They spend all day alone — in a chair. Some seniors are aging at home so quietly few know they exist

Except for one day a year, 84-year-old Myriah Bowen never leaves her Toronto apartment. In fact, she rarely leaves her wheelchair.
She sits near the living-room TV for 15 hours a day, beside a bundle of her most-needed items: crocheting yarn, vitamins, a remote and a telephone that clips onto her T-shirt. If it weren’t for the heavy mechanical lift that hovers over her bed, she’d be trapped on her mattress.
Five kilometres south, near Yonge Street and Eglinton Avenue, Rhona Knowles spends her day in a living room chair.
Everything 95-year-old Rhona needs is on the tables that surround her. In front is a TV remote, a telephone, a box of tissues, a glass of water and a small ticking clock. Beside her is a paper calendar, pens, a one-pound dumbbell and most importantly, a voice amplifier that plugs into headphones so she can hear visitors speak.
Rhona and Myriah are among the fortunate. They have children who spend time in their homes, cook meals, organize appointments or fill the gaps left by the provincial home-care system.
Others have nothing, aging in place so quietly few know they exist.
Across Toronto, some of the oldest and most fragile are left to spend all day, every day, in a chair or bed, often relying on a government-funded personal support worker for food and toileting, if they are fortunate enough to get one. Sometimes those workers don’t show.
If the pandemic left older adults fearing nursing homes, few are talking about the struggle to stay at home in the frailest years, often without enough food, human contact or medical care.
And while the very wealthy can spend tens of thousands of dollars on private specialized care, middle-class and lower-income seniors cannot.
When she’s driving to her patients’ homes, Dr. Christa Sinclair Mills sometimes looks up at the apartment windows in the Yonge Street corridor and wonders how many in there need help.
“Every building you drive past, there are older adults in there who have nobody else,” said Sinclair Mills, a travelling physician with House Calls, a medical team that provides late-life care for “homebound” older adults.
“They are living a completely invisible, separate life from the rest of society,” she said. “And that’s a huge challenge for them, but also for the system as a whole.
The troubles of traditional nursing homes are well known, with strict schedules, noisy institutional spaces and rushed staff adhering to provincial regulations that aim to keep people safe but in doing so, provide little freedom to live.
The new goal, for older adults, is aging at home.
A November report by the Canadian Mortgage and Housing Corp. found that older homeowners are increasingly aging in place, at least until their very late years. And while avoiding long-term-care homes or hospitals saves governments significant sums of money, there are comparatively few investments in at-home programs that offer vulnerable and financially struggling older adults medical care or social connections and their outside world shrinks, leaving many isolated until they disappear, left alone in a chair.
A quick glance at Canada’s demographics shows that for many, the final years or months before death will be lonely.
Statistics Canada says Canadians 85 and older are one of the fastest-growing age groups.
The 2021 Census counted 861,000 Canadians over 85, more than double the number in 2001, and in 25 years that group is expected to triple to 2.5 million.
The average age of a House Calls patient is 88 — a population that has limited options for care other than nursing homes, where many do not want to go although the wait-list to get in can be years long.
The House Calls patients cared for by Sinclair Mills and her fellow other physicians, occupational therapists, social workers, physiotherapists and nurse practitioners have multiple health conditions and 75 per cent are so immobile, she said, their final years or months are spent in a bed or chair.
House Calls is among the few Canadian organizations that offer very frail older adults at-home late-life medical care — that often becomes end-of-life care. As Sinclair Mills said, it reaches just a few of those who need help.
It is increasingly clear that a lot of vulnerable older adults are at risk.
“With our aging-in-place strategies, we have to not just focus on healthy, active seniors,” said Laura Tamblyn Watts, CEO of CanAge, a national advocacy group for older adults.
“It also means that we need to be providing meaningful care to our sick and in some cases, palliative seniors.
“And that, right now,” she said, “is a big miss in our planning.”
House Calls sees 700 to 1,000 homebound older adults a year within its Toronto catchment area, generally bound by the Don River to the east and Humber River in the west, although its leaders are hoping to expand eastward.
Without programs like this, said Dr. Samir Sinha, “homebound individuals likely end up becoming prematurely institutionalized and also likely die earlier.
“They give people the opportunity to live longer in their own homes and communities with their families right until the end,” said Sinha, director of geriatrics for Sinai Health and the University Health Network. “It’s a very special, powerful and cost-effective way to care for some of our most vulnerable.”
What is needed, Sinha said, is a new emphasis on programs focused on social well-being so older people do not become so isolated — which can lead to significant health problems, including cognitive decline.
During the pandemic the province supported the expansion of programs run by organizations like SPRINT Senior Care that connected with older adults by telephone or virtual visits, he said. Some organizations send volunteers into seniors’ homes, for weekly chats.
“There are programs that actually do this,” he said, “but they’re largely kind of organized in a piecemeal fashion.
“Increasingly, we have more and more people who want to stay at home, and staying at home is doing all of us a favour, but it shouldn’t come at the cost of people’s social well-being.”
House Calls’ data said that in 2020-21, it saved Toronto hospitals from 1,121 visits.
Numbers like this, its founder Dr. Mark Nowaczynski said, should inspire more government funding, rather than the constant struggle to make ends meet.
Nowaczynski said House Calls operates on $990,000 a year from the Ontario Ministry of Health (flowing through SPRINT Senior Care), with no increase in the last five years. Philanthropic donations help, but if those aren’t replenished, he said, the team will lose medical workers.
“Every day we prevent hospitalizations,” Nowaczynski said. “People get sick, they get acute illnesses on top of their chronic illnesses. People get pneumonia.
“In every single one of those cases, the families know to call when there’s a change in their baseline. We get in, we assess and we diagnose and treat early and we prevent a hospitalization. And people who don’t have access to that care, they get sicker and sicker and sicker and then they end up in emerg half-dead.
“They get admitted — they spend two weeks in hospital. What is the cost of the treatment that we prevent on an almost daily basis? Our program doesn’t cost money. Our program saves multiples of what it costs.”
After 30 years spent working long hours as a personal support worker in nursing homes and hospitals, Myriah can no longer walk.
She stays in the safety of home, in a small apartment near Avenue Road just south of the 401, although for the last eight years, she has embraced her one-day exit, in her wheelchair, for an annual eye check-up at Sunnybrook hospital.
“I have you to thank for my eyesight,” Myriah said to Sinclair Mills, who, eight years earlier, recognized the aggressive nature of her cataracts after an initial living-room appointment where Myriah sat, between the TV and the front door, the same spot she sits in now.
“I would have gone blind,” Myriah said. “I would have been in a nursing home right now.”
Sometimes it’s about practicalities. That’s often when occupational therapist Leslie Coulter gets involved.
She helped Myriah access funding from the city of Toronto’s “Hardship Fund” for the freestanding metal lift (which Coulter dubbed “The Beast”) that allows workers to place a sling under her body and lift her from wheelchair to bed. (Myriah can independently move from her living room to the kitchen in her wheelchair but the washroom doors are too narrow to allow her chair inside.)
During a visit with Sinclair Mills, Coulter noticed the ragged edges of Myriah’s wheelchair arm and promised to order new padding so her skin doesn’t tear. She looked at the sling that carries Myriah from wheelchair to bed and decided it’s time for a new one. If she can’t get it covered by a city program, Coulter will dip into House Calls’ care fund to cover the $500 cost. Growing frail isn’t cheap.
On the wall beside her hang framed certificates from her years of training as a health-care aide and personal support worker.
Myriah tells Coulter the current PSW’s won’t help her onto the lift and into bed at night because they are not allowed to use the lift without proper training, which sort of defeats the purpose of their evening visits. For now, her granddaughter comes every night to move her into bed.
“My 19-year-old granddaughter can do it, and she does it alone,” said Bowen.
Coulter listened. It’s time, she said, to get a supervisor into Myriah’s apartment for a new assessment of her needs and the staff sent to care for her.
“This is a priority.”
Within days, Myriah’s PSW’s got the training.
On a warm October morning, Dr. Katja Heineck placed her knapsack on a table in Rhona Knowles’s apartment, a few feet from her chair. A smaller bag, with ice packs, holds flu vaccines. Heineck is a House Calls physician, here for a monthly visit with Rhona, her patient of many years.
“I have a present for you today. A flu shot,” Heineck told Rhona.
“Ohhhh … that’s good,” Rhona said.
A pulse oximeter clasped on Rhona’s fingertip finds healthy oxygen levels in her blood.
Next up is blood pressure.
“It’s very good,” Heineck said, loud enough for Rhona to hear. “124 over 70.”
She slipped the stethoscope under Rhona’s cardigan, listening for fluid on her lungs. “No water, nice and clear.”
Heineck slipped off Rhona’s shoes and peered between her toes for pressure ulcers. The skin isn’t broken, she said.
Heineck has already determined that Rhona’s right ear is full of wax but after several attempts to dislodge it with water, it refused to budge. Heineck left Rhona’s son Craig a voicemail with an update on his mom’s vitals, suggesting he get eardrops to soften the wax in preparation for her return in two weeks.
Sometimes Heineck puts the headphones on Rhona so she can hear through the voice-amplifying microphone. The visit lasts an hour and while it covered at least half a dozen medical issues, it also offered social time, and when Heineck leaves, Rhona is in her chair, beaming.
“It’s always a pleasure to see you,” said Heineck, heading to the door, affixed with Rhona’s signed “do not resuscitate” order for emergency workers.
“It was a pleasure to see you,” Rhona said, laughing.
In her 96th year, Rhona relies on at-home medical care and her son Craig Knowles, a flight attendant, who spends days off with her. Craig likes to talk. His mom likes to sing. Every week, he cooks her meals in advance, plates of chicken, mashed potatoes, green beans and cauliflower, ready for warming by personal support workers.
Last fall, Rhona fell at home, spent time in the hospital and later a north Toronto nursing home, one that gets good reviews, but as Craig watched his mother grow depressed, her hair increasingly unkempt, he asked, “Mom, what do you want to do?”
She wanted to go home, Craig said, back to the one-bedroom apartment in a Toronto Seniors Housing building that he, thinking ahead, had not yet relinquished.
“That’s my husband and I when we got married,” Rhona said, pointing to a black and white photograph of a young, elegant couple taken in Cape Town, South Africa, where they survived apartheid, decades before she nursed him through his final months here in their Yonge and Eglinton apartment.
Craig has “cobbled together a patchwork of care” for his mother.
Rhona’s day begins with government-paid home-care workers who arrive at 9 a.m. and noon, for meals and toileting. Craig pays $300 a month for a private PSW to come for an hour at 3:30 p.m. so his mom has a good chat and is toileted again. At 5 p.m., a PSW from SPRINT Senior Care, which provides some supports in the seniors housing building, changes Rhona’s briefs and serves Craig’s pre-made dinner and at 9, another SPRINT PSW puts her to bed in clean briefs. In the middle of the night, a PSW from the building does wellness checks on residents, including Rhona.
“The priority for all visits is toileting so she does not sit in soil,” Craig said.
The challenge for his mother’s future, said Craig, is the quality of care she receives. Some workers are excellent, he said, others less so. When he returns from work, on flights crisscrossing North America, Craig checks the fridge for food. If there are too many meals or fruit cups left untouched, he believes the workers didn’t put in the necessary effort.
Craig is thinking ahead, planning for the next stage of his mother’s life. If she gets to the point where she can no longer feed herself, he plans to find a nursing home, likely one with people who share the same skin colour and similar taste in food, where she will feel comfortable.
For now, the seniors building works.
In the late 1990s, when Rhona’s husband was a popular parking-lot security guard at the Lawrence and Yonge IGA, city councillor Anne Johnston told him to get on the wait-list for a seniors assisted living apartment with the Toronto Community Housing Corp., a piece of advice he never regretted.
The city-run Toronto Seniors Housing Corp. provides homes with some built-in supports for roughly 5,000 low- and moderate-income seniors in 80 buildings across the city.
Those supports now give Rhona more PSW visits than most. She has heart disease, hypertension, a history of stroke, a propensity to fall, cognitive decline, significant hearing loss, an overactive bladder, a meningioma brain tumour at the base of her skull that shows no signs of growing, and in the eight years since her husband died, depression from missing the man in her life.
And yet, Rhona is lucky. Heineck said she has another patient with no family who cannot get out of bed and is supposed to have two daily visits from a government-paid home-care worker. At least once a week, the worker doesn’t arrive. When that happens, the woman sits in her bed, hungry, in soiled briefs, until the next day.
Dr. Nowaczynski, who started House Calls as a pilot project in 2007, often brings his camera, photographing his patients that trust his work.
One of those photos, published on his Instagram account, shows a 79-year-old woman he identifies as “Ms JJ,” a retired nursing assistant, staring up at the camera from an old wingback chair. The room is empty, except for the plastic furniture surrounding her chair where she keeps newspapers, bags, a fan and food, all within arm’s reach because she cannot walk.
Her legs are bandaged from the knees down, to protect the pressure ulcers on the back of her legs created when thin skin rubs against the chair.
It takes a team to care for an older person, and Coulter, the occupational therapist and House Calls program manager with VHA Home Healthcare, tracked down a donated chair, worth $1,800, that will enable the woman to elevate her legs and let those ulcers heal.
For the House Calls medical workers, stories from the front lines, of people aging at home, are scenes of triumph and distress.
Among the saddest, for Sinclair Mills, are the people who struggle almost entirely alone. Her visits stay on top of their health care and at the same time, offer a good hour of conversation for a lonely senior. But as Sinai Health’s Sinha said, the health-care system doesn’t recognize the need to give more support to those who are making a go of it outside institutions.
Another one of her patients, a woman in her 90s, lives by herself in an apartment near Yonge Street.
Like Myriah and Rhona, she sits in a chair in her living room, alone, for most of the day. When Sinclair Mills visits, she does blood pressure and medication checks. The woman chats, happy for the company.
She’s cognitively sharp, it’s her body that is failing. She tells Sinclair Mills about the “support system” she created for herself. It’s the neighbour across the hallway who has the key to her apartment and checks in from time to time, an approach that doesn’t come without risk.
A few days earlier, the woman said, she fell and was lying near her front door for hours, calling for help. Her neighbours weren’t home. When they returned, hearing her cries, they opened the door and helped her to bed.
“I wish that was a unique story,” Sinclair Mills later said, “but it’s really not. It happens all the time. We’ve had referrals in the past from a concerned neighbour or a superintendent. You know, this person is not coping well. Like a lot of our patients, they’re hanging on by a thread.
“And their connection to the world outside of their apartment or their home is very tenuous. And it’s shocking to me. Sometimes I will see somebody in a home that I’ve walked past many times. I had no idea they were in there. Or an apartment building full of patients who all need our help. They’re not a group that can advocate for themselves.
“They are hidden.”