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.