Dementia Care at Home in Toronto

Staying at home in Toronto is usually the plan

Most people with dementia in this city would rather stay where they are, and most families would rather that too. The question is almost never whether to stay home. It is what has to be true for staying home to keep being safe — and that answer changes every few months.

This page is about the practical version of that question in Toronto specifically: the housing, the distances, the hospitals and what tends to go wrong first.

The house is usually the first problem

Toronto's older housing was not built with dementia in mind, and the layout tends to force the issue before the illness does.

Distance is the other Toronto problem

An adult child in Leslieville with a parent in Rexdale is an hour each way at the wrong time of day. Families end up doing the drive four or five times a week, in traffic, after work, and the arrangement collapses somewhere around month four — not because anyone stopped caring but because the commute is not sustainable.

Paid care in Toronto is very often bought to replace a commute rather than to replace a family. That is a perfectly good reason to buy it.

What our support workers and nurses do

• Supervision and company — the presence that makes the rest of the day possible for everyone else.
• Personal care — bathing, dressing, toileting and mobility, at the person's pace.
• Meals and fluids — cooking, sitting with someone while they eat, and noticing when eating drops off.
• Medication reminders — prompting and observing. Administering medication is a controlled act in Ontario; where that is needed it is a regulated nurse who does it.
• Routine and orientation — the same faces in the same order. In dementia this is most of what actually helps at home.
• Responsive behaviours — agitation, repetition, refusing personal care, late-afternoon restlessness. We say clearly whether the worker we are offering has worked with this before.
• Escorts — to appointments, to the shops, to the park. Getting out matters and stops happening early.
• Nursing visits — wound care, continence and catheter support, clinical assessment.

Nights, and when they change everything

Dementia usually breaks the nights before it breaks the days. Someone gets up at three, fully dressed, certain they have somewhere to be. A spouse in their eighties cannot safely stop them, and will not sleep again until they are found.

An overnight worker is there through the night so the household sleeps. 24-hour care means people in rotation so someone is awake and responsible at every hour, including in Toronto specifically.

Hospitals, and the weeks after

A fall, an infection or a bad night often ends in an emergency department — Toronto General, Toronto Western, Mount Sinai, St. Michael's, Sunnybrook, Michael Garron, North York General, Humber River or one of the Scarborough Health Network sites. People with dementia rarely come home the way they went in; delirium on top of dementia can take weeks to clear and sometimes does not fully.

The two weeks after a discharge are when the next admission is either prevented or booked. If a discharge date is being discussed, call before it rather than after — see post-hospital care at home.

Public and private care together

Ontario Health atHome arranges publicly funded home care. No doctor's referral is needed to contact them and the intake line is 1-833-515-1234; if you qualify, that care is covered by OHIP.

Most Toronto families we work with use both. The public allocation covers part of the week; private hours cover the overnights, the weekends or the long gap in the middle of the day. Call them whether or not you use us. How the two fit together is set out in private versus government-funded home care.

Toronto also has genuine specialist expertise in dementia — Baycrest in North York among others — and the Alzheimer Society of Toronto runs support and education for families at no charge. We are not connected to either; they are simply worth knowing about.

Where we work in Toronto

Downtown and the old city, the Annex, Yorkville, Rosedale, Forest Hill, Leaside, Davisville, Midtown, Riverdale, Leslieville, the Beaches, East York, the Danforth, the Junction, Bloor West Village, High Park, Parkdale, Etobicoke, the Kingsway, Humber Valley, Rexdale, North York, Willowdale, Bayview Village, York Mills, Don Mills, Lawrence Park, Scarborough, Agincourt, Guildwood and West Hill.

See also home care in Toronto, North York, Scarborough and Etobicoke.

Questions families ask

My father will not let anyone in the house.

Usual, and usually workable. Start with something that is not framed as care — a lift to an appointment, a hand with the cooking, company for an hour. Most refusal is about being managed, not about the person at the door.

We live in a condo. Where does an overnight worker sit?

Wherever the family arranges — a spare room, or a chair in the living room. Overnight workers are awake and working, so they do not need a bed, but they do need somewhere to be and access to a bathroom.

Can the same person come every time?

That is what we aim for, and in dementia you should insist on it. Where the schedule needs more than one person we keep it to a small named group.

Do you provide care in a retirement residence or long-term care home?

Yes. Private one-to-one hours on top of a building's own staffing are common, particularly where someone needs more supervision than the staffing model provides.

What does it cost?

It depends on the hours and the kind of support, and we will not publish a number that turns out not to apply to you. You get a clear figure before anything starts, and the consultation is free. See what affects the cost of home care in Ontario.

Do you have someone who speaks our language?

Tell us which language and we will answer honestly, for your schedule and your part of the city. We would rather say no than send someone who cannot talk to your parent.

Related pages

Dementia and Alzheimer's care across Ontario · Home care in Toronto · Respite care · Overnight care · All locations