Canada doesn’t have your back: Free health care only goes so far, especially for some seniors

Patty Randall began caring for her 80-something parents in the 1990s. For the next decade, she learned the limits of the Canada Health Act and the merits of advanced care planning. Flying from her home in Vancouver to her parents place in Kelowna, B.C., for a week each month, she was both the long-distance care manager and hands-on caregiver. We eventually moved my father to a long-term care facility and then we basically set up a mini nursing home for my mother in her house, Randall says.

This article was published by Financial Post on September 8, 2014. To see this and other related articles on their website, click here. 

It was a lot to manage. It was also a lot to pay for. My parents had their regular pensions, their house was all paid for, but there was no way they could have paid for those extra thousands every month, she says. So it came out of my budget.

The experience was a wake-up call for Randall, who went on to become a care planning advocate. The experience with my parents taught me that were each responsible for our own care and the care of our immediate loved ones. It also underscored the cost of the care we may need and, more importantly, the kind of care we may want down the road.

A budget-busting sticker price, however, doesnt mean an individual will be stranded by the system. Obviously, no one is going to be left in a dire medical situation in Canada, she says, but without planning, theyre certainly going to be left without choices, without a lot of options and without much independence. Thats an alarming reality for boomers used to some degree of comfort, autonomy and control.

Despite the need to get on top of health-care expenses for ones senior years, a Leger Marketing survey reported that 56% of Canadians are entirely unfamiliar with the costs of long-term care in their province. Its not surprising, then, that two-thirds of those polled dont have a financial plan to cover the costs, either. Prescription drugs are one major cost, but most will likely shell out for things such as mobility aids, accessibility renovations, at-home or assisted-living care and long-term care. And if you dont like the services available in Canada, or dont like waiting, medical tourism costs could factor into play. So much for our free health-care system.

The breakdown

To develop a plan and give yourself some choice when it comes to care, you need to know the costs. For example, a recent Statistics Canada survey found that prescription drugs make up the largest portion ; 27.3% ; of out-of-pocket spending for senior households. Yet 46% of Canadians dont expect to pay out of pocket for prescription drugs, even in their more senior years, a survey by SunLife Financial reveals.

As we age, were increasingly likely to develop chronic conditions, many of which need meds, sometimes indefinitely. Between the ages of 65 and 74, 20% of Canadians have at least three chronic medical conditions. By age 85, its up to 36%. Because of this, its not uncommon for a senior to be taking 10, 12 or even 14 drugs in a day, says Dr. John Puxty, associate professor and chair of the division of geriatric medicine in the department of medicine at Queens University in Kingston, Ont. In Canada, there really is no uniform drug coverage, he says. Provincial programs like the Ontario Drug Benefit Plan may cover a number of medications, but some are not included, even though they may be indicated for some diseases.

its not uncommon for a senior to be taking 10, 12 or even 14 drugs in a day

The average senior household spends $500 each year on prescription drugs. But that doesnt account for the cost of some very pricey treatments for serious illnesses. In the case of cancer treatment, for example, the government covers the cost of drugs administered in hospitals and clinics. But half of the newer cancer drugs are taken at home and become the responsibility of the patient. A 2009 report by the Canadian Cancer Society pegged the price tag for a full course of these newer drugs at $65,000. Some, but not all, provinces have established high-cost drug insurance to protect patients. Even with a private insurance plan, the provider usually requires a 20% co-payment, which amounts to a $13,000 cost in the case of a $65,000 drug. Those plans, too, often have lifetime or annual spending caps, maxing out with less than one round at this price.

In addition to medications, mobility aids are a common expense as we get on in years. Canes, walkers and wheelchairs might be necessary after hip fractures, for example, or as arthritis becomes more debilitating. A basic walker may cost a few hundred dollars, while a wheelchair can run anywhere from $250 to $10,000 for a high-end electric model. Many provinces have programs to help with the cost of basic supplies ; up to a point. In Ontario, for example, they cover 76% of the cost as long as a health professional like a physiotherapist prescribes the piece of equipment, Puxty says. But you still have to find the other 25% somewhere. If you dont have it, you may have to rely on the help of a charitable group like the March of Dimes.

Its not just getting around that will cost extra. A recent Canada Mortgage and Housing Corp. (CMHC) study suggests 85% of Canadians want to stay in their homes for as long as possible, even if there are changes in their health. Often, this means a senior needs to make some structural tweaks to a home. In reality, once were 55 and older, weve really got to start thinking about our housing environment, Puxty says. You might need to consider whether the main floor can act as an apartment, in case stairs become dangerous. Is there room for a ramp, which may cost anywhere form $200 to $1,000, up to the front door? Or will you need a stair lift, which may cost somewhere in the zone of $3,000 and $5,000 for a straight run of 10 to 15 stairs? In older homes, youll need to take a look at the width of door frames to make sure they can accommodate walkers and wheelchairs.

There are also little things like the height of plugs and light switches [for someone in a wheelchair], or the installation of motion sensors to consider, Puxty says. Floor surfaces, too, might be something to consider changing. He notes that intersections between surfaces ; where hardwood meets Berber carpeting, for example ; are common tripping hazards.

For most of us, there will come a time when home modification isnt enough. A senior with health challenges will need some hands-on assistance, too. This might be for meal preparation, bathing and dressing, or general medical care. It might even be live-in help. Typically, Canadas health-care system will provide a certain number of hours of subsidized care for a finite stretch of time. If its not as much care as someone would like ; perhaps someone has a care worker who visits twice each week, but he would like to bathe daily ; the cost of additional help is out of pocket.

Karen Henderson stepped into the role of caregiver for the next 14 years after her father, head of a brokerage firm during his working years, fell and broke his hip, then suffered a major stroke while in rehab. Toronto-based Henderson, founder and CEO of the Long Term Care Planning Network, arranged for a live-in housekeeper for her father as well as frequent home care and medical visits. She installed a stair lift and made several other renovations to the family home. In Hendersons case, her father had made sure he could afford what he wanted, which was to stay at home. My father had all his ducks in a row when it came to financial planning for his retirement, she says. A good thing, since live-in housekeepers or caregivers can run from $2,000 to $3,500 per month or more plus room and board. Depending on where you live, out-of-pocket home-care visits are typically in the $15-to-$25 range per hour, and registered nurses charge between $40 and $69 per hour.

When I share statistics about the average cost of a home health-care worker, clients are usually shocked, says Sara Zollo, a financial advisor at Sun Life Financial in Toronto. Perhaps $15 to $25 per hour may not seem like a lot of money in isolation, but it can add up. Just recently, a friend of mine with prostate cancer had two private caregivers looking after him at home around the clock in two 12-hour shifts, Henderson says. He paid $10,000 per month.

People dont want to go into a long-term care facility until they absolutely cant manage at home

Even with the expense, most people want to stay in their homes as long as possible. If you ask people whether they think theyre going to need to go to a nursing home, theyll fight you on the issue, says Susan Eng, vice-president for advocacy at CARP, an activist group for older Canadians. People dont want to go into a long-term care facility until they absolutely cant manage at home. Only about 7% of older Canadians are in long-term care. For many, however, the price of hiring someone to do the hands-on care at home is simply too steep. Thats when friends and family members step in to become caregivers. Sometimes its not appreciated how much care is given by informal caregivers, Puxty says. In fact, 75% of the care of frail seniors is given through informal care structures, such as spouses, brothers, sisters, friends and other seniors.

The article goes on to provide an overview of the unexpected pharmaceutical and care costs for aging Canadians. Click here to read the article.