The problem nobody looks at
She is walking less. She goes to the dining room less often, holds onto furniture, shuffles. Somebody calls it decline, somebody else calls it fear of falling.
Before accepting that, do something almost no family member does: look at her feet. Not through a slipper — take the socks off and look. A surprising share of the time you will find toenails months overgrown and thickened, an ingrown corner, a callus that hurts at every step, and slippers two sizes wrong.
This is not cosmetic. Foot pain changes how a person walks, an altered gait costs balance, and the fall is what changes everything else. Feet are one of the very few serious problems in an older adult that can be fixed in half an hour.
Two different things that get muddled
Get this straight, because it settles most conversations with a home.
Ordinary foot hygiene — washing, drying between the toes, moisturizing, and trimming a normal healthy toenail — is personal care. It is what the home is there to do and it is part of what she pays for. If you are told nails are not their job, ask to see that in the policy.
Foot care by a podiatrist or chiropodist is different: thickened or ingrown nails, fungal nails, corns and hard skin, deformity, and anything at all on a diabetic foot. That is clinical care, and homes are right that care staff should not be doing it.
So ask two questions: who trims her ordinary nails and how often — and who do you call when the nails are no longer ordinary?
What is actually covered, and it is thin
Be prepared for a patchwork, because pretending otherwise wastes months. Foot care is handled provincially and coverage is generally limited:
- Ontario provides a partial annual contribution toward chiropody or podiatry services under the provincial plan, capped at a modest amount per year — real, but nowhere near a year of regular care.
- Most other provinces do not cover routine foot care for seniors at all, though several fund it within diabetes programs where the foot is at risk.
- Custom orthotics are covered in narrow circumstances under provincial device programs, usually with medical criteria and a co-payment.
Two doors worth trying before concluding she must pay. Veterans' benefits frequently cover foot care in full and are among the least-claimed entitlements in the country. And a private or retiree extended health plan, from her own or her spouse's working years, very often includes an annual podiatry allowance — worth one phone call before assuming there is nothing.
Where none of that applies, foot-care nurses and podiatrists visit long-term care homes routinely. The obstacle is almost always organisational, not availability.
Diabetes changes the whole article
In a diabetic foot, sensation is reduced: a small injury does not hurt, is not noticed, becomes infected, and the chain from there is one everyone knows. Three things to insist on:
- Daily foot checks as part of her care, documented, not on request.
- No improvised nail cutting and no over-the-counter corn removers. On a diabetic foot, that is how it starts.
- A current foot risk assessment and a same-day escalation route for redness, a blister or any break in the skin. Here the difference between today and next week is the whole prognosis.
The slippers, which nobody checks
The most neglected part of all. Many residents spend the day in slippers bought years ago, stretched out, with no fastening — or walk in socks on a smooth floor. Footwear is a documented falls factor: a fastened, well-fitting shoe with a non-slip sole and a low heel is safer than a soft slipper.
Feet change with age and with swelling: her size from ten years ago is not her size. If she has orthotics, ask when they were last reviewed — worn or outgrown orthotics are worse than none.
The link to falls
If she has fallen and nobody examined her feet and footwear afterwards, that review is incomplete. Falls prevention and skin integrity are standard areas of inspection in long-term care, and this belongs in both. Raise it in writing and put it on the agenda of the next care conference so it lands in the record.
Six questions to ask
- Who trims her toenails, how often, and is it included?
- Which foot-care nurse or podiatrist visits here, and how often?
- Has anyone checked what this province covers, or whether she has veterans' or extended health coverage?
- If she is diabetic, are her feet checked daily, and what happens if there is a break in the skin?
- Do her shoes fit and fasten, and when were they last replaced?
- After her last fall, were her feet and footwear assessed?
If nothing moves
Put it in writing to the director of care with the distinction between personal care and clinical foot care set out plainly — that distinction unlocks most cases, because on the first point the home has no argument. The home's family council is a real lever and an underused one; overgrown nails are never one resident's problem alone. Beyond that, every province runs a complaints and inspection line for long-term care, and a diabetic resident whose feet are not being checked is a clinical safety issue, not a comfort preference.
Where to start
On your next visit, do one thing: take her socks off and look. If the nails are pressing on the end of the slipper, or there is a reddened callus under the ball of the foot, you have found the reason she is walking less — and it is not inevitable decline.
If you are still choosing a home, ask how foot care is arranged and how often. Few families ask, and the answer says a great deal about the general level of attention.
If you would rather not run it alone, we can. For CA$99 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical advice on your own situation. If she has diabetes, do not cut nails or treat corns yourself and do not use over-the-counter corn removers — ask her physician or a foot-care specialist. Coverage, device programs and annual limits are set provincially and change: check what applies where she lives. Curalune does not allocate beds and does not guarantee availability.
Paying less is mostly a paperwork problem
What a family actually pays is rarely the advertised rate. Most provinces set the accommodation charge and then reduce it for residents whose income cannot cover it — but the rate reduction is applied for, not granted automatically, and it is income-tested, usually against the previous year's tax return. Two other things get missed constantly: the Guaranteed Income Supplement on top of Old Age Security for low-income seniors, and the Disability Tax Credit, which can be claimed retroactively and transferred to a supporting family member.