A national strategy on aging? Health leaders are asking Trudeau to heed their call

Now that Canada has new – albeit voluntary – national long-term care standards, advocates say the federal government needs a national strategy to support aging.

It is not the first such call for a seniors’ strategy but as momentum builds toward Tuesday’s first-ministers’ health-care meeting with Prime Minister Justin Trudeau, Dr. Amit Arya is leading demands for a federal-provincial collaboration to improve access to primary care teams that include a mix of family doctors, palliative-care physicians, geriatricians, nurses, mental health and rehabilitation professionals who can support the later decades of life.

“It’s a golden opportunity to start transforming elder care in Canada,” said Arya, who is head of palliative care at Toronto’s not-for-profit Kensington Health and a lecturer for the Department of Family and Community Medicine at the University of Toronto.

“I’m really hopeful at this point in time, given the devastation that we’ve seen in the COVID-19 pandemic and the impacts on our health-care system — our collapsing health-care system at times — that we’re seeing this unprecedented moment where finally, there’s some hope of collaboration.”

On Friday morning, Arya joined Dr. Joseph Wong, founder of the not-for-profit Yee Hong Centre for Geriatric Care and registered nurse Laura Bulmer at a news conference organized by the Institute for Change Leaders, a group founded in 2016 by former Trinity-Spadina NDP MP Olivia Chow. Located in Toronto Metropolitan University, the Institute’s advisers include Bernie Farber, a human-rights consultant, Patrick Gossage, founder of Media Profile and Naheed Hassan, an entrepreneur.

While supportive of the new long-term care standards, the group issued a press release calling for a national plan for seniors’ care focused on frontline staff and “transparent, measurable and mandatory conditions that are enforceable,” in long-term care, home care and palliative care.

“As a palliative care physician who works in hospital, home care and long term care, I’ve seen how the health-care system has been experiencing severe strain for many years and now, is on the brink of collapse,” said Arya.

“A significant reason for this is that our health-care system is not designed to care for our aging population. Compared to other OECD countries, Canada grossly underfunds community-based elder care supports …And inadequate home care, long-term care and palliative care are definitely contributors to why we have overcrowded emergency rooms and also are major contributors to the ALC (alternate level of care) crisis. Without action, this crisis is only slated to get worse.”

Canada’s per capita spending on long-term care (services in home or facilities) falls below many OECD countries, including Japan and Germany, according to reports from the Organisation for Economic Co-operation and Development.

In 2019-20, Canada’s provincial and territorial governments spent $13.6 billion to provide “facilities-based” long-term care to about 205,000 seniors, according to the Parliamentary Budget Officer.

An August 2021 report by the PBO said improvements to long-term care and home care would cost an additional $13.7 billion each year. That figure includes $8.5 billion (a 63 per cent increase) on facilities-based care for seniors and $5.2 billion (a 52 per cent increase) on home care spending.

“This cost is expected to grow at 4.1% a year due to rising demand and costs,” the report said.

Wong, of the Yee Hong Centre for Geriatric Care, said he’s watched health-care spending diminish over the decades and now, as a growing number of Canadians are living longer, governments must deal with the cost of caring for an older population.

“We know that with longer life expectancy and better environments, people are living longer and they require resources,” he said.

What is needed in the discussion, said Laura Bulmer, a registered nurse and spokesperson for the Canadian Association of Continuing Care Educators, is a focus on the frontline personal support workers. The pandemic, Bulmer said, exposed PSWs’ low wages and the part-time hours that forced many to work in multiple homes. Despite the shortage of front-line staff, she said many PSW’s still cannot find full-time jobs.

“I’m feeling that a lot of this is related to the sector being made up, mostly of women who are racialized and marginalized,” Bulmer said.

Primary care clinics provide multiple services. In addition to physicians and nurses, some clinics, such as the MINT “Multispecialty Interprofessional Team,” created by Kitchener’s Dr. Linda Lee, include social workers, pharmacists or occupational therapists. Professionals in MINT clinics, said Lee, during a previous interview, are trained to work with people living with dementia and their caregivers.

In 2019, the Ontario Ministry of Health evaluated the outcomes of 100 MINT-trained medical clinics and found the “wraparound” model reduced wait times for dementia care by 50 per cent; delayed long-term-care admission by six months; led to shorter hospitalizations and fewer “alternate level of care” (ALC) hospital stays.

The idea that provincial governments will embrace the new ideas such as long-term care standards took a hit, at least in Ontario, on Monday morning when the province’s Long-Term Care Minister Paul Calandra was asked if he’d mandate the new national standards.

Calandra said he’d “take a look” at them but will not allow the new standards (focused on quality of life for residents and staff) to end up “watering down” Ontario’s current standards. His comments created an outcry amongst many seniors’ advocates.

Laura Tamblyn Watts, CEO of CanAge, said she hopes Calandra’s comments reflect the machinations leading up to Tuesday’s meeting.

“I’m hopeful that these are political manoeuvres and a signalling to the federal government that (Ontario) intends to come in strong on the Feb. 7 meetings and not that the government does not understand or appreciate what national accreditation standards are,” Tamblyn Watts said, on Monday.

Like most calls for better ways to live in the later years the demand for a national strategy focused on older adults is not new. And while some improvements have been made, Canada remains strategy-free, at least for seniors.

The National Institute on Ageing is on the third edition of its “National Seniors Strategy,” updated in 2020, after COVID-19 swept through Canada’s nursing and retirement homes, killing 17,177. The NIA COVID tracker shut down last July after governments stopped releasing death counts.

The NIA strategy called for supports to help people become active and independent and find care close to their home. It also sought support for unpaid caregivers. The third edition cited some improvements, including a 2015 tax credit for home repairs for older adults.

Some take hope that federal action is inevitable, given the large number of Canadians who are aging.

Based on Statistics Canada’s conservative projections, the number of Canadians aged 65 and older will increase from seven million in 2021 to nearly 12 million by 2051. That includes Canadians aged 85 and older, whose numbers are expected to rise from 871,000 in 2021 to as many as three million by 2050.

There is now a greater opportunity, said Arya, for governments to act on the needs of those demographics.

“We are seeing this unprecedented moment where finally, there’s some hope of collaboration,” he said. “And it’s a tricky thing because I think it only comes up very rarely where we see the prime minister and the premiers coming together actually to talk about health care, showing some type of unity in their messaging.

“And I really hope that will translate into action on a comprehensive strategy.”

Moira Welsh is a Toronto-based investigative reporter for the Star leading The Third Act, a Toronto Star partnership with the National Institute On Ageing that pushes Canada to do better for its older adults. Follow her on Twitter: @moirawelsh

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