometimes includes aggressive tendencies, often strike out violently when they don’t have the support they need.

At the end of the day, if employers think we can address violence rates without addressing staffing, it’s not realistic. There’s a correlation between the two,” she said.

A HEU study of care aides in late 2014 found more than 70 per cent of its members felt they did not have enough time to comfort, reassure or calm residents they were caring for when residents were feeling confused, agitated or fearful.

increase pressure on care home providers and their funders to pay more attention to the quality of the environments and the levels of care they provide.