Continuing Care for Seniors: What the System Misses — and How Families Fill the Gaps

Jenna Fralick, BScN RN

Introduction: When "Continuing Care" Isn’t Enough

October is Continuing Care Month in Nova Scotia — a time meant to celebrate the individuals and organizations providing ongoing support to older adults and those living with disabilities. But for many families, the term continuing care triggers something more complicated than celebration. It often brings to mind long waitlists, overworked staff, and systems that feel more like mazes than safety nets.

At Remember When HealthCare (RWHC), we believe “continuing care for seniors” should mean continuous care for life — not just the type that fits into government frameworks. It’s about ensuring that the support doesn’t stop when the paperwork does, and that compassion doesn’t have an expiry date.

The Reality Behind Continuing Care for Seniors in Nova Scotia

The goal of continuing care programs is noble: to help older adults and persons living with disabilities remain as independent as possible while receiving needed health or personal support (Health Association Nova Scotia, 2024). But the reality is that public continuing care systems are strained. Wait times for assessments and placement into long-term care or home support services can range from weeks to months — sometimes even longer for rural residents.

Research from the Canadian Institute for Health Information (CIHI, 2023) shows that over 30% of Canadians waiting for long-term care could safely receive services at home with the right supports. Yet, many remain institutionalized or without help because of bureaucratic backlogs. Family caregivers — mostly women aged 50–70 — are often left filling these gaps themselves (CIHI, 2023).

For many Nova Scotian families, this translates to exhaustion, guilt, and confusion. They’re told to “wait for the system,” but their loved one’s needs don’t wait. They change daily.

What the System Misses — and Families Feel Every Day

Public continuing care frameworks are built to manage populations, not personalize experiences. This creates a tension between what’s efficient and what’s human. Families tell us the system often misses three key realities:

1. Care Needs Don’t Fit Neatly Into Boxes

A senior may need help with personal care, light housekeeping for seniors, and meal preparation services — but if they don’t meet certain “medical need” thresholds, they might not qualify for public support. This leaves families scrambling to cover essential activities of daily living that determine whether someone can stay safely at home.

2. Emotional Care Is Undervalued

Loneliness, anxiety, and loss of purpose are invisible health threats among older adults. Yet, companionship for seniors rarely makes it into formal care plans. The emotional care that family members provide — the conversation, laughter, and reassurance — is often seen as optional. At RWHC, it’s foundational.

3. The System Treats Families as Extras, Not Experts

Caregivers are often expected to navigate paperwork, coordinate providers, and advocate without guidance. But they are the constant — the ones who see what’s missed during rushed visits or inconsistent follow-ups. In a true model of continuing care for seniors, families are not bystanders; they’re partners.

The Hidden Cost of “Free” Care

It’s easy to assume public care means less financial strain. But hidden costs pile up fast: unpaid time off work, transportation, missed medical appointments, emotional burnout, and even health issues in caregivers themselves.

A 2022 study by the Canadian Centre for Caregiving Excellence found that caregivers in Nova Scotia provide an average of 19 unpaid hours of care weekly, often while managing full-time jobs and their own health conditions. These caregivers save the healthcare system billions — yet receive minimal support in return (Canadian Centre for Caregiving Excellence, 2022).

This unpaid labour represents not only an economic gap but an emotional one. As one Halifax caregiver said, “They thanked me for keeping Mom at home, but no one asked what it was costing me to do it.”

Continuing Care for Seniors: What It Should Mean

If “continuing care” truly reflected the needs of today’s families, it would look more like what organizations such as RWHC provide daily — flexible, person-centered, and holistic support.

Here’s what that looks like in practice:

• Customized in-home care plans that evolve as needs change.

• Support for both seniors and persons living with disabilities — not one or the other.

• Personal care and companionship that nourish both physical and emotional health.

• Professional homecare providers who build trust, not just routines.

• Affordable homecare for seniors that prevents crisis before it happens.

At RWHC, we believe continuing care doesn’t end when a case file closes — it continues through every chapter of a person’s life.

How Families Fill the Gaps — and Reclaim Dignity

Behind every “care plan” is a family doing their best. They’re managing medications, meals, emotions, and medical jargon — all while holding down jobs and relationships. The resilience of caregivers in Nova Scotia is extraordinary, but it shouldn’t be necessary to the point of burnout.

That’s why we’re reimagining continuing care for seniors through a family-first lens. We start by asking:

“What does your family need to feel safe, supported, and connected?”

From there, we co-create solutions — from a few hours of home support services to 24/7 senior homecare. It’s about giving families back their roles as sons, daughters, and partners — not just caregivers.

The System vs. the Human Touch

There’s a reason many families turn to private care even after qualifying for government services. Public systems often rotate workers, leaving seniors anxious and disconnected. We believe in a different approach: continuity.

The same familiar faces arrive each day. The care plan is consistent. The dignity is preserved. Families receive updates, reassurance, and peace of mind — things no government form can provide.

We’ve seen how simple consistency can transform lives. A client once told us, “I don’t dread mornings anymore because I know exactly who’s coming and what time they will be here.” That’s what true continuing care for seniors looks like — care that continues without interruption.

A Deeper Look: Why Personalized Care Matters

Canadian studies consistently show that personalized, in-home care leads to better outcomes and reduced healthcare costs.

• A University of British Columbia study found that individualized homecare programs reduce hospital readmissions by 23% (UBC, 2022).

• Seniors receiving continuity in care reported higher satisfaction, lower anxiety, and improved medication adherence (CNA, 2023).

• For caregivers, customized care reduces burnout and increases emotional well-being (CIHI, 2023).

  
  

These findings confirm what we see every day at RWHC: when care adapts to people — not the other way around — everyone thrives.

Redefining “Continuing” — One Family at a Time

At Remember When HealthCare, “continuing care” isn’t a system — it’s a promise.We promise to continue:

• Listening before acting.

• Supporting both seniors and persons with disabilities.

• Offering flexible homecare solutions that adjust as life changes.

• Standing beside families, not above them.

FAQ

1. What’s the difference between public continuing care and private homecare?Public continuing care is coordinated through Nova Scotia Health and offers services based on eligibility, income, and medical need. Private homecare, like RWHC, provides flexible, personalized support that can begin immediately and adapt to changing needs — without waitlists or standardized limitations.

2. Does Remember When HealthCare support persons with disabilities?Absolutely. Our services are inclusive and designed for both seniors and persons living with disabilities. We provide disability support in-home across Nova Scotia, helping individuals maintain independence and dignity in their own homes.

Continuing care shouldn’t mean waiting — it should mean living.

Discover how our Homecare Solutions bridge the gaps in the system: HERE

References (APA 7th Edition)

Canadian Centre for Caregiving Excellence. (2022). Caregiving in Canada: The State of Family Caregiving Report.Ottawa, ON: Canadian Centre for Caregiving Excellence.

Canadian Institute for Health Information (CIHI). (2023). Continuing Care in Canada: Trends and Insights. Ottawa, ON: CIHI.

Canadian Nurses Association (CNA). (2023). Home Care: Strengthening the Continuum of Care in Canada. Ottawa, ON: CNA.

Health Association Nova Scotia. (2024). Continuing Care Month: Celebrating Those Who Care. Retrieved from https://healthassociation.ns.ca/

University of British Columbia (UBC). (2022). Community-Based Home Care: Impacts on Readmission Rates and Family Well-Being. Vancouver, BC: UBC School of Nursing.