TORONTO — Joanne Miller is sometimes afraid at night.
A knock on her door can startle her.
A mistaken call on the building intercom keeps her up at night.
Then there’s the loneliness.
Sitting at her dining room table in her clean and quiet 7th floor apartment in Toronto, the 91-year-old says despite those anxieties, this is where she wants to spend her final years.
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Her late husband Tony needed to move into a nursing home so she moved into the apartment to be near him.
He’s gone now but she can’t bring herself to leave.
“I want to be close to where my Tony was,” she says. “He sits on my shoulder.”
But keeping her in her home takes a small army of volunteers and health care workers who regularly attend to her needs. They come, almost daily, to deliver meals, medication and offer housekeeping services.
“They are angels,” she says of the volunteers. “When I say that, I mean anyone who can come by, put their hand on your shoulder and say ‘I can help you.’”
Twenty years from now, there won’t be enough “angels” to cope with the surge of baby boomers now hitting age 65.
The stress of caring for our aging of baby boom demographic could overwhelm Canada’s already stressed health care and social service system — at least without substantial change.
A key issue — finding ways to help seniors, like Joanne Miller, stay in their homes in future instead of warehousing them.
Susan Eng, vice-president for advocacy of the Canadian Association of Retired Persons, says people admitted to long-term care facilities — old age homes — increasingly are older, with more complex physical and mental health concerns.
“Sixty percent have a dementia diagnosis and only 17% are housed in those special units,” Eng says.
But Canada’s long-term care system hasn’t been designed to deal with seniors who now find themselves in nursing homes, she says.
There are too few nursing homes equipped with locked doors and trained staff to deal with the demanding physical and mental health needs of cognitively impaired residents, she says. That has led to the overuse of physical and chemical restraints to manage residents.
Acute care hospitals, intended to treat short-term maladies, are packed with seniors requiring long-term chronic care.
“The average nursing home is staffed up to deal with a different mix of residents,” she says. “The system has to answer the question: ‘Are they capable?’”
Part of the problem is that government hasn’t been transparent about demands placed on home care services. Worse, it has little interest in disclosing the current service gap because it would then be forced to act, and therefore invest, she says.
“The general public needs to know what the system can or cannot do for them,” she says.
“That is the missing piece right now. So long as they don’t know the government gets away with not doing anything.
“If they are not adequately grappling with the situation right now, how are they going to handle it when it gets worse?”
Home care — helping seniors shop, clean, bathe and get medical treatment so they can stay in their homes — is another big piece of the puzzle. So is training new gerontologists, mental health specialists and therapists.
But University of Toronto demographer David Foot says Canada won’t be able to rely on attracting immigrants with medical training over the next decade.
“We can’t assume we can satisfy that through immigration since all the aging countries of the world will be looking for that,” Foot says.
And the key to ensuring hospitals are not overburdened is to take non-essential procedures out of them and specialize in clinics, he says.
Joint replacements, cataract operations and other less complex conditions should be done elsewhere.
“We should be taking a lot of the non-complex issues and put them in stand-alone hospitals,” Foot says.
Anthony Dale, interim president and CEO of the Ontario Hospital Association, adds the most urgent need in the health system is exactly that sort of regional and provincial planning.
Ontario has had some success targeting wait times for knee, hip and cataract surgery but neither Ontario or any other jurisdiction in Canada is doing that more broadly.
“Unless we start to do that we’re going to find it very difficult to tackle the challenge, whether it’s five, 10 or 15 years down the line,” Dale says.
Sharon Carstairs, a former senator and Liberal Opposition leader in Manitoba, headed several Senate studies on aging in Canada.
Those studies and others done across the country are largely collecting dust, Carstairs said.
She believes Canada’s health care system has grown woefully out of date and is plagued by turf wars between health care workers, physicians and bureaucrats.
Money isn’t the issue — leadership is, she says.
Ottawa needs to take charge and make the impact of the aging boomer population on our health system a national priority.
“Mr. Harper has never had a first minister’s meeting with the premiers of this country at any time,” Carstairs says.
“I think one is required on the aging demographics of Canada to sit down and talk about how, together they can make a change.”
But if that doesn’t happen, the premiers will have to act on their own, she says.
“The premiers must lead the way … they need to speak with one voice to the prime minister. This will be difficult with Quebec but not impossible. The media should put them on the hot seat on this.”
“Without that kind of direction, that this is a problem we are all facing and we must face it together. You’re not going to see any significant change.”