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Samir Sinha, shown making a house call to a patient in April, 2011, has issued a report of recommendations on how to help seniors live at home longer.

Moe Doiron/The Globe and Mail

Affluent seniors in Ontario will begin chipping in for their prescription drug costs next year. And they could also be asked to pay part of the tab for home care and community support services.

Health Minister Deb Matthews said the Ontario government is looking at introducing a co-payment system, tied to a senior's income, for those in need of help with such things as bathing, household tasks and transportation to medical appointments.

Such a system would apply to the 5 per cent of seniors with the highest incomes – more than $100,000 for a single person and more than $160,000 for couples. The cash-strapped government says it would help to curb growing health-care costs and, at the same time, provide better care for older Ontarians.

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"This is a conversation we need to have," Ms. Matthews told reporters on Tuesday.

She was responding to the release of a report on how to help seniors stay healthy and live at home longer, prepared by Samir Sinha, director of geriatrics at Mount Sinai Hospital and the University Health Network. Dr. Sinha's recommendations, including a co-payment system, build on the government's push to shift health-care funding out of hospitals and into community programs.

The government already plans to introduce a co-payment system for its $4.4-billion Ontario Drug Benefit Program, which pays for prescriptions of those 65 and older and those on social assistance. Starting in August, 2014, the 5 per cent of seniors with the highest incomes will pay pay a portion of their drug costs.

The government said the measure for the drug program will save $30-million in fiscal 2014-15 and help the province better support an aging population by increasing access to home care.

Ms. Matthews said in response to questions from reporters on Tuesday that the government plans to explore co-payment systems for community care programs aimed at keeping seniors in their homes longer.

"The system isn't working for seniors the way it should and could work," she said.

Community services play a key role in the government's seniors strategy, because it costs less to provide care in the home with the proper support than in an acute-care hospital. The government froze funding for the province's hospitals in this year's budget and boosted spending on community care services by 4 per cent.

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In his report, Dr. Sinha says the province's aging population is creating enormous challenges for the province, at a time when it is struggling with a $14-billion deficit. Older adults make up only 14.6 per cent of the population in Ontario, the report says, but they account for nearly half of health-care spending. Health care, in turn, accounts for about 44 cents of every $1 the province spends on programs.

"If left unaddressed, our demographic challenge could bankrupt the province," Dr. Sinha says in his report.

Some community services, including Meals On Wheels and those that do gardening and shovel snow for seniors, already charge a small fee to recoup a portion of their costs. These payments are based on the honour system rather than an analysis of a senior's income tax return, said Deborah Simon, chief executive officer of the Ontario Community Support Association.

Ms. Simon said a more formal co-payment system would have to be done carefully to ensure that those most in need get access to services. "We want to ensure that no senior would be cut out of being able to have services by a co-payment system," she said. "Our interest is really in expanding services, not decreasing them."

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