October 31, 2011
By ANDRÉ PICARD
From Tuesday’s Globe and Mail
Health care’s future doesn’t have to be a doomsday scenario if practical solutions are put in place
The aging population and the concomitant rise in people living with chronic illnesses pose many public policy challenges.
The response to this demographic reality has largely been apocalyptic defeatism – an assumption that the rising tide of seniors will overwhelm and bankrupt health programs and there’s nothing we can do about it.
This alarmist view of our aging society is challenged in a thoughtful new report from the Institute for Research on Public Policy.
Instead of falling prey to ageist fear-mongering, Neena Chappell, the Canada research chair in social gerontology and a professor in the Centre on Aging of the University of Victoria, takes a level-headed look at the data and offers up practical solutions for meeting the health needs of the baby boom generation.
“The challenge is to establish a comprehensive community care system to ensure that necessary health and support services are provided based on needs, to recognize informal caregivers in the process and to do so within an integrated care system,” she writes.
Stated simply: We need a plan.
The most shocking reality is not that the population is aging but that we have done virtually nothing to understand or prepare for this change.
“Governments to date have not embraced aging as a fundamental framework for defining social policy,” Dr. Chappell writes.
There have been, of late, a number of studies debunking the notion that seniors are principally to blame for spiralling health costs. In fact, it is new technologies, new drugs and higher wages for health professionals (physicians in particular) that are pushing up costs.
The data tell us that 81 per cent of Canadians over the age of 65 suffer from at least one chronic health condition (arthritis, heart disease, lung disease etc.) But, as Dr. Chappell reminds us, 80 per cent of them are able to live independently.
In other words, suffering from a chronic condition does not translate into incapacity. In reality, disability tends to affect the “old elderly” – those over 80.
Ill health is not evenly distributed either: It disproportionately affects those who are poor, female and socially isolated. It is members of those groups that require the most care and assistance, and also to whom prevention efforts should be targeted.
Probably the most pressing issue in the near future is determining who will provide care for the hordes of aging seniors. Again, there is an assumption that a crushing burden will fall onto the state, with hospitals, nursing homes and long-term care facilities bursting at the seams.
But Dr. Chappell shoots down this dire notion, noting that 75 to 85 per cent of care is provided by informal caregivers.
Family, friends and community groups provide care and they do so willingly. While much attention has been paid to the negative consequences of care giving – stress, depression, physical and emotional strain – the report notes that most caregivers also experience enjoyment and a sense of satisfaction caring for their loved ones. In fact, many of those who provide care to older adults don’t even define themselves as caregivers nor see what they do as work.
These data again challenge the assumption that there is going to be a massive shift to expensive, institutional care as boomers age.
But the key message of Dr. Chappell’s report is this: Caregivers should be supported in the care they willingly provide.
The system that exists in most Canadian provinces today is precisely the opposite. There are some modest tax measures such as compassionate care leave available through the Employment Insurance program. There is also some respite care offered in three guises: sitter services to give caregivers short breaks; adult daycare a few days a week; and temporary beds in nursing homes to give the family a break.
For the most part, though, caregivers are eligible for respite care only when their loved one is already receiving formal care. “Those who are doing such a good job that the recipient does not need formal services are, by definition, not considered for support,” Dr. Chappell notes.
If programs were aimed at caregivers and patients (and not focused on their illnesses), older adults could remain at home and in the community much longer and not need formal services.
The special Senate committee on aging outlined a number of programs that would assist caregivers, including reimbursement of expenses, tax credits and pension credits.
Of course, there often comes a point at which formal care is needed but, again, that does not necessarily mean warehousing. Dr. Chappell notes that much more effort should be made to keep seniors at home by investing in homecare, which is 40 to 75 per cent cheaper than institutional care.
Furthermore, the system needs to be integrated so seniors can move from informal care to home care then to institutional care (and back again) as their needs change. The report also calls for greater recognition and support for community and not-for-profit groups that are playing an increasingly important role in the provision of care.
“The most appropriate care system for an aging society is one that supports both caregivers and older adults in a comprehensive long-term home care system,” Dr. Chappell writes in her conclusion. “Such a system can be cost-effective if established so that it substitutes for more expensive forms of other services when care needs justify it. The good news is that there are known alternatives to provide appropriate and cost-effective care to an aging society. Whether Canada will move in that direction remains to be seen.”
André Picard to receive award
The Globe and Mail’s public-health reporter, André Picard, will receive an award recognizing his work on health issues affecting children.
The National Child Day Award, presented by the Canadian Institute of Child Health, is honouring Mr. Picard for his capacity “to explain and get to the core of important health issues,” wrote Janice Sonnen, executive director of CICH in an e-mail. Ms. Sonnen singled out Holiday Decor That Can Poison (Dec. 15, 2010); Doctor’s Discredited Vaccine-Autism Link Leaves A Legacy Of Preventable Death And Disease (Jan. 12, 2011); Handwashing Urged; Blame Apportioned, But Deadly Enemy Still Stalks The Wards (July 14, 2011).
CICH is responsible for initiatives that led to the implementation of mandatory child car seats, bike helmets and family presence in delivery rooms.
The award will be presented at the Crayons & Cravats Gala in Ottawa on Nov. 14.
Read it online: We need a health plan for boomers now
Read it as a PDF: We need a health plan for boomers now