According to Statistics Canada, the number of people 85 and over has grown by 127% between 1993 and 2013. They predict that by 2036, people over 65 will constitute a quarter of our population. Here in Newfoundland & Labrador, we have the most rapidly aging population in Canada.
A tsunami of seniors will soon come crashing down on our healthcare system, and the levy might not hold. This sudden surge in senior healthcare needs will burden our already over-burdened healthcare system to the point of maybe doing lasting damage, as we scramble to care for these aging baby boomers, both practically and financially.
2015 stats from the Canadian Institute for Health Information (CIHI) state that Canada spends an average of about $6,000 per person in the country, but when you focus in on an age bracket like 85-90, that number quadruples to roughly $25,000 per person. In short, as we know already, older people are a bigger physical and financial burden on our healthcare system because, naturally, their health is deteriorating. While seniors constituted about 16% of the population in 2014, they consumed 46% of public-sector healthcare dollars spent by Canadian provinces and territories.
In response to all these stats, Canadian provinces are scrambling to brace themselves for the forthcoming tsunami of seniors. Matthew Stewart is an associate director with the Conference Board of Canada’s national forecast and analysis division, and he has been very clear that our healthcare funding is already unsustainable. An aging population is making matters worse, very quickly. Canadian tax dollars spent on healthcare in 2015 amounted to $219 billion. This year, the Canadian Health institute expects it to reach $242 Billion. Ten years ago, our healthcare spending was half that figure.
The problem of course, is that Canada’s publicly funded health care system was created back when our population was just over 20 million, and Canadians could expect to live to approximately 70. We now have a population of over 30 million, and on average Canadians live to roughly 80. Our healthcare spending is already a runaway cost that puts Canada down in the books as having one of the highest per capita healthcare costs of the 35 countries in the OECD, and within Canada, NL’s per capita healthcare costs tops the list.
Canada’s current population dynamics make matters worse. For the first time ever, there’s more retirees than young people entering the workforce, so income tax that governments collect from the next generation will be insufficient to support healthcare funding required to care for those in the boomer generation. In our country’s healthcare system, two-thirds of funding comes from tax dollars, largely income tax, so once the baby boomers have left the workforce, they yield les income tax contributing to the healthcare system, and Canada, and certainly the province of NL, has fewer young workers paying income tax than it had 10, 20, 30 years ago. So it’s a disaster scenario of fewer people paying for healthcare funding when more people than ever need it.
The ramifications are evident, but happening incrementally, so they’re going relatively unnoticed. The Canadian Health Institute has shown that between 1988 and 2015, out-of-pocket health expenditure per person increased threefold. Private health insurance expenditure per person increased nearly seven times over, during the same period.
Clamping down on healthcare spending is not politically easy, and it’s a surefire route to bad press and opposing political parties using the opportunity to shame you before the next election. Perhaps for that reason alone, politicians will more likely tend towards building more hospitals or care facilities. It looks good politically, and after all, building accommodations for the boomers is what we’ve always done anyway: as the boomers aged, we built more schools to accommodate them, more neighbourhoods to house them, hence all these empty schools around the province we’re now selling off at bargain prices.
The problem there, aside from being stuck with over-sized hospitals or a multitude of long-term care buildings after the baby boomers have all passed away, is that building more hospitals is not financially viable as a remedy for what’s about to ail us. In 2015, building hospitals ate up a third, or $65-billion worth of healthcare spending, and that kind of spending cannot be allowed to cut in on funding healthcare providers and services (like doctor salaries, or the number of catscans/month a hospital is entitled to), or people in hospital beds will have no one or nothing to tend to them.
Another issue is that Canada’s health care system was not built to meet the challenges of our aging population. It was established to deal largely with short-term, episodic care, like patching someone up after a car accident or during a heart attack. But these days, our hospitals are clogged with seniors requiring long term care, or seniors chronically visiting the hospital as they have no place else to go.
The Canadian Medical Associated refers to the inappropriate stays of seniors in hospitals, while they wait for placement in a more suitable facility, as Alternate Level Care (ALC). High rates of ALC in hospitals contribute to clogged hospitals and lengthy waits in emergency departments and elective surgery for all patients. For example, in New Brunswick, a CMA study found that 33% of their hospital beds were occupied by ALC patients, of whom 63% had been diagnosed with dementia – their average length of hospital stay was weeks or months, not hours or days, as is the intention of a hospital visit.
Governments must provide access to more appropriate home or residential care options to keep medically complex seniors out of hospitals. Not just to save tax dollars, but for seniors’ wellbeing. Speaking from personal experience, a hospital is no place to “get better,” and no one wants to be in there a day longer than they have to be.
So what’s the answer? To answer this, the Canadian Medical Association recently divided stakeholder representatives into six groups, one for each of the sectors on the ideal continuum of care for seniors. They determined that “healthy aging” must be a priority; that means creating a society and senior facilities that keep seniors healthy for as long as possible. Doing so requires efforts like providing “the social determinants of health” – income security, safe housing, and access to good food and social connections.
“People do not inherently have greater needs for health and social services because they are old,” the CMA says, “it’s the fact that older adults are more likely to have complex chronic conditions that will place greater demands on healthcare and social services as the population ages. People who are aged 85 or older and have no chronic diseases use half as many health services as people aged 65 to 74 who have three or more chronic diseases like diabetes and hypertension or heart disease.”
Our province has a strategic healthy aging plan dating back to the Williams’ and Davis’ PC eras, though there hasn’t been an update since the Liberals took over. Our “Provincial Healthy Aging Policy Framework and Implementation Plan” had its principles developed through consultation.
The CMA also says we must better integrate primary and specialist care to keep seniors out of hospitals, and, make better use of home care and/or “ageing in place” as these are cost-effective and what most people want. But as homecare stands, most of it is currently provided by unpaid family and friends. The CMA advocates that any strategy for senior care must offer homecare providers more support such as tax breaks, leave, and respite.
Another issue is that specialty care requires such wait times that people opt for hospital stays instead, costing governments, on average, thousands of unnecessary dollars per hospital visit, after which, poor coordination of post-hospital care lands the senior back in hospital again, awaiting a long-term care bed or home care. These poor transitions between levels of care are known to put patients at risk. We need better fluidity and transition between the different levels of care seniors need, as well as better access to specialists or integration of specialist care in senior care.
The need for end-of-life palliative care that focuses on quality of life and death, rather than treatment, is increasingly in demand, but access to it is limited and poorly coordinated. A recent report by the Conference Board of Canada found that fewer than 16% of people needing it actually received it. The vast majority of people in that study died in hospital, a place paid to fix people, not house them while they pass away, and no one should die in the discomfort of a hospital.
The Canadian Medical Association also sees family doctors as key in navigating the tsunami of seniors, but only if we can lower wait times to see our doctor. “He or she acts as the central hub for the timely provision and coordination of the comprehensive menu of health and medical services patients need, ensuring medical advice and the provision of, or direction to, needed care seven days a week.”
They go on to say that, while it’s true 98% of Canadians have a family doctor, “their ability to get timely access based on a same-day or next-day appointment was among the lowest of 11 nations in a 2014 survey.” As a result, Canadian seniors are more likely to use the emergency department, unnecessarily clog up hospitals, or experience coordination of care problems than seniors who live in countries where people can see a family doctor within 48 hours. That same survey also found that only 46% of seniors could not get in to see a specialist in under 4 weeks. As a result, our emergency department use is more than twice that of a country like France.
In March, the Fraser Institute released a document entitled, The Sustainability of Healthcare Spending in Canada 2017. Its opening line is, “Health care is the single largest budget item for every province in Canada.” The report clearly states and demonstrates that between 2001 to 2016, provincial spending on healthcare has been unsustainable. “Indeed,” the report says, “during this period, healthcare spending grew by 116.4 percent, outpacing growth in other program spending and GDP. As a result, we’re at risk of crowding-out spending on anything but healthcare, of lowering social services [to pay for healthcare], and requiring higher rates of taxation and debt in most provinces.”
We should be particularly concerned about all of this here in Newfoundland. A recent report by CIHI examining the cost drivers of the healthcare system found “there is a noticeable east–west gradient in Canada, in which the impact of aging is more significant in the Atlantic region.”
As Canadian baby boomers retire, they will shrink government’s pool of income tax payers. Our solution for that on both federal and provincial levels involves immigration strategies – import foreign workers to fill gaps in the workforce from whom we can collect income tax. There’s also talk of progressive childcare strategies to encourage more Canadians to have more babies — these plans would ultimately help lessen the costs associated with childrearing. But securing more Canadians to pay the taxes which fund healthcare may not sufficiently do the trick, and there’s rational fear mounting that this coming senior-care crisis will crash the system and force changes, not temporary ones, to the healthcare system in our province and/or country, such that by the time anyone currently 50 or younger enters seniorhood, they might not enjoy the same system their parents did.
If this should bother anyone, it should be the millenials and Generation X-ers. They’re already earning wages lower than their boomer counterparts did, and are way more in debt, yet, our system continues to take equal tax revenues from everybody, and spread them out disproportionately, such that they’ll end up paying more to get the same thing the boomers got for less. Unless, of course, dealing with the boomers breaks the healthcare system younger generations are paying for, before they get to enjoy it themselves. People are already suggesting we ought to start paying medical fees “at least for certain things,” like we do for dental, prescription drugs, eye health, and ambulance services.
A lot is bound to change, and without enacting a solid plan, now, to brace for it, who knows what Canada’s healthcare system will look like in 20 years, after the peak boom from the baby boomers has rolled through the system.