A place to see the sky. Walls to hang pictures of the kids. A kitchen to serve strong coffee with Dutch cookies.

The tidy two-bedroom downtown apartment is home to Corry and Alex Steenkist, who are 78 and 80. Living in their own home is all they ever wanted. It's often all anybody wants.

Yet, despite several key economic studies that have found staying at home costs the country less, for those seniors on limited incomes, finding affordable, continuous and enough help to stay at home can be difficult.

That's the finding of a recent, hard-hitting report by a local seniors advocacy group, Hamilton Cares. Many members of the organization are not only seniors themselves, they're also retired professionals who once worked in the field of senior or health services. They've submitted the report to local MPPs and Minister of Health George Smitherman to push for change.

The Canadian Home Care Association says the number of home-care recipients has increased by almost 100 per cent from 1995 to 2006, and totals an estimated one million Canadians.

Put that next to the fact that by 2036 there will be double the number of seniors (9.8 million) from 2005, and it's clear that there needs to be more support for those over 65. Hamilton is home to about 100,000 people aged 65 or older, according to 2001 Statistics Canada data.

The Hamilton Cares report expresses concern about the emphasis of community care access centres (CCACs) on medical-based care in the community while not including enough forms of home support such as housekeeping or friendly visits.

"The CCACs are excellent at post-acute care and palliative care," said Tish Butson, co-author of A Commonsense Approach to the Delivery of Home Care Services: A Challenge. "That's great, but we've lost that home care as part of the health-care system."

Joyce Caygill is 75, her husband is 83. "If you've just been released from hospital, it's excellent," she said of services. "If you just need help with changing bed linen, there's nothing."

The Hamilton Cares' report refers to a well-known study by research company Hollander Analytical Services which observed that over time, for all levels of care needs, home care, on average, is much cheaper than care in a long-term care facility. The study found, for example, that average annual costs to government for individuals with moderate needs in British Columbia in the mid-to-late 1990s amounted to $9,624 each for home care, but $25,742 for those in institutions.

Butson said the concern over the state of home care is based on three disturbing trends: the medicalization of home care (less emphasis on simpler services such as housekeeping, transportation, etc.), offloading of public responsibility for care with a movement to private, for-profit organizations and an overall human-resource crisis in the home-care workforce.

Current provincial regulations cap the amount of personal care support from the CCAC at 60 hours a month. That averages out to two hours a day for those with such chronic health issues as dementia or terminal illness. Sherry Parsley, director of client services at the CCAC, said the agency assesses each client's case, eligibility and then plugs the client into other community-based programs. The Ministry of Health funds the CCAC's services, so there's no fee.

Last year it provided 883,348 hours of personal support services (assistance with bathing, eating, dressing, etc.) in Hamilton alone.

The CCAC has a number of contracts with organizations such as the VON to provide services such as nursing care, and also has a central information phone line with seven staff to field inquiries (905-523-8600).

If you're a senior, you may already know that finding out about such services is the first hurdle, being eligible might be the second.

There are no hard and fast rules about eligibility. Generally seniors require help bathing, eating or getting dressed. Problems walking or concerns about safety at home can also get services. A medical need for nursing care is the best bet.

Where government-funded homemaking services have receded, community, charitable organizations have worked hard to fill the void. They have grown to be an army of thousands of volunteers. Victorian Order of Nurses (VON) enlists 1,500 volunteers.

Many nonprofits will offer some services, such as friendly visits for free. Others may have small fees.

Glenys Currie, volunteer co-ordinator at St. Joseph's Home Care, said the agency offers a kind of brokerage service for housekeeping or minor home repair companies for seniors. St. Joe's screens the companies and ensures they offer service for reasonable rates.

Mae Radford, manager of VON volunteer services, said the agency is expanding services with such programs as Your Heart Matters for those with recent heart-disease issues. It also offers an adult day-care centre which provides respite to caregivers of family with dementia. It's currently renovating the centre to offer an overnight service. At the same time, Hamilton's diverse cultures are creating a demand within the Meals on Wheels program for kosher and curried meals for Jewish and Indian seniors, and is hoping to offer culturally sensitive programs in the future.

The need is great. VON served up 76,500 meals last year to seniors in Hamilton.

A more pressing issue may be the social isolation of seniors living on their own. VON has created a unique program to deal with both concerns with its Shopping By Bus program.

It's a party on that bus every second Thursday as the vehicle makes the rounds of several downtown seniors' buildings. (There are two similar programs in Stoney Creek and on the Mountain.) Everyone piles on and off -- with a little help. The din of laughter forces participants to yell conversations.

"You need to get out as much as possible beyond the four square walls," says Neil Putnam, pulling a shopping cart filled to the brim. "Some people just come for the laughs."

The difficulty -- as with many seniors' programs -- is in getting the word out to those who need it. The shopping bus is popular, but organizers worry about the many people living alone in these apartment buildings who never catch a ride.

Corry Steenkist has seen that social isolation up close and knows it's not restricted to live-at-home seniors. She tours retirement and nursing homes as a singer in a seniors' choir. "The seniors sometimes line up at the door in their wheelchairs desperate to talk to anyone who walks in."

For information on the VON's Shopping by Bus program, call 905-522-0053.

For more resources to support living at home, check out the links page at thespec.com/fullcircle.

lmarr@thespec.com

905-526-3992

Saturday: The search: One family's journey

Today: Staying home: How to get help

Day 3: Long-term care: Finding answers

Day 4: Know your rights: Legal and personal issues

Day 5: End of Life care: Compassion and planning

Day 6: The Sandwich Generation: Feeling the squeeze

* Log on to thespec.com/fullcircle for the full series, more links, videos and slide shows.

* Give your views on today's issues on the Full Circle forum at ideas.typepad.com/circle/.

* Send us tips on how to navigate eldercare. E-mail fullcircle@thespec.com

* "It's almost like the world doesn't care. It's a really lonely feeling."

Check out Living Alone video at

thespec.com/fullcircle.