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Opinion Our hospitals are not ready for the grey tsunami

Today, the average life expectancy for women is 82.5 years, and for men 78 years.

In 2030, or a little more than a decade-and-a-half from today, the federal Department of Finance predicts the average life expectancy for women will be 87 years and for men 82.8 years.

Think about that for a moment: average life expectancy of 87 and almost 83 years of age. In the 1960s, the average for women was 77 and for men 73. From the 1960s to 2030s, the life expectancy rose by almost a decade. Roughly speaking, the average age has been rising by one year every decade. Get ready for a whole lot more people over 65 years of age, and especially people over 80 and into their 90s. But are we ready?

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The great news from this ongoing demographic change is that more people will live longer – and in reasonable health – than ever. According to the OECD, a whopping 85 per cent of Canadians over 65 report themselves to be in good health, the second-highest share for any country.

Are we thinking now, however, about what it will mean when, as the OECD suggests, by 2050 about 10 per cent of Canadians will be over 80 – right on the OECD average for its member countries. Are our pensions and retirement plans ready? Is the work force and workplace? Are our public finances? After all, public pensions were created in the 1960s, as were large elements of the health-care system.

With an aging society comes slower economic growth, because fewer people will be working, earning income, and more people will need government programs. Says the Department of Finance: "Slower nominal GDP growth will reduce the growth rate of government revenues, thereby limiting the capacity of governments to continue to finance growth in public expenditures as high as in the past. At the same time, population aging is expected to put upward pressure on public expenditures, notably for age-related programs such as elderly benefits and health care."

Today, the average cost to the health-care system of someone aged 65-69 is roughly $6,700. For someone aged 80-84 the average cost is $15,000, and over 90 it is $26,000. Today, about 14 per cent of the population is over 65. By the end of the next decade that share will be about 26-27 per cent, or roughly double.

A "grey tsunami" is not about to blow apart the health-care system, but aging will certainly stress it. Experts suggest aging will drive up costs by 1 per cent, but actuaries recently have been struck by how much faster the population is aging than they had thought just a few years ago. That 1 per cent looks like the best possible estimate.

It's very hard for societies and democratic governments to look at, let alone plan for, something well beyond the electoral cycle. How much better off our health-care system would have been if, a decade ago, instead of spending $41-billion on increasing pay for providers and cutting wait times for certain surgeries we had spent the money on building a health-care system for the older population that is now upon us.

Everywhere provinces are scrambling – give them credit, they are trying – to catch up to the aging wave. They know there is a need for more home care, more long-term institutionalized care and more nursing homes. They are tilting budgets away from acute-care hospitals toward community care.

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They know that a minority of the elderly population drive a disproportionate share of the costs, and are trying to focus support on this minority – the so-called frail elderly. They know it is better for them, and less costly, to be cared for at home rather than in hospitals at $1,200 a night. They know that it is better to keep them from emergency departments.

The ailments of seniors drive them into hospitals: lung problems; heart weaknesses and failure; pneumonia; accumulated chronic conditions; and surgeries for diseases. These challenges cannot be treated at home. Home care is great, to a point, after which it can be oversold.

Big hospitals are already at or overcapacity. Emergency departments, among the banes of the system, have long wait times – more than 16 hours on average in Quebec, the worst in Canada. The number of people presenting at emergency departments continues to rise for a variety of reasons, one being the emerging new demography of the old.

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