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The next discussion we need to have: Caring for seniors

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We asked, you voted: what are the next eight discussions Canada needs to have?

We held a live discussion Thursday, Dec. 9 at 12 p.m. ET on one of your top choices: Caring for seniors.

What are the challenges we face as Canada's senior population grows? There is a widespread belief that an aging population will bankrupt the health system, but what is the evidence? Does Canada have the resources to cope properly?

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Globe and Mail public health reporter André Picard joined the discussion, along with our guest Susan Eng.

Mr. Picard has written extensively about senior care and has authored three best-selling health and policy books. He is widely acclaimed for his reporting and writing.

Ms. Eng is Vice President of Advocacy for CARP, a national organization committed to advocating for social change that will bring financial security, equitable access to health care and freedom from discrimination for all Canadians as they age.

Below is a transcript of Thursday's live chat:

Natalie Stechyson: Welcome to today's live chat on caring for seniors - the second topic in an eight-part series on the next discussions you think Canada needs to have. I'm Natalie Stechyson - one of The Globe's online editors. I'll be hosting today's chat with André Picard and Susan Eng. We'll be getting under way momentarily. In the meantime, please start submitting your questions.

Susan Eng - CARP: Hello

Natalie Stechyson: Hi Susan, thanks for joining us.

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André Picard: Hi. I'm happy to join the discussion today and look forward to the questions and comments.

Natalie Stechyson: Hi André. Let's get started. We read over and over that Baby Boomers are going to bankrupt the health system. Is this inevitable?

Susan Eng - CARP: Canadians are indeed aging and the challenge is to do things better and smarter - not to keep doing the same things but now with resentment. The healthcare budget will continue to grow exponentially - but not because the population is aging. People are living longer but also healthier lives. Everyone is using the healthcare system more and the treatments are much more costly. The Health Council of Canada, which actually analyzes healthcare spending, declares that "The persistent belief that our aging population will overwhelm the health care system is a myth" The smarter options are right in front of us if we can look past the blinding presumptions. We can stop wasting untold billions on outmoded methods of healthcare delivery and get going on primary health teams, electronic health records, better home care and support for family caregivers. CARP argues that if aging at home is properly funded and supported, with the potential to lever the contribution of family caregivers, there is the potential to divert massive amounts of demand from the health care budgets - leaving more money to build the long term care beds for those who need them.

Natalie Stechyson: Thanks, Susan.

Natalie Stechyson: What do you think, André?

André Picard: The greatest cost driver in our health system is increased utilization - not aging. Costs for treating the sickest of the sick have remained pretty constant but we spend a lot of money on treatments for people of all ages who are healthy.

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Natalie Stechyson: We have a few reader comments now .

Comment From Ken Collier: Studies I've seen from BC and Alberta, plus Andre Picard's recent column in G&M show seniors are not the big pressure on the health system sometimes portrayed. Are there other studies from Canada or other countries that are the same, similar or different?

André Picard: The research is similar around the world - particularly from countries like the UK that are a little "older" than Canada. I think a lot of the confusion stems from the fact that the data show that the biggest healthcare costs are in the last few weeks of life -- and most people who die are elderly.

Susan Eng - CARP: There are a lot of expert reports - including recently the Parliamentary Budget Office which repeated that the rising health care costs are due to the price of treatments and more people, as Andre says, taking them up - all the case of prevention and self reliance -which in itself is not a bad thing But it is easier for politicians who do not have the political will to make structural changes - something they can do - to blame rising health costs on the aging population. Something they can't do anything about.

Natalie Stechyson: Is caring for family members at home a possible solution to health care costs?

Susan Eng - CARP: CARP argues that if aging at home is properly funded and supported, with the potential to lever the contribution of family caregivers, there is the potential to divert massive amounts of demand from the health care budgets - leaving more money to build the long term care beds for those who need them. This requires political will - the vision was already provided in the Romanov reports - but the funding pursuant to his health care accords is coming up for renewal. How willing are people to hold their politicians' feet to the fire to get the change we need? money has in fact been spent but we are still waiting for demonstrable results - as outlined in the recent Ontario auditor general's report

André Picard: I agree with Susan. Aging at home is what most people want, and our system should be built to facilitate that choice. If done properly, it's not necessarily a cost-saving measure, but it is more humane and results in better care. But aging at home is not just about homecare; it requires a broad range of social policies, from flexible work policies for caregivers through to decent public transit and clean sidewalks for seniors living in the community.

Comment From Alan Burke: Your own newspaper shows that most of the problem is increased demand from the entire public. There's also gross inefficiency in the system. As I commented to the article, I'm caught in the middle, caring for both children and an 89-year old parent.

Natalie Stechyson: Do you have any advice for Alan?

André Picard: There are many people who, like yourself, are in the sandwich generation, caring for children and parents. our health and social system does a lot for parents with young children, but a lot less for children with older parents. To me, the problem is not necessarily inefficiency but a lot of consistent policies. We should be offering similar levels of care (though not identical services) to the young and old alike.

Susan Eng - CARP: The politicians talk about sandwich generation but offer little besides hand wringing. The ideas are out there - to make it easier for people to care for their loved ones - younger and older. Some financial relief for those people who have to take time off work - and in the case of older loved ones - sometimes unexpectedly. There has to be workplace protection so that people don't loste their jobs over taking time off - just as we have protection for maternity leave

Comment From MW-MD: As we focus our efforts on keeping our elderly at home longer before they absolutely need nursing home placement what financial help is there already in place and proposed in the future for the family looking after their loved one?

Susan Eng - CARP: Aging at home is an idea that resonates with most people - the trouble is whether we see anything on the ground that allows people to face their medical challenges at home. Are family members able to get the home care, respite care and training that they need to care for their loved ones? The Veterans program provides a "navigator" to help a person get all the services for home or institutional care [even if they have to pay for them] What about getting such a navigator in the public system for everyone?

André Picard: As Susan mentioned, our public policies have not kept pace. We need to have maternity benefits and paternal leave provisions at both ends of the spectrum, not just for parents of young children.

Natalie Stechyson: Is there any appetite for people to buy private insurance to look after long term care needs?

Susan Eng - CARP: This is something the CMA has been touting. People need to realize how much long term care costs - even with public healthcare. Even nursing home co-payments - which may be the cheapest option because the co-payments are regulated - run from $1,500 to $2,200 per month - on top of what govt pays for the nursing care. Add in a couple of drugs that are not covered, or a brace for a broken arm, or a walker etc. and you can see how the costs mount up.

André Picard: In an article I wrote recently about health insurance, I noted that the two fastest-growing products are 1) critical illness insurance, which pays out a lump sum when you have a grave illness like cancer and 2) long-term care insurance, which pays for nursing home care.

Susan Eng - CARP: The problem is that such insurance is very, very expensive. Can people afford the private insurance - average families in the US who buy their own insurance have $10,000 deductibles

Comment From Rees Moerman: The Romanow report (2002) stated home care was the critical third leg of care in Canada and was vastly under supported and the default option for most chronic care. Our hospitals are 15% in permanet over capacity by frail stable patients that do not need to be there but due to lack of home care support stay in hospitals at $1200.0 per day versus the $50.00 per day homecare rate. Nursing home the second option cost $250 per day with 80% supported by taxpayers. Its time to get real abotu low cost functional care options that are telemedicine based. Why with 50% of entire Provincial budgets that strangle the taxpayer burden with 25% of every dollar going to acute care hospitals that are not designed nor service seniors best. Why do we not by now have a critical tasked"Manhattan" plan in Canada for senior care with the boomer-doomer wave fast approaching.

Susan Eng - CARP: Good question. Be sure to ask it during the next election. And make your vote is conditional on their answer

André Picard: Very eloquently stated Mr. Moerman. We spend $191-billion on healthcare in Canada. We have the money to care for everyone properly. But we need to make better choices about how money is spent, and make elder care a priority.

Comment From Terry: I take Susan's point that Canadians need to make senior care a political priority, but it seems like even though health is constantly at the top of Canadians' political priority list, that doesn't translate into effective policy reforms. What's the impasse?

Susan Eng - CARP: We need to confront the politicians with the best practices of other jurisdictions and ask why not here? There are ways to bring down healthcare budgets. Try bulk purchasing of the drugs on the public formulary - but then the politicians have to go toe to toe with the pharma companies. New Zealand takes up the responsibility of taking up the patents as soon as they run out and issues a RFP for companies to manufacture the generic drug. Political will.

André Picard: I think the impasse is that the political life cycle - you spend two years in office then start preparing for re-election - favours addressing short-term problems, not long-term ones. Countries that do a better job of planning - like France - have a more powerful and independent public service. Canada has an emasculated public service and that results in a lack of creative public policy.

Comment From Rees Moerman: Why do we not have our PHd. Nurses, policy wonks, change agent Doctors studying best proven successful low cost geriatric practices in France, Cuba, Denmark, Hollland and Swizterland where they have worked out a non-institutional non industrial medical service model.

André Picard: We don't need more study. We know what needs to be done. We need leadership and action.

Natalie Stechyson: What else do we need to start doing to bring down the health care budgets and provide better care for older loved ones?

Susan Eng - CARP: The "conversation" between citizens and their elected officials has to get specific. What are you doing to ensure the system is working for me TODAY? There are examples world wide - and now faced with an out of control health care budget, our politicians might actually concentrate on some solutions

Susan Eng - CARP: But vested interests are a major issue. Bulk purchasing of prescription drugs is coming and you can bet there is an all-out campaign to push back. Remember the industry provoked backlash this year when the Ontario govt changed generic drug pricing?

André Picard: Let me give you just one example of how we can solve a long-term problem, that of "bed-blockers" -- people who live in hospital rooms because there is a shortage of nursing home beds. In Sweden, the government decided it would pay providers not according to where patients were being treated but where they should be treated. Suddenly, health regions found themselves getting $500 a day instead of $1200 a day for their bed blockers, and $250 a day for people who should be in homecare. Magically, homecare programs expanded and nursing homes were build -- and hospital beds were freed up. Again, it's about making choices and adopting policies that support those choices.

Comment From MW-MD: I feel that our Gov. is scared to make the major move to put the money where it is needed. Look what happen to the electronic medical record implementation! Support the public option, have a private option, and have over site by an agency and lets get on with looking after our family members!

Susan Eng - CARP: Solutions require a political willingness to fundamentally change the way we are doing things now. Andre profiled a Vancouver hospital that was funded on the basis of how many patients they treated. So the hospital thinks of patients as revenue sources rather than as added costs. Completely changes how people are treated And on E-health - don't even ask where all the money went

André Picard: We have so many vested interests in our health system that the status quo reigns. Governments fear making changes because they get hammered. The public has to make clear - through the ballot box and otherwise - that their interests are more important than those of specific groups.

Comment From Richard K.: We're talking a lot about "care for seniors", but I'm 58 and a long way from being "cared for" any time soon. What I worry about more is that my pension will be there to let me take care of myself. The news today is about Nortel disabled workers benefits not getting protected in the Senate. It makes me wonder if our government is serious about protecting other pensions.

Susan Eng - CARP: People are becoming more and more concerned about whether they will have enough for their retirement especially to deal with unexpected health costs. Keeping the focus on politicians is the right thing to do - the final policy making begins and ends with our elected officials. People cannot created parallel health systems by themselves.

André Picard: You're right, we have to shift our focus from "caring for" people to "caring about" people. Healthcare delivery is just one part of the equation. The single most important factor in being healthy is having a decent income. So if we want to have a healthy population it requires a broad range of public policies, including protecting pension plans, a decent minimum wage, and support for seniors.

Natalie Stechyson: We have time for one more question

Comment From Ken Collier: Perhaps the panelsists could comment on other aspects of senior care - differences between Long Term Care for the almost completely disabled versus assisted living for those who are ambulatory and somewhat able; what the standards of care are, and who is qualified to assess adherence to those standards; what those levels of care actually cost (Andre Picard's comment above tells part of it); whether humane Long Term Care at home is trumped by efficiency of instititional care; models of senior care that seem to work better than others.

André Picard: The short answer to your complex question is that it really varies by jurisdiction. In some parts of Canada, there are consistent standards for placement in care and, in others, it's hit-and-miss. In nursing home care, in particular, it's the Wild West in many ways. The public is not being well served by the lack of oversight and standards.

Susan Eng - CARP: There have been smaller scale research that compares costs and health outcomes which always puts home care ahead of institutional care for most people. Some people cannot be cared for at home and need more intervention. But most can manage at home. They key is having this properly thought through and implemented - and now is a good time to start.

Natalie Stechyson: We have to wrap up. André and Susan, do you have any final thoughts?

André Picard: I would like to make a closing comment on a much more positive note -- unusual for a journalist, I know! When we talk about aging at home, there are a lot of fears expressed about the financial costs, the time demands, etc. But anyone who has cared for a loved one at home knows it can also be a wonderfully intimate, life-affirming experience. What we need to do is ensure people have the support so that caring is not pure drudgery, but an act of love and caring. It's what all our parents deserve.

Susan Eng - CARP: I agree - It seems that the public is way ahead of the politicians. It's time for them to catch up

Natalie Stechyson: Thanks to both our guests for joining us today on That's all the time we have. Thanks to everyone for contributing their comments and questions.

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