André Picard
Canada's Baby Boom began in 1947 and continued through to 1965. Since then, the demographic bulge has been moving, slowly, steadily and predictably along – a bit like a rabbit swallowed by a python.
Along the way, Boomers have reshaped society not only demographically, but culturally, politically and economically. But their impact has just begun.
Over the next 25 years, the number of seniors will double to 10 million from five million. We will, for the first time in history, live through a period where there are more elders than children, more people over 65 than under 15.
In the coming years, this aging cohort of Boomers will hit the health and social services system with its full force.
"So what have we done to prepare?" the sensible, forward-looking policy-maker would ask.
The honest answer would be … crickets.
In fact, a new report from the Conference Board of Canada, entitled "Understanding Health and Social Services for Seniors in Canada," paints a pretty grim picture of the current state of affairs and an equally un-rosey view of the state of care in the future if we continue with the status quo.
Dr. Chris Simpson, president of the Canadian Medical Association, which commissioned the report, calls it "a reality check on where we are today [that] emphasizes our national imperative to act before the demographic shift gets too far under way."
The care and support available to seniors is, in some ways, comprehensive. But eligibility varies a lot, and services are not always easy to access. Not surprisingly, what seniors get is a mirror of the health and social welfare system writ large: A hodge-podge that differs substantially depending on where you live and characterized by an almost-total absence of co-ordination.
But the impact of these everyday holes in the social safety net are magnified because seniors tend to need more services than any other group.
Consider that seniors, who currently make up just under 15 per cent of the population, already consume about 45 per cent of ever-rising health care budgets.
What will happen to health budgets when seniors make up 25 per cent of the population and there are fewer and fewer younger workers to foot the tax bill?
Similarly, the social services bill can be expected to soar. Currently, seniors' families get an average of $25,300 in government benefits (compared to just under $4,000 for non-seniors families). To soften that blow governments are using methods like clawbacks and means tests that can cause hardships.
Now we have to be careful not to be too alarmist about the data. As salt-of-the-earth philosopher Yogi Berra once said: "It's hard to make predictions, especially about the future."
The good thing about the Conference Board report is that it avoids the rhetoric that holds Boomers "will bankrupt medicare." The reality is that, as people age, they tend to need more health and social services and, as a society, we need to find a way to make that care available, equitable and affordable.
Bear in mind too that considering people "old" at 65 is an artificial construct and an outdated notion. When medicare (and more importantly the concept of retirement and pensions) began in the 1950s, 65 was old – meaning that was about average life expectancy. Today, life expectancy in Canada is over 80 for both men and women: 80 is the new 65.
Aging is not, in itself, causing health costs to rise; utilization is.
In the time since Boomers were babies there have been dizzying advances in medical care that mean people live longer and better than ever before. One of the most impactful results is the emergence of what we now call chronic illnesses – conditions that were once fatal that are now managed and treated, often for decades.
The biggest killers in Western society – cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes – used to kill swiftly and at what we now consider a young age; now they kill slowly, and they are costly to manage.
More than 60 per cent of our health budgets are used to treat chronic illness. Yet we have a system that was built to treat acute illness.
We need to essentially take our hospital-based system and turn it on its head, making it a community-based, primary care system. Along the way, we need to bolster the health services seniors (and especially senior seniors – the over-80s) need, like home care, long-term care and palliative care. And we need to pay special attention to dementia, and the impact it is having on unpaid family caregivers. And we have to do all this without spending too much more money – which is no small feat.
None of this is news. We've known what was coming for a pretty long time. But we have been slow to act.
Why?
There are a host of reasons, from turf protection through to fear of change. But above all, we haven't acted because we don't have a plan, because politicians in Ottawa, the provinces and territories haven't shown much leadership on the issue.
That's actually the central between-the-lines message of the new report, and the theme the CMA has been trumpeting in recent months: Canada needs a seniors' strategy.
We can't just sit back and watch, in horror, as the population ages. We need to create a health and social welfare system that respects its elders, and that requires political action now.
André Picard is the The Globe and Mail's health columnist.
André Picard