SENIORS
Glebe Report April 15, 2022
31
Canada still needs a national seniors strategy By Terrance Hunsley The 2020 report by the National Institute on Ageing (NIA), called An Evidence Informed National Seniors Strategy for Canada, follows a 2015 seniors’ strategy. It starts with some stark data: • Canadians over 65 account for about 17.5 per cent of the population and represent almost 44 per cent of public health care expenditures. • By 2035, they will be 25 per cent of the population. • Despite a total COVID-19 mortality rate lower than other OECD countries, more than 80 per cent of deaths by the summer of 2020 were older Canadians in long-term care residences, compared to an OECD average of 42 per cent. That’s a shameful exposure of substandard care, which eventually cost the lives of more than 16,000 people. From 1920 to 2020, our life expectancy increased from around 60 to over 82 years. Our health care system is built on the Medical Care Act of 1966 when the median age was 25.5 years. It focused on providing physician services and acute hospital-based health care. What is clear is that Canada’s health care system was not built to focus on the needs of Canadians living into their late 70s and 80s with chronic health issues and greater levels of social isolation, which are now established and growing realities. The issues affecting older adults and an aging population must be liberated from government department silos. The NIA has been pleading with the Ontario and federal governments for years to take their heads out of the sand and reorient the health care system for an aging population. This report says “the array of policies in relation to older adults still represents a patchwork of ideas. While an older population will continue to need physicians and hospital care, it will also need a more comprehensive health care system that emphasizes preventive care, pharmacare and long-term care, which includes home, community and nursing home care…Furthermore, to meet the growing need for publicly funded long-term (residential) care over the next three decades, the costs of doing so are expected to rise from $22 billion to at least $71 billion.” With that kind of financial pressure, you can see why governments
agree with seniors that they should age at home. They want communities to be “age-friendly,” providing social supports, inclusive and healthy activities, good diets, exercise and other valuable services. But this report is clear that there is much to do before a community is actually age-friendly, and much of it has to be done with the support of federal and provincial governments
What improvements does the NIA recommend? 1. Community support and health services tailored to seniors’ needs. These include geriatric primary care with home- or community-based access to an interdisciplinary team which can respond to chronic conditions, psychosocial problems, needs for prevention, health maintenance and rehabilitation. Seniors’ needs are not met by walk-in clinics where patients get to discuss one symptom per visit. Amazingly, even with the aging population being discussed for the past 40 years, our medical schools still don’t focus on turning out doctors with geriatric training! “In 2018, there were approximately 304 geriatricians serving 6.6 million older adults in Canada, while at the same time, 2,887 pediatricians served 8.1 million children and adolescents under the age of 20. No Ontario medical school, for example, currently offers core training in geriatrics, but every school offers core training in pediatrics, despite that the majority of patients in the health system are likely to be older people.” Ageism in the medical community? 2. Supporting informal caregivers, who face increasingly complex needs of loved ones. They already report serious impacts on their personal health, psychological well-being and finances, and they themselves are aging. A crisis in the making. 3. Improving a broader range of formal and long-term care services in the home. Inadequate home care leads to failing health and higher costs for institutional care. They suggest that Ontario could save up to $268,000 in capital costs for every residential care bed it does not need to provide. 4. Ensuring that seniors have access to appropriate and affordable housing, with “universal design standards.” Innovative housing models include home-sharing, communal living, co-housing and “life-lease” rental
Canada’s health care system was not built to focus on the needs of Canadians living into their late 70s and 80s
purchases. 5. Providing an inclusive and accessible transportation system that meets seniors’ transportation needs. 6. Eliminating ageism, elder abuse and poverty. 7. Providing opportunities for participation in social, cultural, leisure and spiritual activities, as well as employment and volunteerism. “Socially isolated older adults are four to five times more likely to be admitted to hospital than older adults in general…social isolation has been identified as one of the top four predictors for placement into more costly nursing home settings.” 8. Increasing prevention to improve health and decrease health care costs. “Falls amongst older Canadians not only threaten their independence and overall well-being, they also account for an estimated $2.3 billion annually in related health care spending across Canada. Furthermore, Canadians who are hospitalized for falls remain
hospitalized for an average of 14.3 days…In Canada, between 20 to 30% of older adults fall annually, making it one of the most common preventable health care issues for older Canadians.” This comprehensive report is in good company with others that have been generated over the last several decades by social policy and medical planners. The fact is that very little has been done to change an outdated system. Senior Watch of Old Ottawa South (SWOOS) is trying to bring about the kind of services that are recommended, as summarized in an article in this issue of the Glebe Report by Carolyn Inch. Terrance Hunsley is a co-chair of Senior Watch of Old Ottawa South (SWOOS) and an OSCA board member. The full report is available online on the National Institute on Ageing website at nia-ryerson.ca.
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