Aging? What’s to be done?

Some 60 years ago, about the time the last of the baby boomers were being born, people over 65 made up about 7.5 per cent of Canada's population. Now they are 17.5 per cent and will be nearly 25 per cent (10.8 million) in twenty years. And they are living longer. Currently the fastest growing cohort are centenarians, people over 100. Soon the majority will be 75 and over, at ages when the manageable but incurable chronic diseases of old age make necessary more costly and frequent hospitalizations and physicians' services, health care as opposed to the much less expensive health-support services needed to meet the needs of most seniors. That Canadians are living longer is good news. What's not to like about living to a ripe old age provided you can age well—happily settled in housing appropriate to your needs, with a stimulating social life with old friends and new, where you can pursue an active, lifestyle, and have available the reliable support and care needed to maintain the activities of daily living and robust good health? The problem is that it is not easy to meet those provisos in Canada. Relative to many other countries, notably Japan, Denmark, and others noted for enabling seniors to age happily and well, Canada and its provinces and territories do not score well. We spend far less on long-term care overall and disproportionally much more on institutional ($6) than on home and community ($1) care, the reverse of comparable ratios in Denmark and other leading nations. There, the predominant policy thrust is not to institutionalize or, crudely, "warehouse" seniors, but to facilitate their "aging in place." Canadian seniors, like others, strongly prefer to retain their independence and to age in place for as long as possible in their own homes and communities with the support of an expanded range of home care and community support services with which they are familiar and comfortable. Ironically, meeting their preferences would be much cheaper for both the affected seniors and for the public purse; daily care in a hospital costs upwards of $850 to $950, in an LTC-home $150 or more, and with support and care at home about $45. Given the still building wave of aging seniors and the Canada's foreseeable economic circumstances, continuing with the same policy choices defies comprehension. First, as COVID-19 has made clear, care-homes are both expensive and dangerous places; some 80 per cent of deaths in the first wave in Canada were in LTC-homes. Second, they are not where our senior citizens want to be. Third, the numbers make it clear that continuing with our warehousing propensity is just not on; the care-home beds that would be required is simply beyond what we could afford. And fourth, adding together the capital and ongoing operating cost of institutional accommodation and care to the residents, their families, and to the public purse, exceeds by far what it would cost to provide an extended range of seniors' needs through beefed-up home and community support services. That will be expensive too, but it's an approach that would both help seniors age well, certainly better than at present, and one that our country could afford. What do we need to do to get to it? Governments have to work together, federal, provincial, and territorial, and municipalities, given the latter's funding of so many community services out of the property tax base and the charitable giving of the residents. Solutions and their implementation are primarily under provincial and territorial ownership, apart from our Indigenous communities where the feds are on the hook. The federal government must decide what role it wants to carve out in facilitating a coordinated response to a problem that is both bigger and will extend well beyond what was foreseen in the 2015 election platform and its promise of $3-billion over four years, and the 2017 budget in which it was proposed to invest $6-billion over 10 years for home care and the fall 2020 fiscal statement with its offer under conditions of $1-billion between this year and next for long-term care. The provincial and territorial governments at the very least have to refocus their policy objectives from institutionalization to ageing in place and work with one another and the federal government, with the provinces and territories, on the development of appropriate national standards and with municipalities on their implementation and enforcement. And we have to hurry! The problem is real, here right now, and time is short. Don Drummond is the Stauffer-Dunning Fellow at Queen's University. He is a former senior official at Finance Canada and the chief economist at TD Bank. Duncan Sinclair is an adjunct professor and distinguished fellow at Queen's University and a member of the Canadian Medical Hall of Fame. The Hill Times