This is a follow-up note to the Social Canada post on January 29, 2021 by Terrance Hunsley on the Pearson Centre report:  National Goal for Senior Care.  The purpose is to support the suggestions and to further the thinking on what Canada should consider appropriate care for its seniors in the future. It is in two parts addressing long term and immediate needs.

Long Term

Social Safety-Net Review:

The social safety-net has worked well in the past century and this may be the time to improve and update it for this century, when the context and demands will be very different from when the social policies were created.  The tragic consequences of the COVID-19 pandemic create an opportunity to re-examine Canada’s social policies to critically assess how effective they are now, how well they integrate with each other and where they may fail Canadians under new and evolving situations. So, the first suggestion is to create a Federal Review of the Social Envelope during the coming year as part of the COVID-19 recovery plan while responding to the immediate demands for corrective action.

Updating should include the progressive shift to policies based on the life course, which means citizen rights, responsibilities and benefits extend from birth to death. Thus, for seniors, the national goal should be: Every aging person has equal right to care, whether social, mental, health or pharmaceutical services regardless of where they live. The role of government would be to monitor this goal and to support individual responsibility for self care and the services provided by social institutions while intervening only when the public good case can be made.  Some life stages that may have probabilities of fatal outcomes due to societal threats (like the pandemic) should be given priority. The success of each policy should be measured by outcomes, not by the amount per person being spent on the population life stage. It is known that outcomes in earlier stages affect later outcomes. This national goal may not be reached right away but all new and amended aging related policies should be checked against this goal.

Suggestions for immediate policy actions for seniors

Governments have five common ways of responding through policy: (1) Information and knowledge sharing (2) Legislation (3) Regulations and standards (4) Financing (5) Public programs.

Information and Knowledge sharing:

• Policies should include not only production of information but also access and targeting.  Do older people know where to go for help with long term sequelae of COVID?
• Public benefit accounting provides a picture of effectiveness and returns to public investment. Outcomes should be measured through life. These results should be reported to parliament and the public.  For instance, health promotion pays high returns in benefits but is poorly funded because the results are not immediate.  This responsibility could be assigned to the Parliamentary Budget Office.
• The Statistics collected should cover necessary topics and samples as well as reported in fine grained detail. For example: mortality and morbidity data by single years of age after 75; statistics on care and services consumed in every municipality per person 75 and over by age, in relationship to percentage of elderly population, whether living in a retirement community to not.
• Research on tradeoffs resulting from the heavy use of informal and family care (unpaid care) and its major impacts on the labour market, the economy and the individual (pensions).

Legislation:

• Should Canada prohibit private long term care housing for vulnerable seniors? (See later for mixed models).  Canada prohibits private prisons, for example.
• A case cannot be made for seniors needing care to have lower standards of living in the last years of life. Why should a person give up decent housing because they need care? Some Scandinavian countries require some semblance of home in long term care accommodation: Single person bachelor type apartments consisting of one bedroom (Can accommodate two beds, for couples) bathroom, balcony and minimum kitchen facilities (coffee makers, microwave and small refrigerator) is provided so that this housing can also be used for students, migrants and refugees,  depending on demand. This adds to general housing stock rather than limited single purpose housing.
• The aim is to ensure that the death and illness rate in long term and residential care homes do not exceed the rate of those of similar age and health without lower quality of life. Therefore, an annual assessment could be required for people over 75 to determine the best combination of housing, health and services required. Advice and recommendations then can be suggested with the understanding that the individual’s decisions will be respected.  (We require an opticians recommendation, before a driver’s license is issued to older persons, for example.)
• Caregivers should have a minimum wage and informal care givers should be given respite care. Lack of both of these can affect the quality of care.
• To prevent poverty in old age, a maximum percentage of individual contribution from income for long term care can be set, above which seniors may be subsidized through existing mechanisms.

Regulations and standards:

• Dormitory accommodations should be forbidden. Single person accommodation should be encouraged, as part of pandemic preparedness.
• Federal and/or provincial governments should establish and publish standards of care – for consumers, care professionals and service providers. Currently, standards that exist are fragmented.  Desired outcomes should be noted.
• New configurations of integrated care should include care provision by family (visiting, social, feeding) and community care (culture and recreation, library, exercise). Long term and residential care should not be isolated from the community.
• The Canadian Standards Association (CSA) should provide standards for age/care friendly environments and pandemic protection.

Financing:

• Negotiations on the Canada Health Transfer should consider the growing percentage of seniors in the population and whether some proportion of the funding be tied to national objectives/standards related to aging. At the least, to reporting of outcomes.
• Federal incentives should encourage the private sector to provide useful products for an aging population: home elevators? driverless cars?
• Perhaps government bonds could ease financing particularly if private investors (domestic and foreign) are prohibited from investing directly in long term care.

Public programs:

• New models of provision should be tested in experimental projects.  Should long term care be public?  Non-profit?  Totally private is under a cloud.  In Canada, long term care always bundles housing, health and social services on one site and under one management while other countries have been able to un-bundle the three, at least partially. Public discussions should also look at hybrid models. Ideally some type of public protection should be provided for residents.
• Constructive private public partnerships or public non-profit partnerships in the sector could be investigated. Examples: Leasing private buildings, contracting out food services, co-op arrangements, etc.
• Pharmacare is being considered.  Should long term care insurance be considered, too?
• A Sector Council for aging care should be set up with wide representation (including immigration and training and licensing bodies). It should report annually through a minister to parliament.

These suggestions are offered to stimulate public discussions on effective and equitable ways in which care can be provided to Canada’s seniors in accommodation of their choice.  Seniors will form a quarter of the population in this century.

Satya Brink

February 2, 2021