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 on a collision course?

Part 1: Sorting Definitions, Medical & Accommodation Factors

Community home care for an aging demographic; what does it mean? The term “community home care” s bandied about as though it has a specific meaning and that we should all know what it is – but it can mean:

Aging in place: remaining in your own traditional home, supported by housekeeping and healthcare services, until you are no longer able to cope

Purpose built or adapted housing residences: for those who want to be part of a “community” of people that might be comprised only of older seniors, or a mixture of people of various ages, as in a neighbourhood, with housekeeping and healthcare services available.

Care residences: where older seniors are the main residents because they require dedicated care provided by community members, volunteers and professionals; paid for by residents or by government, non-profit or charitable organizations or a combination of these. This is where Long Term Care facilities enter the discussion.

Essentially, there are four major factors to consider in this mix: Medical, Accommodation (housing), Demographics and Funding. Here are the first two.

Medical. There are risks to the “aging in place” model. Many older seniors become trapped in the “tea and toast” syndrome wherein they do not eat properly or take care of themselves physically and mentally. Loneliness and depression and physical injuries, which may be undiscovered for hours or days, can occur.

Accommodation. Moving to a smaller home, whether purpose-built or in the broader neighbourhood can be a daunting prospect. Most people rightly dread moving, with its stress and upheaval. Sometimes, too, family members pressure their elders into staying put since the home is “the family home” and repository of happy memories (and increased, non-taxable capital gains over time.) In terms of their housing, many older seniors are house rich but cash-flow poor.

Hope and reality on a collision course? Should government direct scarce resources into caring for seniors in need at home when the logical solution is for them to sell their valuable house and downsize, and then use the surplus to pay for the help they need?

This sets context for the next blog post on demographics and funding. In brief, Boomers looking forward should consider their assets owned as well as their income streams; as their hope and reality for community home care for themselves may be on a collision course.

 

Marie Howes

Canada’s Health Care System: Facing an Aging Nation

Far too many Canadians believe that “Canada has the best health care system in the world.” The Commonwealth Institute in Washington D.C., a health care think-tank, conducted a survey in 2014 ranking the health care systems of 11 advanced countries.

The top health care system was that of the UK, while Canada ranked 10th; the United States ranked 11th. The UK and all the other countries that ranked above Canada and the USA – Switzerland, Sweden, Australia, Germany, The Netherlands, New Zealand, Norway, France; have integrated private and public health care systems.

Our reluctance to review and reform our system of “one payer” (government) is not sustainable. The tail end of the Baby Boom generation turns 50 in 2015. The number of employed workers is declining, while the number of retirees (and users) is increasing.

Some weaknesses to address in our current system include:

  • Lack of timely access to diagnosis: emergency room backlogs, limits on the number of ailments to be discussed by doctors in any one patient appointment, etc.
  • Slow delivery of appropriate care: long wait times for those requiring joint replacement etc.
  • Inadequate planning for the coming bulge of seniors needing long term care beds; continued focus on acute care
  • Creation of large and unwieldy hospital complexes: excessive administration costs; likelihood of infection spreads
  • Lack of choice in the system: people can receive and pay for cosmetic surgery in Canada, but not major surgeries or joint replacements.  Medical tourism results.
  • Poor transparency and accountability on many fronts: Infection rates in hospitals, competency of various specialist surgeons, comparisons of cost of administration etc.
  • Lax regulations/laws, compliance and enforcement of rules covering patient care, disease and infection prevention and public safety
  • Insurance programs which cannot guarantee access to diagnosis or care:  programs which are of questionable value to policyholders
  • Mistrust of the whole idea of “private” health care. Yet the top nine countries have successful systems, which DO include private facilities, often paid for through insurance.
  • Pressure on governments to reduce ALL spending – including health

So the question up for further discussion is – can system changes start small and succeed?

 

Marie Howes

Landscapes of Aging, 2014

Niagara Falls. What a perfect location as a symbol of longevity in the beautiful landscape of the Niagara region. From Oct.16-18, 2014 the Canadian Association of Gerontology (CAG) holds its 43rd annual conference – Landscapes of Aging – Critical Issues, Emerging Possibilities.

Suzanne Cook, (apart from being a scout for Planet Longevity), will be a presenter at the conference on the Saturday morning, chairing the session under the banner “Intergenerational Learning within Formal Educational Programs”. Suzanne’s specific piece will focus on the work she has been doing at York University in a one-year course – Sociology of Aging. More from Suzanne on this in our next Planet Longevity blog post.

Take a scan through the CAG conference program and you will be amazed if not overwhelmed by the wide range of niche topics related to aging issues. There is no room to say that you aren’t spoiled for choice; and you don’t have to be a gerontology professional or academic to understand that each of the aspects covered has a real connection to what everyday people are experiencing.

Setting aside keynote speakers, the granular details of the “critical Issues & emerging possibilities” are parcelled out in thematic doses over three days, too many to mention here. Sample of a few that popped out at me:

  • Person centered home care
  • Challenges in long term care
  • Experiences of caregivers
  • Aging and social exclusion
  • Rural aging
  • Changing the culture of dementia care
  • Aging and technology

Gerontology as a field of knowledge and professional practice encompasses so much as any Google search will reveal, a “multidisciplinary” field as the CAG describes itself. Considering the direction society is taking in terms of aging demography, it serves all of us to be well informed about the challenges and possibilities.

So much news on the social aspects of aging is headlined in caution and worry words like risk and cost or being under capacity to serve the old. Easy as it is to define the critical issues, the more enlightening outcome from this conference will hopefully be about what the world of gerontology is doing with the emerging possibilities.

Mark Venning

Planet Longevity: Leading Thought Begins!

With great enthusiasm I am pleased to announce the launch of Planet Longevity, a thought leadership panel; a group of eight people who collectively offer forward thinking with a broad perspective on issues related to aging and longevity.

Our extended life expectancy as we know it now, is changing outlooks on how societies will adapt differently around the world. The aspects and prospects for our longevity beg for clear observation, practical ideas and positive re-framing.

The Planet Longevity goal is to position the many dimensions of this subject so as to influence, enlighten and challenge assumptions around how we will actually adapt to the experience of aging and longevity in our foreseeable future:

  •  Healthy aging and social policy
  • Personal wellness – body, mind and spirit
  • Elder care and family dynamics
  • Later life career renewal
  • Aging and work re-modelled
  • Financial foresight for later life
  • Smarter marketing to an aging consumer
  • Community redesign and cross-generational networks

All of this and more is perpetually changing individual attitudes and societal policy approaches for generations now and to come. For example: How do we reshape our world from the narratives constructed from our familiar past? Old narratives around issues like old age pensions, long term health care and our relationship to work, jobs and economic progress.

Planet Longevity has a crisp offering, as you will see cruising quickly through the web site. You could say we serve almost like your one source conference program, advisory group or speaker’s bureau. Our bi-weekly blog will feature all our members throughout the year and we invite you to contribute your questions and comments to encourage positive ideas.

The photo on the home page of fingers intertwined is a sequence from the Japanese film exhibit at the 54th Venice Biennale, 2011.

“In some of the images…a human brain comes rising like the sun or the moon, and the world unfurls itself in the light that appears shining from the brain. Up-and-down movements like this form the basis of the images of this work…the mirrors make people imagine the world spreading sideways….and the energy reflected by the mirrors continues to expand endlessly by the imagination of the viewers.” Tabaimo, Artist

Aging is natural and inevitable. How well do we foresee, prepare for and actualize our longevity? It is in our collective minds to answer and in our daily life actions to fulfill.

Welcome to Planet Longevity; where Leading Thought Begins!

Mark Venning