Making it last

By Leslie Campbell, December 2011

A boomer wonders if health care will be there for her at 85.

Mom, aka Jade, fell (again), breaking a hip (again). For over two-and-a-half months now, she’s been up on the 6th floor of the new patient tower at the Royal Jubilee. She says it’s been a “wonderful experience.” She loves the nurses and physiotherapists and enjoys the food. And regularly marvels that it’s all “free.”

I’ve seen my mom pretty much every day for the past two months. Fortunately, the Royal Jubilee is only a few blocks away. It has become very familiar territory. I can tell you about the new café that just opened (giving Tim Horton’s some well-deserved competition). Or the Art by Nurses gallery that runs down a hallway on the main floor; Mom and I watched it being hung one day as I wheeled her about. Or the First Nations healing room and the landscaping. I know the place well and am impressed by its design, functioning and people.

Mom resides in what I think is the lone double room on her ward. She has had four roommates over the course of her stay, ranging in age from about 60 to 97. Broken femur, broken pelvis, osteoporosis. None have surviving husbands. All of them have provided welcome companionship and good cheer to Mom—as do the people she meets at lunch and dinner in the communal dining room.

Mom is not sure that she’ll be able to manage on her own anymore, and neither are the professionals or her family. Her balance is not good, even with a walker. The doctors have discovered she has a condition that normally could be addressed through surgery but because of other medical issues (blood thinners due to clotting problems), they think the surgery might be too risky. But tomorrow they will do a lumbar puncture that will help assess whether in fact she would benefit from surgery. No one seems in a rush to discharge her, for which we are grateful.

Even so, we have been researching options for Mom’s care so that when her time on the ward is up, we are as ready as possible. We’ve looked into both in-home assistance and care facilities. Mom’s experience in communal living makes us all feel a whole lot more comfortable with the idea of a care home than ever before. We’ve learned about the publicly funded vs. private complex care facilities; and we’ve also learned about the great experience many have with live-in care supplied by immigrants. And we’ve been informed about VIHA’s subsidies for limited home support.

Sorting through it all has been a lot of work, and a little stressful given the changes involved, but in many ways the whole experience has been reassuring: it appears “the system” works pretty well. We’ve had fruitful meetings with her doctor and two family conferences during Mom’s hospital stay. Those present included a social worker, an occupational therapist, a physiotherapist, a few nurses, a community liaison professional, all of them astute and caring.

The system has also been serving my husband David’s parents well. A team of professionals, both private and publicly subsidized, support 88-year-old Bob in taking care of his wife Pat who is largely bedridden with lymphoma and dementia. She is registered with Hospice which provides Bob with occasional respites. He’s soon to have surgery himself, so services will be stepped up, including those by his family.

Seeing my elders’ declining health and frequent use of the health care system has brought home in a visceral way that I may one day need it myself.  The trouble is, I can’t honestly fathom how the current service level is sustainable—I have little confidence it will be there for my sisters and my husband and me. And none of us have children or pensions. So I am concerned. How is the government preparing for my generation hitting 80? While I realize I need to take personal responsibility for my health, like most Canadians I’ve embraced the collective nature of our public health care system. I do expect it should be there for me when I need it.

But will it?

Experts like Neena Chappell, Canada Research Chair in Social Gerontology at UVic’s Centre on Aging, have been sounding the alarm for sometime and urging the government to have a plan in place to address the coming bulge of seniors with health challenges. Those over 65 already account for over 44 percent of all government health care spending, with 81 percent of them having at least one chronic condition. Maybe the system can handle us for the next five or ten years, but as we near 80, with more complex health issues, our needs will ramp up significantly. Some economists suggest the health care services liability associated with the pressure of an aging population amounts to more than 50 percent of Canada’s GDP.

In Chappell’s recently published report, Population Aging and the Evolving Care Needs of Older Canadians: An Overview of the Policy Challenges (www.irpp.org), she says it’s not just the sheer numbers that will put pressure on the system. The largest factor behind increases in health care spending, according to the Health Council of Canada (2008), is our increase in use of services: “On average we are all getting more care, undergoing more tests, and receiving more prescriptions.” 

Demographic shifts resulting from lower fertility rates, more divorce, remarriage and blended families will squeeze the system. Echoing my own situation, Chappell says, “Projections show there will be more older adults reaching old age without any surviving children to provide them support, and that suggests there will be more demand for home care.” She advocates integrating home care as an “essential service” under medicare as this will decrease the use of more expensive hospital and nursing home care.

Chappell also believes the system should provide more support for the informal family caregivers (like Bob). This would be both a just and cost-effective strategy: one Canadian study estimates they provide $25 billion-worth of care yearly. The system needs them.

Health promotion, particularly around chronic diseases, is also crucial to making the system sustainable—$1 invested in health promotion has been estimated to yield a return on investment of $6 to $8 in health cost savings. And my intuitions on the rehab ward are confirmed by this statistic: “A 20 percent decrease in falls experienced by older adults would result in 7,500 fewer hospitalizations.” 

Finally, notes Chappell, we need to critically assess whether and when increased technological innovations and pharmaceutical intervention—that are known cost drivers—are truly effective.

Such measures, she believes, will allow Canadian boomers to get the care they need in their declining years without emptying government coffers. 

Leslie Campbell is the editor of Focus. She wishes all readers a holiday season full of health, happiness, family and friends.