Bill C-356, an Act Respecting a National Strategy for Dementia, was defeated last week in the House of Commons by the razor-thin margin of 140-139.
NDP member Claude Gravelle sponsored the bill after watching his father struggle to care for his spouse, who was suffering from dementia.
Like many people thrust into the role of caregiver for a loved one with dementia, the senior Mr. Gravelle soon realized that services are disjointed, help is difficult to come by and being a family caregiver 24/7 can prove costly – emotionally, physically and financially.
With the tide of dementia rising at a frightening rate – there are an estimated 747,000 Canadians living with Alzheimer's and other forms of dementia today and that number is expected to rise to 1.3 million by 2031 – there is no question we need a plan. If you are not convinced by the demographics alone, consider that dementia cost the Canadian economy about $33-billion a year now, and that is expected to jump to $293-billion by 2040.
That we need a dementia strategy is a no-brainer – medically, economically and politically.
So why did Mr. Gravelle's private member's bill go down to defeat?
It's all about political strategizing trumping sound public policy.
Make no mistake, there is going to be a national dementia strategy. This is too important an issue for seniors – who vote in large numbers – for it to be ignored.
The bill was defeated because the Conservative government wants to act on its terms, not have its hand forced by the opposition New Democrats.
Bill C-356 called on the government to initiate discussions with the provinces and territories within 30 days on creating a "comprehensive national plan" and create an advisory board to do the actual grunt work of drafting a strategy.
If there is one political position that the government of Stephen Harper clings to fiercely, it is that health is strictly a provincial responsibility.
Still, the bill came surprisingly close to becoming law. It is worth noting too that a number of Conservative backbenchers broke ranks and voted for the bill, because they know that, on the campaign trail, being portrayed as someone who opposes a dementia strategy is going to hurt.
The good news is that, last October, at a meeting of federal, provincial and territorial health ministers, there was unanimity that the country needs a national (not federal) dementia strategy. Work is proceeding apace.
A strategy – a plan – needs to be pointed and precise; it needs specific goals and deadlines, and resources. There also needs to be a formal structure of some sort to ensure its implementation.
The obvious model – because it was endorsed by all the national parties and has been successful – is a stand-alone institution like the Mental Health Commission of Canada.
However, if Ottawa takes that route, it will likely create a body that focuses on the broader needs of seniors in our aging society, not strictly on dementia. (The Canadian Medical Association has undertaken a fearsome campaign for a seniors' strategy, and given the demographics of Canada, it has the government's ear.)
The political machinations aside, it's worth examining what a dementia strategy should look like and what it will achieve. The model championed by the Alzheimer Society of Canada (and copied, more or less in Bill C-356) can be translated into lay terms as:
- Care needs to be more prompt and standardized, and that will require national guidelines and wait-time benchmarks;
- We have to do a better job of tracking people with Alzheimer’s and related dementias so we can better plan for the large numbers coming down the pipeline;
- More resources need to be pumped into specific parts of the system, such as rehabilitation programs and specialized long-term care homes for people with dementia;
- Human resources have to be shifted to ensure we have the right type of health works, including geriatricians, geriatric nurses and personal support workers who can deliver specialized care;
- There needs to be support for caregivers, including flexible work rules and employment insurance benefits;
- Education needs to be done to demystify dementia, and ensure sufferers are part of society, not warehoused and ostracized;
- More money has to go into research and that research has to be focused.
We can take some comfort in knowing that all of those strategic points are being acted upon to varying degrees. Now, it just needs to start happening in a coherent, organized fashion. Ad hoc is not good enough.
Two years ago, the leaders of the G8 (of which Canada is a member) issued a rather startling declaration, saying they were committed to finding a "cure or a significant disease-modifying therapy for dementia by 2025."
Thirteen other industrialized countries have dementia strategies and most are making significant changes to their health systems as a result.
Mr. Gravelle's bill may not have been adopted but it has served an important function, to remind us that ensuring that our mothers, fathers, grandmothers and grandfathers suffering from dementia are cared for properly is urgent, not something that should be delayed until it is political expedient.
André Picard is The Globe's public health columnist.