Community Home Care: Hope & Reality – 3

Part 3: Solutions, Home Care as one part of Health Care

Solutions to the issue of elder care, whether as part of “community home care” or the broader matter of frail, ill elders needing institutional care, are part of the need to consider radical changes to our health care system in general. The Commonwealth Institute think-tank, ranks Canada dead last amongst the 11 top advanced nations in terms of timely health care access by its citizens. Timely acute care access is lacking, and so is access to long-term care.

Part of the solution lies in creating new funding models for Canadian health care: systems that have already proven successful in the other 10 leading health care jurisdictions. All have a mix of public and private funding and facilities.
Some possible means of changing Canada’s “government as gatekeeper/payer” system include the following ideas:

• Phase out “pay as you go” funding (payments from current general government revenues) and replace it with revenue generated from an investment or insurance entity modeled on the Canada Pension Plan Investment Board. The smaller number of taxpayers in the future will not be able to pay for health and other services for the looming bulge of aging Boomers if the current funding method remains.

• Bring back tax incentives such as the Multiple Unit Residential Building program (MURB). Target the construction of universal access, single or multiple family residences, and long-term/chronic care residential/medical facilities, which would reduce the pressure on acute care hospitals currently warehousing patients who cannot live at home.

• Adapt ideas from the successful systems of the nine other countries with better health care outcomes. Start a meaningful discussion of alternatives. Begin by discounting the “straw man” argument that any discussion of change in Canadian Medicare means “American health care”. No one proposes American health care.

• Consider introducing “medical savings accounts” for all Canadians. It would be a voucher system where each Canadian can spend on either public OR private health care services. Special funding would be provided for chronic or exceptional cases. This was first proposed in 2002, in a paper presented by the Fraser Institute.

• Ensure that publicly funded health care programs have elements of self-funding. Require that the means test for government payments includes the value of assets not just cash flow. Many people have substantial assets that could be used to pay for services they need – yet they can access subsidies because they have low cash flow, currently the main criteria for assistance.

• Channel more medical students into specialties such as geriatrics and areas related to caring for aging Canadians. It costs over $1 million to educate a doctor in Canada. Surely, it is reasonable to expect medical practitioners to work in critical fields. There is also a shortage of medical technicians. Incentives are needed to boost their numbers, too.

• Encourage philanthropic investments in communities across Canada through special charitable donation credits for the construction and maintenance of senior and disabled-friendly residences and care facilities. Palliative care centres need to be part of this initiative. Many religious and ethnic communities have already begun providing these facilities. As a corollary, beef up the health and safety inspection of residences for seniors in care, and make penalties meaningful.

• In Norway, local municipalities are responsible for getting patients out of acute care hospitals and into innovative, long-term care facilities. Daily fines for non-compliance help focus administrators on achieving results. (Local municipalities do receive increased funding for their role in these services.) Canada and its provinces could learn from this.

Are these revolutionary ideas? Yes, but the need for discussion is urgent.

Marie Howes

Community Home Care: Hope & Reality – 2

Part 2: Demographics & Funding Factors

The stage was set in my Jan.30th blog. Community home care has four factors to consider – Medical and Accommodation as outlined, and now Demographics and Funding.

Demographics. By 2031, the estimation is that the proportion of seniors 65+ in the Canadian population will be at 23%, up from 17.3% currently. (Around then, deaths will outnumber births in Canada.) If our total population reaches the projected 40 million, that would make the 65+ population about 9.2 million. These demographic statistics form a base for figuring out what various social needs are likely to be for an aging population including community home care.

Funding. The Baby Boom generation, now retiring, is the wealthiest generation in history. Bank of Montreal economist Sal Guatieri said in The National Post July 19, 2014; that “the typical senior today is 9 times richer than the typical Millennial”. Boomers are also the generation that expects to get what it wants.

Currently, given that the number of working Canadians is declining, it is unlikely that the Boomers’ demands can be met as expected. Statistics Canada states that by 2031, the number of people in the labour market for each person aged 65+ (not working), could be lower than three. This ratio was close to 5 to 1 in 2010.

The key question is – what level of responsibility must the individual assume for their living and care arrangements? And what is the responsibility of the community or governments? Who will pay for these obligations? Can we mobilize popular support for community-based programs, or must we rely on governments for action?

Canada’s current approach to funding such programs (and many pensions, too) is “pay as you go”. This means that payments for these services are taken from current general tax revenues. If there are fewer active workers than those over 65 not working, how can we expect that programs benefiting mainly seniors will be acceptable to working taxpayers, who will want some funding room for their children’s education and family health care?

In an era of tight budgets and a future with fewer taxpayers contributing to government programs, “universality” is a problem. The Canada Pension Plan was changed from “pay as you go” to fully funded with contributions by workers who expect to benefit in the future. With pay as you go, the Boomers have no “skin in the game”. The burden is on younger taxpayer – and with a smaller number of workers/taxpayers there is enormous potential for inter-generational conflict of interests.

So far, the clamour for community home care is too broad and unfocused. I’ll set some talking points for solutions for the next post – a more refined and targeted discussion, given scarce resources now and in the future.


Marie Howes

Longevity & Community Care – 2

Age awareness has meaning to everyone at every life-stage, so by leading a charge advocating for community home care for older adults the question is; how are we serving our community if we don’t bring a broader range of insights to the issue? After reading Carol Goar’s Dec.9 Toronto Star article “Senior citizens are mobilizing against ageism”, it occurred to me that we need doable solutions that everyone can share in.

In my work with Big Brothers Big Sisters of Toronto over the years, I’ve always been drawn to their ‘strength based’ approach to mentoring.  Simply put, volunteer mentors are trained to allow the child to be who they are without ‘fixing’ them or trying to make them ‘better’.  It’s about accepting them ‘as is’ and building their self-confidence. This in turn allows them to be equipped with a toolbox of life skills that (as studies confirm), serve them as they mature.

Likewise, the conversation on confronting ageism raised by organizations like Carewatch needs to be strength based. What are the skills that all segments of the population (from Gen X, to Millennials, to Boomers) bring to the table, and how can we take each groups strengths to assist those who need help. What if we made care of seniors who wish to remain in their home a community issue, not just a family or government issue?

Let’s look at ageism through a different lens by examining an inter-generational approach which would allow learning and support at all ages. If we looked at community home care as a way to build a foundation for a caring community – we would all be better together. And it’s not just about health care delivery. There are other basic living and social needs to be served with more of what we might call an “age share model”.

For example, how about having a high school student earning community hours by teaching a housebound senior computer applications that could open a new world to them? Cyber-Seniors is an example.

What if a local apartment/condo dweller who loved to garden was matched with an older homeowner who was unable to tend to their garden, and took on the task of planting and tending a vegetable or flower garden in their yard? Tyze is an example of one of those doable solutions; an inter-generational social network.

So literally – let’s look in our own backyards to find other workable options for advocating quality community care.


Sandra Downey