In the 1950s and ’60s when medicare was developed, life expectancy was a bit over 70 years, and seniors were only 7.5 per cent of the population. Today, life expectancy is 82 years, and seniors constitute 17 per cent of Canadians. Numbers will peak at 25 per cent in 2041 with 10.8 million seniors, by which time the majority will be 80 and older, entering a period in their lives when they will need better and more varied support services to age well, and not just in health care.
In November 2020, we published our report Aging Well with Queen’s University School of Policy Studies calling to revolutionize Canada’s approach to seniors’ care. In our report, we propose a proactive, co-ordinated, and holistic model that considers the health-care needs of Canada’s rapidly aging population in tandem with seniors’ housing, lifestyle, and social needs.
We have seen the tsunami of a rapidly aging population for some time. But we have so far failed to address the challenges that come with it, or even ask if there is a better way.
The COVID-19 pandemic has jolted our federal and provincial/territorial governments out of what appears to have been a version of sleepwalking up the beach as the tsunami built out to sea. The predominant policy of meeting the needs of seniors continues to be to “warehouse” them in long-term care (LTC) homes.
Infectious diseases in what amount to grounded cruise ships can spread quickly: 80 per cent of deaths in the first wave of COVID were residents of care-homes. While several provincial governments have established inquiries into how to make LTC-homes safer for residents and workers, shining a light on only LTC-homes will still leave Canadians in the dark about how to ensure our elderly age healthily and happily.
Why? Because the current approach reflects a fragmented policy framework that silos seniors’ health care, housing, lifestyle, and social needs rather than viewing them together, which leads to a system that addresses seniors’ problems after they have arisen rather than promoting health to reduce their incidence and severity.
If the current propensity to place seniors in LTC-homes continues, the number of beds needed will double between now and 2041. Current provincial plans would only supply a fraction of those beds, which will further drive up the costs of LTC-homes (each bed in a LTC home costs the system about $142 per day, compared to $45 per day with home care).
Not only are LTC-homes expensive for the health-care system, many seniors do not want to live there; they want to “age in place” by continuing to exercise their independence by living in the community they love. Policies that support services that are brought to them as they age-in-place for as long as they can would not only enable them to age better and more happily, it would also be much more cost-effective for the users and taxpayers alike.
Canada is an international outlier when it comes to investing in home care with one of the lowest allocations in the OECD — a measly 0.2 per cent of GDP. Many countries spend equally on institutions and home care, and some that are renowned for the life satisfaction of seniors spend more on home care than institutional care.
Other countries, such as the United Kingdom and Japan, have proven the effectiveness of age-in-place services. This includes community-driven programs to offer senior-friendly physical and mental activities that keep seniors healthy and engaged.
One example comes out of the United Kingdom, where villages in which seniors can downsize to a housing option that meets their evolving needs while continuing to live in the community have grown in popularity. We have success stories here at home too: in Kingston, Ont., the Oasis communal living home serves about 60 seniors with communal meals, exercise programs, skills training, and entertainment.
Canada must learn from other jurisdictions by investing in home care and community services as one side of the spectrum for seniors to age well, with LTC and acute care facilities on the other end. Implementing only one option for seniors’ care is outdated and should be gone the way of the rotary telephone.
Compassion, political considerations, economics, common sense, and lessons from other countries all point to the necessity of changing the current siloed policy approach that results in seniors feeling isolated, frail, and “warehoused” in LTC homes, to one that meets seniors’ preference to “age in place” with a co-ordinated seniors’ care policy framework.
That it has taken a global pandemic to make Canada reconsider how we care for our elderly is shameful, but we know now we can never go back to the way things were before.
Change must happen now. Our seniors don’t have time to wait.
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