At the 2014 Council of the Federation meeting in Charlottetown, PEI, provincial and territorial premiers, once again called for a National Plan on seniors’ health care; nor were they the only ones advocating this. The Canadian Medical Association (CMA), the Canadian Association of Retired Persons (CARP), the Canadian Health Coalition (CHC), and the Canadian Association of Retired Teachers (CART) have been vocal about the need for a Pan-Canadian, coordinated, comprehensive, long-term strategy to address the needs of Canada’s ageing population. The CMA’s 2014 national report card focuses on the impact an ageing population will have on the country’s health system.
Life expectancy in Canada has grown by more than six years since 1979 and the proportion of seniors per population has grown from 8 per cent in 1970 to 17.3 per cent in 2014. The CMA survey shows:
- 95 per cent of seniors support a national strategy for senior’s health care (up since last year)
- 81 per cent worry about the quality of health care they can expect, in the future
- 71 per cent are concerned about access to quality home and long term care
- 26 per cent of Canadians now provide care to ageing relatives, 64 per cent of these care-givers experience high levels of stress, and 71 per cent worry that this responsibility impacts their work and personal life
- 61 per cent worry that hospitals and long-term-care facilities will be unable to handle their needs or help seniors live longer at home
Currently, hospital and emergency departments are overcrowded with chronically ill and elderly patients, who occupy beds and contribute to increased wait times for urgent and acute care. Consider that hospital costs per patient ranges from $825-$2,000 per day while home and community care averages $200 per person daily. Consider that chronic care patients occupy over three million bed days a year in acute care institutions and do the math! The solution seems logical: restructure the system toward primary and community care. Yet, access to home and community care varies widely by province, as do the number of seniors per population.
Providing home and community services for chronic and senior care, by primary care, multi-disciplinary teams would be cost effective and provide better outcomes, freeing hospitals for urgent, acute and emergency care.
These structural changes were clear objectives in former Liberal Prime Minister Paul Martin’s 2004 Health Accord with provinces and territories, and with a $41.2 billion cash infusion to ensure collaboration and federal leadership. That was abandoned by the Harper government in 2006; the objectives were not achieved because of abandonment of federal leadership and collaboration. Prime Minister Stephen Harper added insult to injury by refusing to meet with Premiers on health care and by imposing a unilateral, per-capita, funding formula that does not recognise regional ageing demographics and the needs of provinces like British Columbia, and the Atlantic provinces with large senior populations.
Provinces have been told to go it alone, with a “one size fits all” formula. The future of Medicare, as defined by the five principles of the Canada Health Act, is compromised and access will be determined by where one lives or by ability to pay as the Health Council of Canada demonstrated in their 2014 final report. Seniors will be amongst the most vulnerable because of inadequate retirement income, a propensity to chronic disease, and unfulfilled housing needs. The B.C. health Coalition’s research shows that in Vancouver, three in five seniors live on annual incomes of $25,000, in the most expensive city in Canada, with high housing and rental costs. Cross-country surveys demonstrate the inequality of access among provinces, to home, long-term and community care.
A pan-Canadian Strategy that would achieve equal access to health, dental care, therapeutics drugs, housing and social services for seniors and a policy that would allow for families to care for ageing relatives at home, would be impossible without a federal government role. So premiers, health care advocates, health care professionals and seniors continue to become more vocal and more anxious, as the CMA Ipsos Reid survey shows.
Other countries, like the Netherlands, have for many years, shifted away from hospital to community and home care, with excellent results both in cost-effectiveness and in quality of care. The United Kingdom has expanded home and community care to include housing and social services. They recognize the complexity of seniors and chronic care.
There are best practices to emulate globally, but our confederation must exist within the framework of provincial/territorial jurisdictional dictates. This requires negotiation, setting of common goals and standards and a willingness to work together across jurisdictions.
The Liberal government’s Health Accord recognized that; the Council of the Federation recognizes that; health care advocates and health professions recognize that. They are all calling for participation and leadership by the federal government which by all measures should and must be the level of government that ensures all Canadians have equal access to public services, regardless of where they live.
This is the mandate of the federal government and it is time to stop passing the buck to provinces.