Amidst an aging population, technological change, and shifting attitudes about long-term care, a new conversation about home care and aging-in-place in Canada has begun. In the wake of the COVID-19 pandemic, there has been increased attention to avoiding unnecessary institutionalization and providing the care people need to stay safe and independent at home.

In this context, March of Dimes Canada undertook the first national study of aging-in-place and modifying the home for health. Our goal was to understand the experiences of people in Canada who have modified or plan to modify their home for reasons related to care, as well as to measure attitudes toward aging-in-place and care-motivated home modifications. Through the research, we gathered the perspectives of people with disabilities, seniors, caregivers, and the general public across Canada. 

March of Dimes Canada’s interest in this area is twofold: as one of Canada’s largest non-profit organizations serving people with disabilities, and as the provider of Ontario’s Home and Vehicle Modification program. This program provides funding for residents of Ontario with permanent or recurring disability to pay for basic home and/or vehicle modifications. By reducing or eliminating life safety risks, these modifications enable children and adults with mobility restrictions to continue living at home, avoid job loss, and participate in their communities. 

Commissioned by March of Dimes Canada and coordinated by Caregiver Omnimedia, the survey was conducted by Vivintel. In October 2020, Vivintel surveyed 4,507 respondents residing in Canada (aged 18-85) with targets for those who identify as living with a disease, disability or health condition (1,100), who have performed home modifications (1,100), and who are/have been caregivers (1,100). The study projects results to Statistics Canada’s reporting of the Canadian population by age, gender, region, and household income with a +/- 5% margin of error.

To complement the survey, March of Dimes Canada established an advisory panel of experts in the key sectors of home and community care, occupational therapy, home modification construction, and aging in place. They have helped shape the research framework and questionnaire, and we are grateful for their contributions and knowledge.

Home modifications for care-related reasons range from installing assistive devices like railings, lift devices, and access ramps, to shower modification, automatic door opener installation and more. Just over one in four adults in Canada have modified their home for reasons related to care, including 28% of working age adults (age 18-64) and 27% of seniors (age 65+). Another 35% of working age adults and 40% of seniors plan to modify their home for care-related reasons. This represents a sizable proportion of the Canadian population who have or will address disability- or aging-related concerns through modifying their homes.

Supporting an individual with a disability to live at home more independently is the main reason Canadians have completed care-related home modifications. Among those who have modified their home for care, 55% of working age adults and 64% of seniors cite this reason. To a lesser degree, but still significant, are home modifications that were made to avoid or delay admission to a hospital or long-term care facility (37% among working age adults, 45% among seniors) and to support homecare services (37% among working age adults, 39% among seniors).

For those with future plans to modify their homes, working age adults indicate the primary reason is to support an individual to live at home independently (49%), while the primary reason for seniors is to delay admission to hospital or long-term care (65%).

For both those who have modified and who plan to modify their homes, the primary source of funding is out of pocket, at 55% and 54% respectively. However, there is a significant funding gap. Notably, among those who plan to modify their homes, over one third (36%) earn an annual household income of less than $50,000, demonstrating significant financial need in covering the full cost of modifications. Correspondingly, more than half of Canadians (55%) identify “paying for home modification” as a challenge of aging-in-place. 

To alleviate this financial burden, more than two thirds (69%) of Canadians agree that home modifications should be fully covered by public funds for people with below-average income, and 66% agree they should be publicly funded for people with permanent disabilities.

More than three quarters (78%) of Canadians identify their current home as their preferred location to age, and this increases to 81% of seniors. Seniors in particular see the benefits of aging in place: 90% agree it promotes independence, and 80% agree it promotes making decisions for themselves. However, only 26% of seniors predict that they will stay in their current home when thinking about their future years and aging – indicating a disparity between their desire to age at home and their ability to do so.

The research findings can be complemented by recent trends in March of Dimes Canada’s Home and Vehicle Modification Program (HVMP). In 2019-20, 2,909 applications were received but only 903 could be granted, resulting in funding for only 32% of eligible applications. Approximately 66% of HVMP applicants are age 65 and over, and the vast majority of modifications completed are for entryway and bathroom modifications. The program statistics underscore the realities of an aging population who require modifications to live with dignity and independence at home, and a significant unmet need for additional public funding for home modifications.

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March of Dimes Canada is one of the country’s largest non-profit organizations for people with disabilities, their families and communities, offering a wide array of programs and services to support their everyday independence and empowerment. March of Dimes Canada has operated as a service delivery organization since 1951 and has an in-depth understanding of the diverse needs of people living with disabilities based on our role as a service provider. For more information, please visit www.marchofdimes.ca.