Seven days a week, Margot Algie can’t get out of bed before noon. Not from choice. She has amyotrophic lateral sclerosis (ALS), a debilitating neurodegenerative disease, and needs a home care worker to help start her day.
But once someone arrives to shift her into a wheelchair, dress her and help with toileting, Algie often only has one hour — sometimes two — before another home care worker arrives to put her back to bed at 4 p.m.
“Being stuck in bed … isn’t great for my body, my skin or my psyche,” said the Toronto woman, who is gradually losing the ability to do all basic living activities.
But the home care company says “that’s all that’s available,” she said.
At least once a week, she gets a call to say no home care worker is available at all.
“I’m terrified when they say I can’t have help,” said Algie, 63, who says she’s fully dependent on the care she receives.
A home care worker helps Algie transfer to her wheelchair. (Norm Arnold/CBC)
Algie is not alone when it comes to complaints about substandard home care. A recent CBC Marketplace investigation sparked hundreds of stories from home care clients and their families across the country, complaining of missed visits, shortened visits and the inability to get visits at all.
Compounding problems, the number of people who rely on home care is expected to increase by more than 50 per cent in less than a decade, according to the Canadian Medical Association (CMA).
It estimated in a recent report that more than 1.1 million Canadians receive home care and that by 2031, that number will likely increase to 1.7 million. On top of that, the report estimates the annual cost for long-term care and home care in Canada will almost double during that period, from $29.7 billion to $58.5 billion.
“This problem is getting worse,” said CMA president Katharine Smart. “There is a real risk we will see our systems start collapsing over the next months and years.”
It’s a grim prediction that doesn’t have to materialize, said Dr. Samir Sinha, director of health policy research for the National Institute on Ageing and director of geriatrics at Sinai Health and the University Health Network in Toronto.
Geriatrician Dr. Samir Sinha says more investment in home care is needed to avert a financial long-term care crisis a decade from now. (Tiffany Foxcroft/CBC)
“The problem that we’ve had in Canada is this notion that if you can’t care for someone at home, they need to go live somewhere else,” said Sinha. “And so we have this real culture of institutionalizing people.”
Sinha said what’s needed isn’t rocket science. Provinces need to invest more in home care to help people age in place.
“Right now there are about 200,000 Canadians living in long-term care homes,” he said. “About a third of them — 60,000 or 70,000 people — could’ve actually stayed in their own homes, with proper home care support.”
Meantime, he said, at least 50,000 Canadians are waiting to get into a long-term care bed but there’s no room. Many have no option but to wait in hospitals for a spot to open up.
WATCH | The system this clinician says he’s up against:
‘That breaks my heart,’ says Canadian geriatrician
23 hours ago
Duration 0:30
Dr. Samir Sinha says Canada’s home care system often robs the dignity of his patients. 0:30
But Sinha said making a fundamental change to invest more in home care is a hard pitch to sell.
“Our politicians are living on four-year political life cycles and just trying to focus on getting re-elected — rather than figuring out how to create a sustainable health-care system for the future,” he said.
Smart says time to act is running out.
“I think there has never been a more urgent moment to shift our health-care system.
“This is a real example of where the government needs to get beyond politics and understand that Canadians need this system. It has to be functional. And right now it is not.”
Look to Denmark, geriatrician urges
The way forward is to take a page from Denmark, said Sinha, who has travelled to the Scandinavian country to study its long-term care strategy and returned last month with a CBC Marketplace crew.
In the late 1980s, Denmark — which, like Canada, has an aging population and publicly funded home care — slowed the growth of new nursing homes and instead used that money to heavily invest in home care.
In Ringsted, Denmark, elder dwellings with no stairs are available to rent. Here seniors receive home care and live independently. (Katie Pederson/CBC)
The funding means people in Denmark can get anywhere from 20 minutes to 10 hours of home care a day, depending on their needs.
When Danish people turn 80, they are automatically offered a home visit by a nurse to assess how things are going and whether they need any support to help keep them aging at home.
“We talk about if they have lost their husbands or wives, and how it is to be alone,” said Camilla Hove Lund, who manages the home care program in the municipality of Ringsted, 70 kilometres southwest of Copenhagen.
“We talk about their network — do you have some friends? Some family? Do you have activities you go to?” said Hove Lund. “And if we hear they need a little bit of help, we give that to them.”
Camilla Hove Lund runs the home care program in Denmark’s Ringsted municipality. She says focusing on prevention keeps aging people out of long-term care beds. (Katie Pederson/CBC)
It may sound like a warm and fuzzy approach, but don’t be fooled, said Sinha. “It’s actually a deliberate strategy to keep the overall health-care system sustainable.”
When Danes find themselves struggling physically — perhaps no longer able to bathe themselves — they’re registered in what’s called a “reablement” program.
“We offer them the bath,” said Hove Lund. “But we also offer training with our workers … to do the bath by themselves again.”
WATCH | Come inside a home in Denmark:
‘The goal is to strengthen his legs,’ says Danish PSW
23 hours ago
Duration 1:07
Johnny Olsen does rehab exercises with a trained personal support worker as part of Denmark’s ‘reablement’ program in home care. 1:07
It’s a much different approach than the home care most often provided in Canada, said Sinha.
“The little home care that we make available to Canadians is often what we call ‘reactive’ home care,” he said. “Someone falls, they need a bath, we send in people to help. Whereas [in Denmark] there is this idea of preventative home care.”
In Ringsted’s rural outskirts, 72-year-old Johnny Olsen, a former farmer, is struggling with Alzheimer’s disease.
He gets six home care visits a day, including physical therapy twice a week to strengthen his arms and back and try to prevent him from falling.
Johnny Olsen, who has from Alzheimer’s, pictured here with a regular home care worker, gets six home care visits every day in Ringsted, Denmark. (Katie Pederson/CBC)
“It’s working,” he said, as he diligently followed the prompts of his home care worker to raise and lower his legs.
In Denmark, all home care workers are trained to do preventative physio to try to keep people aging in place, whereas in Canada, it’s not standard practice for home care workers to get rehab training and physiotherapists are in high demand.
“We have a big group of elderly who need a lot less help if we give them rehabilitation,” said Hove Lund.
Those who do get rehab also have their progress tracked.
“The results are very important to us,” said Hove Lund. “We have to show our politicians that this works. You have to give money to this.”
Lonni Bensadon stands next to one of many electric vehicles provided to personal support workers in the Danish municipality of Ringsted so they can conduct home care visits. (Submitted by Samir Sinha)
It’s all a deliberate effort to help people age at home — and all a far cry from what’s being delivered back at home, said Sinha.
“We need to say that we don’t have a system that’s currently working as well as it could,” he said. “These aren’t pie in the sky ideas — we’re physically seeing them here in Denmark.”
Promises to invest more in home care
In 2018, Ontario’s Conservative government hired Sinha to develop a Senior Strategy — a long-term care plan for the province’s aging population.
He presented a report that called on the government to build fewer long-term care beds and invest more in home care.
But he said the Ford government basically shelved his report and instead committed to spending $6.4 billion to build 30,000 new long-term care beds by 2028. That’s on top of its annual $6-billion budget for long-term care and $3 billion for home care.
Ontario Premier Doug Ford talks on Feb. 1, 2022, about committing $6.4 billion to build 30,000 new long-term care beds by 2028. (CBC)
“They chose the solution that frankly is a lot more costly to taxpayers, but works really well for developers,” said Sinha.
“It really troubles me because we’re not getting the fundamentals right here. Nobody actually aspires to end up in a nursing home. But for the public, it’s being presented as, ‘We’re doing this big thing to take care of this big problem.'”
But earlier this week, in a surprise announcement, the Ontario government said it plans to invest an additional $1 billion over three years in home care if re-elected in June.
“This significant investment will ensure Ontarians can receive the care they need in the comfort of their own homes,” said Health Minister Christine Elliott.
It’s a step in the right direction, said Sinha. “This investment will help to fix fundamental problems [the Ontario government] created after four years of deliberately starving Ontario’s home care system.”
The Ontario government said this week that it plans to invest an additional $1 billion over three years in home care if re-elected in June. (David Donnelly/CBC)
Meanwhile, the Ontario Liberal Party said that if elected, it would invest a further $2 billion in home care over four years and end for-profit long-term care by 2028.
The provincial NDP said it would invest up to $1 billion in home care if elected and would also end for-profit long-term care.
A survey by the National Institute on Ageing found that almost 100 per cent of people said they hope to age at home, as opposed to moving to a long-term care facility.
Figures obtained by Ontario’s Ministry of Health show that providing home care is also half the price of a long-term care bed — roughly $100/day compared to $200/day — and far less costly than a hospital bed that costs approximately $700/day.
Home care clients in Canada receive, on average, 4.9 hours of care a week. According to the CMA, even if that number was increased to 22.2 hours per week, to reflect higher need clients, it would still be cheaper than institutionalized care.
Algie has amyotrophic lateral sclerosis, a debilitating neurodegenerative disease, and needs a home care worker to help start her day. (Tiffany Foxcroft/CBC)
“When you’re delivering care in a long-term care home, you’ve got to buy a piece of land, you’ve got to erect a building, you have to heat and cool it,” said Sinha.
“You don’t have to be a mathematician to realize that the care that most people actually want is the most cost-effective for the taxpayer and more in line with what everybody hopes for.”
Stuck in bed for most of the day, Algie said she’s tired of struggling with a broken home care system that’s in desperate need of better funding.
“It really gets my goat,” she said. “Everybody knows it. And yet, we’re still in this pickle of being underfunded. I just don’t get it.”
WINNIPEG – Some 250 coloured tacks pepper a large-scale world map among bookshelves at Whodunit Mystery Bookstore.
Estonia, Finland, Japan and even Fenwick, Ont., have pins representing places outside Winnipeg where someone has ordered a page-turner from the independent bookstore that specializes in mystery and crime fiction novels.
For 30 years, the store has been offering fans of Agatha Christie’s Hercule Poirot or Arthur Conan Doyle’s Sherlock Holmes a place to get lost in whodunits both old and new.
Jack and Wendy Bumsted bought the shop in the Crescentwood neighbourhood in 2007 from another pair of mystery lovers.
The married couple had been longtime customers of the store. Wendy Bumsted grew up reading Perry Mason novels while her husband was a historian with vast knowledge of the crime fiction genre.
At the time, Jack Bumsted was retiring from teaching at the University of Manitoba when he was looking for his next venture.
“The bookstore came up and we bought it, I think, within a week,” Wendy Bumsted said in an interview.
“It never didn’t seem like a good idea.”
In the years since the Bumsteds took ownership, the family has witnessed the decline in mail-order books, the introduction of online retailers, a relocation to a new space next to the original, a pandemic and the death of beloved co-owner Jack Bumsted in 2020.
But with all the changes that come with owning a small business, customers continue to trust their next mystery fix will come from one of the shelves at Whodunit.
Many still request to be called about books from specific authors, or want to be notified if a new book follows their favourite format. Some arrive at the shop like clockwork each week hoping to get suggestions from Wendy Bumsted or her son on the next big hit.
“She has really excellent instincts on what we should be getting and what we should be promoting,” Micheal Bumsted said of his mother.
Wendy Bumsted suggested the store stock “Thursday Murder Club,” the debut novel from British television host Richard Osman, before it became a bestseller. They ordered more copies than other bookstores in Canada knowing it had the potential to be a hit, said Michael Bumsted.
The store houses more than 18,000 new and used novels. That’s not including the boxes of books that sit in Wendy Bumsted’s tiny office, or the packages that take up space on some of the only available seating there, waiting to be added to the inventory.
Just as the genre has evolved, so has the Bumsteds’ willingness to welcome other subjects on their shelves — despite some pushback from loyal customers and initially the Bumsted patriarch.
For years, Jack Bumsted refused to sell anything outside the crime fiction genre, including his own published books. Instead, he would send potential buyers to another store, but would offer to sign the books if they came back with them.
Wendy Bumsted said that eventually changed in his later years.
Now, about 15 per cent of the store’s stock is of other genres, such as romance or children’s books.
The COVID-19 pandemic forced them to look at expanding their selection, as some customers turned to buying books through the store’s website, which is set up to allow purchasers to get anything from the publishers the Bumsteds have contracts with.
In 2019, the store sold fewer than 100 books online. That number jumped to more than 3,000 in 2020, as retailers had to deal with pandemic lockdowns.
After years of running a successful mail-order business, the store was able to quickly adapt when it had to temporarily shut its doors, said Michael Bumsted.
“We were not a store…that had to figure out how to get books to people when they weren’t here.”
He added being a community bookstore with a niche has helped the family stay in business when other retailers have struggled. Part of that has included building lasting relationships.
“Some people have put it in their wills that their books will come to us,” said Wendy Bumsted.
Some of those collections have included tips on traveling through Asia in the early 2000s or the history of Australian cricket.
Micheal Bumsted said they’ve had to learn to be patient with selling some of these more obscure titles, but eventually the time comes for them to find a new home.
“One of the great things about physical books is that they can be there for you when you are ready for them.”
This report by The Canadian Press was first published on Sept. 15, 2024.
MONTREAL – Canada’s labour minister is praising both Air Canada and the union representing about 5,200 of its pilots for averting a work stoppage that would have disrupted travel for hundreds of thousands of passengers.
Steven MacKinnon’s comments came in a statement shared to social media shortly after Canada’s largest air carrier announced it had reached a tentative labour deal with the Air Line Pilots Association.
MacKinnon thanked both sides and federal mediators, saying the airline and its pilots approached negotiations with “seriousness and a resolve to get a deal.”
The tentative agreement averts a strike or lockout that could have begun as early as Wednesday for Air Canada and Air Canada Rouge, with flight cancellations expected before then.
The airline now says flights will continue as normal while union members vote on the tentative four-year contract.
Air Canada had called on the federal government to intervene in the dispute, but Prime Minister Justin Trudeau said Friday that would only happen if it became clear no negotiated agreement was possible.
This report from The Canadian Press was first published Sept. 15, 2024.
When it comes to plant-based alternatives, Canadians have never had so many options — and nowhere is that choice more abundantly clear than in the milk section of the dairy aisle.
To meet growing demand, companies are investing in new products and technology to keep up with consumer tastes and differentiate themselves from all the other players on the shelf.
“The product mix has just expanded so fast,” said Liza Amlani, co-founder of the Retail Strategy Group.
She said younger generations in particular are driving growth in the plant-based market as they are consuming less dairy and meat.
Commercial sales of dairy milk have been weakening for years, according to research firm Mintel, likely in part because of the rise of plant-based alternatives — even though many Canadians still drink dairy.
The No. 1 reason people opt for plant-based milk is because they see it as healthier than dairy, said Joel Gregoire, Mintel’s associate director for food and drink.
“Plant-based milk, the one thing about it — it’s not new. It’s been around for quite some time. It’s pretty established,” said Gregoire.
Because of that, it serves as an “entry point” for many consumers interested in plant-based alternatives to animal products, he said.
Plant-based milk consumption is expected to continue growing in the coming years, according to Mintel research, with more options available than ever and more consumers opting for a diet that includes both dairy and non-dairy milk.
A 2023 report by Ernst & Young for Protein Industries Canada projected that the plant-based dairy market will reach US$51.3 billion in 2035, at a compound annual growth rate of 9.5 per cent.
Because of this growth opportunity, even well-established dairy or plant-based companies are stepping up their game.
It’s been more than three decades since Saint-Hyacinthe, Que.-based Natura first launched a line of soy beverages. Over the years, the company has rolled out new products to meet rising demand, and earlier this year launched a line of oat beverages that it says are the only ones with a stamp of approval from Celiac Canada.
Competition is tough, said owner and founder Nick Feldman — especially from large American brands, which have the money to ensure their products hit shelves across the country.
Natura has kept growing, though, with a focus on using organic ingredients and localized production from raw materials.
“We’re maybe not appealing to the mass market, but we’re appealing to the natural consumer, to the organic consumer,” Feldman said.
Amlani said brands are increasingly advertising the simplicity of their ingredient lists. She’s also noticing more companies offering different kinds of products, such as coffee creamers.
Companies are also looking to stand out through eye-catching packaging and marketing, added Amlani, and by competing on price.
Besides all the companies competing for shelf space, there are many different kinds of plant-based milk consumers can choose from, such as almond, soy, oat, rice, hazelnut, macadamia, pea, coconut and hemp.
However, one alternative in particular has enjoyed a recent, rapid ascendance in popularity.
“I would say oat is the big up-and-coming product,” said Feldman.
Mintel’s report found the share of Canadians who say they buy oat milk has quadrupled between 2019 and 2023 (though almond is still the most popular).
“There seems to be a very nice marriage of coffee and oat milk,” said Feldman. “The flavour combination is excellent, better than any other non-dairy alternative.”
The beverage’s surge in popularity in cafés is a big part of why it’s ascending so quickly, said Gregoire — its texture and ability to froth makes it a good alternative for lattes and cappuccinos.
It’s also a good example of companies making a strong “use case” for yet another new entrant in a competitive market, he said.
Amid the long-standing brands and new entrants, there’s another — perhaps unexpected — group of players that has been increasingly investing in plant-based milk alternatives: dairy companies.
For example, Danone has owned the Silk and So Delicious brands since an acquisition in 2014, and long-standing U.S. dairy company HP Hood LLC launched Planet Oat in 2018.
Lactalis Canada also recently converted its facility in Sudbury, Ont., to manufacture its new plant-based Enjoy! brand, with beverages made from oats, almonds and hazelnuts.
“As an organization, we obviously follow consumer trends, and have seen the amount of interest in plant-based products, particularly fluid beverages,” said Mark Taylor, president and CEO of Lactalis Canada, whose parent company Lactalis is the largest dairy products company in the world.
The facility was a milk processing plant for six decades, until Lactalis Canada began renovating it in 2022. It now manufactures not only the new brand, but also the company’s existing Sensational Soy brand, and is the company’s first dedicated plant-based facility.
“We’re predominantly a dairy company, and we’ll always predominantly be a dairy company, but we see these products as complementary,” said Taylor.
It makes sense that major dairy companies want to get in on plant-based milk, said Gregoire. The dairy business is large — a “cash cow,” if you will — but not really growing, while plant-based products are seeing a boom.
“If I’m looking for avenues of growth, I don’t want to be left behind,” he said.
Gregoire said there’s a potential for consumers to get confused with so many options, which is why it’s so important for brands to find a way to differentiate themselves, whether it’s with taste, health, or how well the drink froths for a latte.
Competition in a more crowded market is challenging, but Taylor believes it results in better products for consumers.
“It keeps you sharp, and it forces you to be really good at what you’re doing. It drives innovation,” he said.
This report by The Canadian Press was first published Sept. 15, 2024.
