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NOW Atlantic: Smart thinking for a changing world
Atlantic Canada’s not getting any younger. More people are reaching the point of requiring some measure of assistance. More are requiring long-term care. It’s a demographic wave we know won’t last forever, but we must respond to. So how are we coping? How is seniors' care being approached? And how does the system keep supplying quality care without sending health-care spending skyrocketing?
“In 2016, 16.9 per cent of Canadians were aged 65 years or older, and 2.2 per cent were aged 85 years or older, representing a 20 per cent increase in these age groups since 2011. The proportion of the Canadian population aged 65 and older is expected to increase to 20 per cent by 2024.”
— Statistics Canada, Health Report, May 2018
TIME OF TRANSITION
A NEW WORLD FOR PERSONAL AND LONG-TERM CARE
Mike Browne remembers when he was told his mother was going to be moved out of town. She had to go where a higher-level long-term care bed was available.
Her destination hadn’t been settled, but it would be a facility at least 45 minutes away.
He was upset, and spoke to others with family facing forced relocation for care. High demand means there often aren’t beds where people are living, or no beds at all for some needing to transfer out of acute care.
“Then to have to relocate them at a crucial time of their life, near the end of their life, was certainly heartbreaking to the patients and heartbreaking to the families,” Browne said.
His mother (who fell ill and ultimately wasn’t transferred) died a few years ago at age 92. By then, he and his friend John Burke had petitioned and demonstrated, calling for an increase in the number of long-term care beds in their town.
The Newfoundland and Labrador government is building additional long-term care facilities through public-private partnerships.
Shovels are expected to hit the ground this summer for a 60-bed care home in Grand Falls-Windsor, where Browne is now deputy mayor. Another 60-bed facility is going up in Gander, an hour away. There are new beds coming in Corner Brook and St. Anthony.
Browne says new facilities in central Newfoundland will reduce wait times and transfers temporarily, but they won’t be enough to meet swelling demand.
“For our town, I mean we expect the government to address the serious situation we’re going to have in 10 years, with all the baby boomers needing Level 3 health care…,” he said.
“So, although the 60 beds will help, I think it’s imperative that the government come up with some programs to deal with what will be a significant problem.”
“With seniors aged 65 and over projected to make up nearly a quarter of our population by 2036, demand for health care will rise sharply, putting increased pressure on middle to low income families to help pay for care for their loved ones.”
— Alan Arcand, associate director, The Conference Board of Canada
Every province has to grapple with the same pressures, on a limited budget.
Canada is not alone in facing a challenge of demographics and care. The percentage of people over the age of 65 has been on the rise throughout the G7 countries.
While birth rates are down since the baby boom, people are living longer, and, while there are plenty of healthy seniors, in general, care demands increase with age.
At the time of the 2016 census, 6.8 per cent of Canadians 65 and over were living in nursing homes or seniors’ residences. The figure jumps to 30 per cent for those 85 years and over.
Atlantic Canada has the added challenge of trying to keep younger, population-building immigrants from moving on to larger centres like Toronto and Montreal. By 2038 (based on a 25-year forecast from 2013), this region is expected to have the highest proportion of seniors in Canada — more than 30 per cent.
And, as the region struggles with chronic illness, it’s generally worse off than the national average when it comes to health indicators like the obesity rate — only adding to the long-term health challenge.
“We’re seeing the aging population requiring health care for complex issues. So, it’s not just that people are getting older and what might come with that, but they’re bringing with them already underlying health conditions, which I think has to be acknowledged,” said Debbie Forward, president of the Registered Nurses’ Union of Newfoundland and Labrador.
Forward said the system is struggling with care placements and the movement of people with long-term needs out of the acute-care setting.
The result is over-capacity hospitals and long waitlists.
In addition, a wave of people are reaching retirement age and leaving the workforce. Unions throughout Atlantic Canada say more staff are needed in care facilities. In a vicious cycle, staff shortages contribute to greater rates of injury and illness, compounding the shortcomings.
There has been a move in Atlantic Canada toward “home first” programming. But making it possible for seniors to stay in their own homes longer requires more supports for homes and communities.
"He had the frustration of being separated from her, because they'd been together so long and were so in love."
— Debra Nagle, discussing her late father Cecil Parsons separation from his wife, Shirley Parsons, when she moved into long-term care. The experience is described in his book: "A Road Taken: A Journey Through Dementia.”
There are a mountain of issues to work through, particularly in rural areas. But, it’s clear the status quo and brick and mortar projects aren’t enough.
As of February 2019, more than 1,000 Nova Scotians were waiting for nursing home beds, while about 20 per cent of hospital beds were occupied by people awaiting outside placements.
Caregivers at home — the people who are expected to help make ideas like home first work — need more support. The Canadian Medical Association has called on the federal government to put another $21 billion into seniors health care over the next decade.
While the system is being adapted, personal costs keep going up.
“(In 2015), the average age of an RN in Canada is 44.9. With more than a quarter of the RN workforce 55 or over on the cusp of retirement, and 13 per cent aged 60 or over, at or nearing retirement age, the Canadian health-care system could be facing a mass departure of the most experienced, knowledgeable and productive nurses at a time when they are needed the most, making retention strategies for older nurses and the recruitment of new nurses critical.”
— Canadian Federation of Nurses Unions, Bridging the Generational Divide (2015)
From personal care homes, to long-term care and acute care hospitals, demand in the care system is leading to new challenges across the board.
WANTS IMPROVED STAFF PLANNING
The president of the Newfoundland and Labrador Association of Public and Private Employees (NAPE), Jerry Earle, says the writing is on the wall when it comes to the pressing demand for physical care space and services.
His union’s members, which include personal care attendants and licensed practical nurses (LPNs) in long-term care, have been facing overtime requests, mandated work, sacrificed holidays and — triggering recent protest action — refusal of full annual leave as selected by staff, based on facility needs.
“Infrastructure is one thing, but the human resources piece… we have to start planning today for what’s going to happen in two, four, six, eight years’ time,” Earle said, noting it can take a year to train personal care attendants and two to train an LPN.
A negotiator for years before he became union president, Earle said they expected a certain level of retirements in the system given employees’ ages, but staff recruitment to meet the demand for service has not kept pace.
Meeting demand will require intense collaboration, he said, plus a commitment to planning ahead and then following through, so plans don’t end up as lip service.
COST OF SUPPORT
The Canadian Medical Association (CMA) has called for a national seniors strategy, to help achieve proper supports for seniors and their families.
In March 2019, the association warned that home support and long-term care costs are set to balloon, with out-of-pocket expenses for care set to outstrip disposable income.
Existing tax credits are underutilized and, at the same time, more help will be needed.
“Current programs are inadequate and the issue will only get worse as our population ages. We must address this and provide the kind of support seniors and their families not only deserve but desperately need,” said CMA president Dr. Gigi Osler, in a statement.
ADVOCATING FOR INDIGENOUS SERVICES
As the Nunatsiavut government’s deputy minister of Health and Social Development, Michelle Kinney was recently working with two beneficiaries in hospital in Happy Valley-Goose Bay who were waiting for a long-term care placement. Others are already in formal care settings, away from home.
Labrador Inuit often find themselves not only separated from family, but also facing language and cultural barriers when they enter long-term care.
“Because people have to leave their communities to go into the long-term care facility and… there’s no nurse or physician or LPN really who speaks the language. So, once they’re there, we often try to get an interpreter to go in for some of the cultural events, some of our community health workers to go in and do some activities, that sort of thing, but the whole language and culture piece is huge for us,” Kinney said.
There are practical concerns regarding care in the North, where the funding per person just doesn’t stretch as far.
Kinney said there’s been dialogue with Labrador-Grenfell Health and the provincial and federal governments, and she’s hopeful new options for long-term care can be introduced, including at the personal care level.
“We need more beds. There’s no doubt about it. But the other piece that would be less costly and better for our beneficiaries would be more personal care options in the community, so we keep people out of long-term care,” she said.
TIME FOR CARE
“According to a recent RBC Insurance survey among working Canadians, two in 10 had to take time off work to provide care for a loved one, and only one in three said they could comfortably afford the loss of income if they were to take three months off work to act as a caregiver, adding significant burden to an already difficult time.”
— RBC Insurance, Jan. 15, 2019
Saltwire Network journalists have reported for years on personal and long-term care for Atlantic Canadians. From the archives…
The Telegram, July 25
The Telegram, Oct. 18
The Western Star, Aug. 9
The Cape Breton Post, Jan. 15
The Telegram, Nov. 27
The Guardian, Feb. 14
The Chronicle Herald, Jan. 15
DEMENTIA ON THE RISE
“An estimated 564,000 Canadians are living with dementia (as of 2016). By 2031, this figure is expected to rise to 937,000 an increase of 66 per cent.”
— Alzheimer Society