Timely report on Aging Well

Jeff Green | Feb 24, 2021

One of the public policy outcomes of the COVID-19 pandemic has been a renewed focus on the long term care system in Ontario and across Canada.

When the virus infiltrated long term care homes, it caused very high death rates, in very short order, not only because people in long term care are more susceptible than the general population, but also because of lapses in protocols in many homes, overworked and underpaid staff, and other factors.

Issues around the current long term care system's failings, and the pressures that will be ever increasing over the next 20 years, as the baby boom population bubble ages, are certainly not new, but they are now getting more public attention, and in response the Ontario government launched an inquiry intro long term care.

In the midst of this, Queen's University researchers Don Drummond and Duncan Sinclair released a study called Ageing Well, which looks beyond the long term care issue towards, and at options for, an effective, financially viable way to provide the kind of supports that ageing people and their families will need in order to “age well”.

Duncan Sinclair knows a thing or two about healthcare reform and about ageing well. He wrote a book about healthcare policy, after he retired from Queen's University in 1996, where he was the first non-medical doctor to be the head of a faculty of medicine in Canada. He chaired a provincial commission on health services restructuring, in the late 1990s, in Ontario, and has written extensively about the subject. He lives on Buck Lake.

Don Drummond is an economist who worked for the federal government, then became the chief economist for TD bank. After that he chaired the commission on public finance, for the Ontario government, and released the Drummond report in 2012.

Ageing Well, a report that was co-written with Queens University researcher Rebekah Bergen, brings some of the policy ideas about ageing and the health care system, that have been a feature of Sinclair's thinking and writing over the last 15 years. Paired with the fiscal and data based economic analysis that Drummond brings to the table, it presents the argument that the government needs to look at more than long term care homes, if it hopes to make the kinds of investments that will help Ontarians age well over the next 20 years.

“The Ageing Well report is intended to head off a short term fix for care homes, which will just increase staff and eliminate some shortfalls, which needs to happen, but which is totally inadequate for most of the ageing population, and for what is coming very soon,” Duncan Sinclair said in an interview with the News this week.

A couple of the key findings in Ageing Well are that not only will the over 65 population rise from 17 – 25 percent between now and 2041, but the percentage of that ageing population who will be in the 75 and over demographic will rise as well, to 58% by 2041.

When the public healthcare system was established almost 60 years ago, seniors made up 7% of the population.

The report then presents the case for government investments in services designed to keep people out of long term care, and in the community, as they age.

It discusses community services aimed at helping people age at home, communal arrangements outside of long term care, and a number of other options.

“The country that has done this the best, in my view, is Denmark, followed by Japan. They have really taken the bull by the horns and designed a system based on what people really want and really need,” Sinclair said.

The Ageing Well report points out that no new long term care beds have been brought on stream in Denmark since 1987, but massive investments have been made in home-care and other services.

“The argument, that Canada needs primarily to expand the capacity of LTC-homes, misses the mark on several points. It is based on the current policy of “warehousing” seniors, among whom there is actually little demand for such homes. Rather, the problem is a paucity of alternatives from which seniors can choose, coupled with chronic underfunding of preferred alternatives such as home care and community services. Surveys have shown that seniors want to stay and age in their homes and communities. While some LTC-home expansion will be required to accommodate the fast-growing number of ageing seniors, the real need is for promotion and investment in home and community services and other alternatives, to provide seniors with choices that enable them to maintain the highest possible quality of life as they age,” the report says.

Ageing Well also shows that spending, on a provincial and national level, on services related to ageing at home, has lagged well behind other countries with similar demographic challenges.

Its concluding paragraphs sum up the current reality and the potential for a change in focus.

“The preponderance of COVID-19 deaths in LTC-homes has focused attention on the inadequacies of many institutions. The plethora of reviews across the country may lead to much needed improvements to their infrastructure, personnel, regulation, and protocols. But the reviews will miss the broader picture. If current practices continue, the need for beds will double over the next twenty-one years, and current expansion plans will do little more than replace beds that will be decommissioned. Demographics and institutional improvements will more than triple spending. All for something few seniors would choose.

“Most wish to age well and in place, in homes and communities they call their own. Canada is an international outlier in spending much more on institutional care of seniors than on home care. We need to develop housing options that are flexible and adjustable as needs change with age. Factors such as frailty and dementia, that compromise independent living, must be addressed through changes to lifestyle and approaches to care. Social needs must be satisfied. The best time to change course, to address better the well-being of seniors, was many years ago. The second-best time is right now.”

For Duncan Sinclair, issues around services for seniors are tied in with the healthcare reform process that is currently underway in Ontario, with the dissolution of the Local Health Integration Networks (LHINS) and the establishment of the new Ontario Health Teams (OHT) which will happen in the spring of this year.

“This is the third time the government has tried to reorganise health care” he said. They failed the first time, and they failed spectacularly the second time, with the LHINS .

“They need to get it right this time. They need to provide policies, guidance and funding, and let the services be provided in the community by people who know what their own communities are all about. What works in Toronto will not work in Kingston, and what works in Kingston will not work in Sharbot Lake.”

Duncan Sinclair is a former board member of Southern Frontenac Community Services.