- The costs of sustainability
- End of life care needs fixing
- Caring for your parents. Changing demographics means boomers face new challenges.
May 27, 2010 The Globe and Mail
Concerns about an aging population, and the crisis of health-care funding, loom at the edges of public policy in Canada, and few concrete steps are being taken to address them. Two new reports put into stark relief the changes that will be required to Canada's social safety net.
Statistics Canada's population projections issued on Wednesday had one eye-catching finding. No matter which of two scenarios StatsCan used, "seniors would become more numerous than children somewhere around 2015."
Short of another baby boom or a radical change in immigrant selection, the effects are going to be lasting, and profound. A society with more people over 65 than under 15 years of age needs more seniors' facilities than schools. That in turn means more adult educators (and, of course, health-care providers), and fewer conventional teachers.
Meanwhile, a report released today by the TD Bank focuses on how to keep publicly funded health care sustainable. The aging population is one cost driver, but a larger one has been utilization, or the quantity of health services used per person, which accounts for 42 per cent of the cost increases in Ontario in the last decade.
Many of TD's ideas have a familiar ring: governments across Canada are experimenting with electronic health records, health-promotion strategies and ways to encourage collaboration among health-care workers; B.C. and Ontario are changing how hospitals are funded. Many of these ideas should work in theory, but have yet to deliver the promised savings.
The report argues that an oft-mooted idea – more private payment for health services (as opposed to private delivery of services through the public system) – runs the risk of transferring costs to private payers while draining the public system of its best resources.
Other radical fixes are available. One, a proposed user fee charged through the tax system, would be unfair. But three ideas may well need to be part of a sustainable future: paying more doctors per patient, or through a fixed salary; means-testing drugs for seniors; and creating a fund for seniors' drug coverage that people pay into while they are of working age, like today's Canada Pension Plan.
It will take some visionary political leadership even to air these proposals, and to make the existing drive for greater efficiency yield fruit. The alternative – a health-care system that still devours resources but makes every other government department go hungry – is unpalatable, and it is on our doorstep.
End of life care needs fixing TOP
Cancer Society, CTV.ca News Staff, May 19, 2010
Too many Canadians with terminal cancer do not have a say in where their lives will end, simply because palliative-care services and support for their caregivers varies so widely across the country.
That's the conclusion of a special report about end-of-life care in Canadian Cancer Statistics 2010, released today by the Canadian Cancer Society.
The report found that while most terminally-ill people would prefer to die at home, more than 55 per cent of deaths occur in hospitals.
Part of the reason for that is because community-based services are simply not available for dying people in some jurisdictions, the report concludes.
The report found that Canada has a "patchwork approach" to end-of-life care, so that while some Canadians can access excellent services, other patients are unable to die with dignity in the setting of their choice.
Uniform, high-quality support for any person dying of cancer should be available no matter where they live, says Gillian Bromfield, the senior manager of cancer control policy with the Canadian Cancer Society. What Canada really needs is a national program for providing end-of-life care.
"The quality of care that's available across the country can vary between provinces and also within provinces. And that's not acceptable," she told CTV News Channel Wednesday, following the report's release.
The report found that oftentimes palliative care services do exist in an area, but they are not being used.
Bromfield says it's not exactly clear why that is, because not enough research is being done on the issue of end-of-life care.
"We don't know yet if it's about availability of services, or whether it's about knowledge of those services -- there's a lot of information we need before we can make recommendations," she said.
The issue of how to care for dying cancer patients is a pressing one, the society says. That's because 29 per cent of all deaths in Canada in 2005 were from cancer -- making the disease the leading cause of death in Canada.
This year, an estimated 76,200 Canadians will die from some form of cancer -- a number that will grow with Canada's aging and growing population.
With so many patients, families, and even doctors not wanting to broach the subject of death and palliative care, misunderstandings can result. The report found that oftentimes, patients and their families delay accessing palliative care services for their loved ones. By the time patients and their families start to seek out help for palliative care, the delays can mean a patient doesn't get the care they need in time.
Not only are many patients suffering but so are the family members who care for them, the report found. The report found a lack of solid support for families who choose to offer palliative care themselves at home.
Not only do these family members need help with offering physical and medical care, they themselves need emotional -- and financial --support that often isn't there for them.
The Canadian Cancer Statistics 2010 report estimates that a family caring for a terminally-ill cancer patient at home incurs costs of more than $1,000 a month on average. And that doesn't include the costs of lost income from taking time off work.
The Cancer Society is calling on Ottawa to extend compassionate care benefits to 26 weeks from the current six weeks. They also want to see a tax benefit to help families with costs. They say the government should be willing to support people whose caregiving relieves some of the burden from the health-care system.
Dr. Larry Librach, who runs the Temmy Latner Centre for Palliative Care, at Mount Sinai Hospital in Toronto, says he knows all too well that palliative care doesn't get the funding it needs. At any one time, his program is offering care to about 600 patients in the community, many of whom are dying of cancer.
But he says he knows there are many patients that his program can't help.
"The estimates are we're serving about 25 to 35 per cent of cancer patients who are dying. We'd like to serve as many as possible who want to be served," he told CTV.
He says when he saw the Cancer Society's report, he thought he had "died and gone to heaven" because the report was bringing to the forefront something he's been trying todraw attention to for years.
He says he's glad the Cancer Society is not just talking about how cancer can be beaten, but also talking about what happens when cancer can't be beat.
"It brings it right into the open. Palliative care should not be a secret. It should be there for every dying patient," Librach says.
"Some patients and families don't know about palliative care. So when you speak to the patients, they'll say, 'Where were you when I needed you early on?' We are a well-kept secret."
Caring for your parents. Changing demographics means boomers face new challenges. TOP
St. John's Telegram, May 19, 2010
In 2011, the first baby boomers will turn 65. Many of our "boomers" are now "zoomers," enjoying life while also helping their parents day-to-day.
And that can be a source of stress. Because what will happen when zoomers lose their "zoom" and the baby boom generation itself begins to need some assistance.
Canada's population is definitely changing.
A Statistics Canada news release, headlined "Population projections for Canada: provinces and territories, 2005 to 2031," estimates that seniors 65 and over will number between 4.8 million and 6.6 million by 2031, or roughly 23 to 25 per cent of the population.
The projections even took a stab as far ahead as 2056, when the number of seniors 80 and over is expected to triple, to one in 10 people.
This shifting, aging, demographic will no doubt have an impact. Will there be a greater potential for seniors re-entering the workforce? Increased investment in seniors recreation programs?
It also raises the issue of caregiving. While long-term care facilities are receiving government investment (more than $46 million in this province in budget 2010), caregiving by families is still provided at these facilities and many seniors who require some assistance choose to remain in their homes.
What resources will we have to help care for seniors who require assistance? How much of the day-to-day care will fall to families, friends and neighbours?
Take the age group of those 45 and older. In 2002, just over 2 million Canadians in this category reported they were providing care for a senior who was a family member or friend.
By 2007, that number had risen to almost 2.7 million people aged 45 and over who were now caregivers.
That's one in five.
The information comes from an October 2008 Statistics Canada article entitled "Eldercare: what we know today."
Of course, the age group "45 and older" is pretty broad.
Breaking it down, as of 2007, three-quarters of people between 45 and 64 were providing care for a senior.
Sixteen per cent of people 65 to 74 were providing care, and eight per cent of people 75 and older were doing the same - perhaps performing household chores, changing clothes, reminding loved ones to take medications and/or driving them to and from doctors' appointments.
One in every four people providing care for seniors were seniors themselves.
As our population ages, how will this number change? What will it mean?
Francine Russo has covered aging and the baby boomer beat for Time magazine, and is the author of "They're Your Parents Too! How Siblings Can Survive Their Parents' Aging Without Driving Each Other Crazy."
Having interviewed family after family, Russo writes about everything from the need to recognize an emerging frailty or health problem in the family, to decision making with mentally capable seniors who may still require assistance, to working with families to assist parents with dementia.
She raises questions raised by some of the people she's interviewed.
On arguments: "Your dad won't take his pills, goes out without his oxygen tank and drives away the aides you hire. Besides wringing your hands, what can you do?"
On the selection of decision makers: "If we have been given this authority, we may ask ourselves, 'Am I parent to my parent?' If we are not given the power, we question, at some level, 'What does it mean that my brother is making decisions that my parents used to make, decisions that affect all of us? And why him? Why not me?'"
Over 265 pages, she confronts a myriad of issues, not all easily resolved.
"Often no one in the family wants to see that a change has come," states Russo. "As adult children, we don't want to see our parents as people with failing bodies who are likely to need assistance and care. After all, they are people who have always cared for us, raising us as children, being our parents throughout our lives, loving, approving, criticizing, demanding."
Another thing to remember is that when parents or friends need help, it may not always be an opportune time for the people who find themselves having to be caregivers.
Consider that common label "the sandwich generation."
"In 2007, nearly 43 per cent of the caregivers were between the ages of 45 and 54, the age at which many Canadians still have children living at home," according to "Eldercare: what we know today."
They are working to raise their own children and then being asked to add to that the needs of a parent or parents.
Of course, caregivers have other considerations that can arise, from job changes to relationships.
For those in this province feeling the pressure, there are ways to find help.
Jill Barron, a peer advocate manager at the Seniors Resource Centre, said caregiver stress is well recognized.
"They may be feeling frustrated or exhausted or stressed and they need someone to talk to," said Barron, who suggested joining a caregiver support group for help or calling the toll-free, confidential help line (726-2370, toll free 1-888-571-2273) maintained by the centre and its community partners.
The line receives about 40 calls a month from caregivers around the province.
"(The callers) ask about the supports that are out there. Things like home care, respite care - for example, if they're caring for their parents and they are going on vacation and don't know what to do," Barron said.
Sometimes, she added, it is about simply directing caregivers to where they can find the help they need.
"They may know that it's out there, but they may not know the right person to call," she said.
Barron said a caregiver guide is currently in the works, with support from the provincial office for aging and seniors.
Aside from the guide and other offerings from the resource centre, Barron said the province could also use more adult day programs, community-based caregiver organizations, tax credits and more flexible services for caregivers.
Helping those who help others is something to think about now, in preparation for the future