Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Physicians with postgraduate training in caring for older adults–geriatricians, geriatric psychiatrists, and Care of the Elderly family physicians (FM-COE)–have expertise in managing complex care needs. Deficits in the geriatric-focused physician workforce coupled with the aging demographic necessitate an increase in training and clinical positions. Descriptive analyses of data from established matching systems have not occurred to understand the preferences and outcomes of applicants to geriatric-focused postgraduate training. This study describes applicant and match trends for geriatric-focused postgraduate training in Canada. In this retrospective cohort study, data from the Canadian Resident Matching Service and FM-COE program directors were analysed to examine program quotas, applicants’ preferences, and match outcomes by medical school and over time. Based on their first-choice specialty ranking, applicants to geriatric medicine and FM-COE signalled a preference to pursue these programs and tended to match successfully. The proportion of unfilled training positions has increased in recent years, and the number of applicants has not increased consistently over time. There is a disparity between applicants to geriatric-focused training and the health human resources to meet population-level needs. Garnering interest among medical trainees is essential to address access and equity gaps.

New approaches to residential continuing care for frail seniors include a shift toward more social care models that involve hiring multiskilled workers and expectations of family involvement as partners in care. Recall and stylized time-use methods were used to assess the types of tasks and amounts of service provided by family and staff caregivers in three models of care. Findings are that family members provide about 30 per cent of on-site services to residents. Family members spend most time in enhancing well-being, while staff spend most time in housework. Patterns of care differ across Adult Family Living, Assisted Living and Dementia Care settings. Sustainability of these patterns of care depends upon adequacy of staffing and reasonable expectations about family resources.

This paper extends an earlier analysis of the geography of caregiving to elderly relatives (Joseph & Hallman, 1996), by closely examining the implications of time-distance between family caregivers and their older relatives. We hypothesize that overlaying a highly gendered social behaviour (eldercare) onto the distinctive time-space geographies of men and women will translate into demonstrably different “eldercare geographies”. Analysis of data from two interrelated CARNET surveys suggests that female and male caregivers provide assistance within very different time-space contexts. Women demonstrate greater engagement with caregiving and more extensive commitments to travel in order to provide assistance. This “distance-defying” behaviour translates into the use of residential relocation as a means of modifying time-space in order to improve caregiving provision. In contrast, male caregivers are more sensitive to the limiting effects of time-distance, including the manipulation of their eldercare geographies. The paper concludes with a discussion, based on comments made by caregivers, of the negative impacts of eldercare involvement, focussing on perceived effects on personal time for other family relationships.