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Comparing Long-Term Care in Canada and the United States

by Derrick

When elder care in the United States is compared to other countries, it ranks near the bottom in certain aspects including affordability, care coordination, access, and timeliness of care. Canada comes out looking better, however, there are loads of out-of-pocket expenses that make elder care management quite difficult at times.

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Overview of Canadian Long-Term Care

Canadian long-term care assistance varies from state to state, both with the cost and what the government will provide. The majority of the elderly remain in their own home or with family members and receive in-home care as needed. 

In British Columbia, the state may foot the bill for 28 hours of personal care assistance per week if you meet the requirements. However, for the most part, families pay for this service. A private or agency care worker can cost up to $30 an hour, registered nurses up to $70. If you or your loved one needs round-the-clock care, a live-in caretaker might cost up to $3,500 per month with the additional room and board expenses. 

Only about one in 16 Canadians over the age of 65 will move into an assisted care facility. The wait time to be admitted can be several months. In Nova Scotia, the waiting period is about 154 days while in Ontario, people wait about 113 days.

Wait time for treatment in Canada is also very high. Nationwide, patients must wait 13.3 weeks for medical procedures to be scheduled. These long delays are especially taxing on the elderly who must wait for cataract surgery, hip replacement, or cardiovascular surgery. MRI procedures may take up to 10.8 weeks.

What Does Long-Term Care Cost in Canada?

Canada’s healthcare system is funded through federal and provincial taxes. The national health care system averages about 70 percent coverage. However, not all procedures, medical equipment, or medicine are covered. The average out-of-pocket cost per year for a Canadian that is using public services is about $5,789. Private retirement homes in Canada can cost up to $5,000 per month, as a base rate, with additional services, like bathing or doctor visits, costing more. 

Canadians can purchase private or provincial insurance to help make up the difference between what the national health care covers and what services are needed. The Canadian health care system does not cover vision and dental care, private rooms in hospitals, prescription drugs, rehabilitation services, or home care. For these services, private health insurance will defray the out-of-pocket costs considerably.

Overview of American Long-Term Care

The United States has Medicare for those 65 and older, as well as Medicaid managed through the states for low-income people which the elderly can take advantage of. In addition to Medicare and Medicaid, many also enroll in Medicare Supplement Insurance (Medigap). This type of coverage is offered through private companies and helps defray the costs of deductibles, coinsurance, and co-payments. 

However, most must subsidize these programs with private insurance policies as well. Almost 28 million people in the U.S. have no insurance whatsoever. Even with insurance, ¼ of Americans find it difficult to pay their deductibles and three in 10 are not taking their prescribed medications because of the cost. Out of pocket expenses, premiums and deductibles averaged about $11,000 per person per year in 2018.

Where Does Medicare Come In?

Medicare has two parts, neither of which will cover assisted care services unless it is on a “skilled” basis, where the resident of a facility is there for skilled medical services (as opposed to permanent residence). Part A is funded by taxes while Part B has a combination of monthly premiums and general taxes finances, although there are a co-payment and deductible for most services in Part B and long-term hospital services under Part A.

  • Part A: covers inpatient hospital care, some home health services, and limited nursing home services.
  • Part B: covers physician services, outpatient laboratory and radiology services, outpatient hospital services, and home health services.

What Does Long-Term Care Cost in the United States?

More than 63.9 million in the country have some form of Medicaid in 2020. Medicaid does not cover the assisted care facility’s room and board. 

More than 800,000 people live in assisted care facilities. Nursing homes in the United States vary by state and facility as to costs and quality of service. On average, a private room will cost $8,365 per month at a nursing home, however, location and care services provided may influence that amount. Alaska, Connecticut, and Hawaii have the highest costs, while Oklahoma, Louisiana, and Missouri cost less overall. 

In-home health care may cost less depending on the number of hours and duties required. Wages are about $20 per hour for in-home care and $28 per hour for skilled nursing assistance.

Conclusion

While long-term care in Canada certainly isn’t free, it does on average cost less than comparable services in the United States. Both countries have long wait times for procedures and often require a co-payment for medication, treatment, and care. However, the type of treatment covered and costs varies from state to state in the U.S. and province to province in Canada, so it’s difficult to compare the two countries as a whole.

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