By 2021, the number of seniors in Canada is projected to exceed the number of children aged 14 and younger – for the first time ever. This means more Canadians will be entering an already stressed care system.
According to demographic projections from Statistics Canada, the number of seniors is expected to increase rapidly until 2031, when all baby boomers will have reached age 65, with the most rapid growth in seniors over the age of 85. By 2036, seniors could represent up to 25 per cent of the total population.
“We’ve got to plan for that,” said Seniors Advocate Isobel Mackenzie. “The population is aging, there’s going to be more people, we need more long-term care.”
The Office of the Seniors Advocate analyzes services and issues B.C. seniors face. Headed by Mackenzie, it also makes recommendations to government and service providers to address systemic issues. With this changing demographic, Mackenzie said the government needs to take steps to plan ahead for individuals who don’t have the means or the ability to do that for themselves.
Entrenched in the wrong system
With roots in the Elizabethan Poor Law of 1601, not the health care system, Canada’s long-term care (LTC) sector was first established as poorhouses, county homes, parishes, poor farms and almshouses – housing people who were unable to care for themselves. Over time, different groups were separated into facilities with housing specifically for older adults gradually introduced during the early 20th century. LTC remains outside universally insured health services protected by the Canada Health Act.
Commissioned by the Royal Society of Canada, a report was released in June that focused on 24-hour residential LTC and the impact of the novel coronavirus. The report found provincial and territorial plans are disparate and piecemeal, while the Canada Health Act does not protect or ensure universal LTC. With different levels of government oversight and legislation, jurisdictions offer different ranges of services and cost coverage, meaning there is little consistency across the nation in the level of care offered, how it is measured, how facilities are governed, who owns them, or even what they are called.
“Concerns about quality of care and safety persist, tragic events continue, inequities deepen, root issues are not challenged, older adults suffer needlessly, and many Canadians are truly frightened at the prospect that they themselves may need to be admitted to a nursing home,” the report states.
While the majority of seniors live independently – 72 per cent of people over the age of 85 live on their own and are able to take care of most of their own care needs – the older an individual gets, the more complex their care needs become.
But 30 years from now, a typical 85-year-old will be quite different than an 85-year-old today. They’re less likely to be married and have children – the typical care-providers for seniors – and a larger percentage will have lived in a multi-unit residence.
Individuals who have lived in condos are more likely to make that shift back, as they are comfortable with the environment. Whereas today, Mackenzie said most seniors are used to single-family homes. They’re reluctant to give up theses homes and wait too long to downsize, which means many end up in care homes.
“If you look at where people are living and where they want to live, we’ll need more long-term care beds.”
The current situation
A report prepared last fall by Westbridge Group Valuation Partner, paid for by the Saunders Family Foundation, examined existing LTC beds in Greater Victoria and found an urgent need for more on the West Shore, with most located in the core municipalities.
Historically, health authorities in B.C. held a target of 75 funded LTC beds per 1,000 seniors aged 75 and up – but the current provincial average is lower, according to the report. In 2019, there were an estimated 69 funded long-term care beds per 1,000 seniors aged 75 and over.
In Greater Victoria, the report estimated there are 36,785 residents over the age of 75 – approximately 9.5 per cent of the population. In the entire region, the report found 2,680 funded long-term care beds – 665 private-pay, 398 funded assisted living suites, as well as 2,037 for-profit assisted living suites and 544 not-for-profit assisted living suites. There are also 10 hospice beds at Victoria Hospice (Royal Jubilee Hospital), 10 at the Saanich Peninsula Hospital, and two in Sooke’s Ayre Manor.
Mark Blandford, Island Health’s former executive director of primary care and seniors health, told Black Press Media in August that 40 people a week are placed into care on Vancouver Island.
“Fifteen per cent of people going into a care bed today fit the profile of care that can be provided in the community.”
The current LTC system lumps all levels of care together.
“This has an impact,” Mackenzie explained. Some individuals don’t have complex care needs but don’t have the ability to get care outside LTC.
“They don’t need to be in the environment we have.”
As Canadians live longer, the prevalence of chronic diseases, especially dementia, and other social challenges have also increased. This means more Canadians will be living with Alzheimer’s disease and other age-related dementias – an umbrella term for a set of degenerative brain disorders. Today, one in 40 Canadians aged 65 to 74 and one in three over the age of 85 have aged-related dementia, according to Statistics Canada. More than two-thirds of seniors with dementia will require nursing home care.
Residents are entering nursing homes with more complex social and medical needs which have raised the level of care required at these facilities – even compared to just a decade ago. The highly critical peer-reviewed report commissioned by the Royal Society of Canada found in response to these challenges, hands-on care is now almost entirely given by unregulated workers including care aides and personal support workers. These employees receive the lowest wages in the health care sector, minimal formal training and are rarely part of the decision-making process.
The main issues Mackenzie sees are also in regards to staffing, including the number of hours a client receives, experience, training, cultural sensitivity and engagement. And those issues aren’t all fixed by having an adequate number of staff on site.
Who is providing care?
The LTC sector increasingly relies on unpaid care by family members and friends of residents. Exacerbating this problem, by 2050, approximately 30 per cent fewer close family members (spouses and adult children) will be available to give this unpaid care. Relying on these caregivers leaves the LTC sector especially vulnerable in a crisis, such as COVID-19. Reports from Europe and now Canada found many preventable deaths occurred during the early waves of the pandemic and some were even from a lack of timely access to care, water, food or basic hygiene, not from COVID-19 itself.
“It epitomizes our failure … this was more than a communicable disease crisis,” the report states. “Canada has systematically failed to deal with the consequences of population trends in aging, dementia prevalence and fewer family caregivers for older adults.”
Mackenzie echoed the sentiment of the report’s authors, “COVID didn’t break the system, COVID exposed the system.”
While B.C. fared much better than other provinces – Ontario especially – she said B.C. is far from perfect.
How do we fix it?
The Office of the Minister of Seniors noted the federal government has been assisting provinces and territories to address these gaps to keep residents safe.
“Despite the improvements in many of the hardest-hit homes, significant work remains to address the challenges the virus poses to long-term care. The government of Canada is continuing to work with the provinces and territories to help address these issues.”
But if nothing else is done immediately, staffing levels also need to be addressed. Authors of the report are urging the federal government to develop national standards for staffing and training.
“Canada’s reality is that, without federal financial support, provincial and territorial governments are unlikely to have resources for the high standards that our frail elderly deserve,” they stated.
Along with staffing, Mackenzie noted the key to addressing shortfalls in the system is getting services into the community. “We need to look at the supports leading up to long-term care,” she said. “We don’t have very much subsidized assisted living.”
Listening to seniors who want to stay in their communities, she said it’s clear these supports are needed. While she believes the proximity of these services will only improve, she noted there’s speculation COVID-19 will reverse this current trend.
But as the report stated, “We have a duty, a responsibility, and the ability to fix this – not just fix the current communicable disease crisis, but fix the sector that helped that crisis wreak such avoidable and tragic havoc. We can restore trust.”
– with files from Don Descoteau
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