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How To Defuse The Baby Boomer 'Demographic Bomb' And Save Health Care

"I think there's still time but the crisis really is here. It's not an abstract thing anymore. It’s not that the baby boomers are coming, they're here."
(Photo by Frank Lennon/Toronto Star via Getty Images)

This campaign season, HuffPost Canada is going past the sales pitch, away from the attacks, and beyond the ballot.

Our Beyond the Ballot series is deep diving into three major problems facing Canadians: climate change, housing insecurity, and elder care. This election is our opportunity to join forces and come up with solutions.

The federal election is just days away now, and the parties have spent the last month or so parsing out piecemeal promises as if this was a marketing campaign for the latest Marvel movie. But despite what some folks in our comments section might think, this isn't a comic book battle between good guys and bad guys.

It's about the future of Canada, and what the next government will — or won't — be doing to ensure that it's a viable one for all Canadians. This is especially true when it comes to elder care.

An unprecedented situation is unfolding in Canada — and across the Western world — as the baby boomer generation reaches retirement age. The way our society takes care of our seniors has always been predicated on a population pyramid where the large number of young people at the bottom help pay for the smaller number of seniors at the top.

But the pyramid got flipped, turned upside down.

In fact, it was just revealed that seniors outnumber kids under 15 for the first time ever.

And this is just the beginning.

Seniors will hit 20 per cent of Canada's population by 2024, and 25 per cent by 2036, at which point they will account for 62 per cent of health costs according to the Canadian Medical Association (CMA).

To put that in perspective, they make up 14 per cent of health expenditures today.

That's not even counting what the CMA calls an "army of informal caregivers" who spend 1.5 billion hours of unpaid work each year looking after elderly relatives, depriving the economy of $1.3 billion worth of productivity.

No wonder NDP leader Thomas Mulcair has dubbed this a "demographic bomb."

The Huffington Post Canada sat down with Dr. Chris Simpson, the outgoing president of the CMA, which represents 80,000 doctors, residents and medical students, to discuss the coming crisis if we continue treating sick seniors in hospitals rather than coming up with alternate care solutions.

"It costs $1,000 a day in a hospital bed, or $150 a day for a long-term care facility, or $50 bucks for home care," Simpson explains. "It’s a simple economic argument. And it just happens to be the right thing to do, as well. It’s just pushing through that complacency and notion that we can't change things. This is a real sticking point; it’s a home-run economic argument as far as I’m concerned."

Including issues like medically assisted dying and the impact of dementia on families, what would a national seniors strategy need to look like in order to care for our elderly with dignity and save universal health care for the next generations?

"I think there’s still time but the crisis really is here," Simpson adds. "It's not an abstract thing anymore, it’s not that the baby boomers are coming, they're here."

Can you explain what could happen if we don't do anything different from what we're doing now?

If you go to provinces like New Brunswick and Nova Scotia that have the highest proportion of the population over the age of 65, what you find is they’re already living this crisis that we're all saying is coming. They're actually in it right now. And it creates this really alarming window into the rest of the country's immediate future.

What we see in New Brunswick are things like 25 per cent of all acute care hospital beds are taken up with patients that should be in nursing homes or at home with enhanced home care support.

And it is paralyzing their health-care system.

Part of our message is transforming "It's coming, it’s coming, it's coming" into an "It's here" or "It’s almost here" kind of urgency. It really is a matter of trying to help people understand that when we fail to care for seniors appropriately, the entire acute care hospital system becomes paralyzed and that affects every single Canadian.

The baby boomers are a huge voting bloc in Canada, and they vote at the highest rate. Do you see that playing a role in politicians not wanting to get in the nitty gritty of elder care for fear it might dissuade voters?

That could be part of it. I would broaden it to say that unfortunately — and this is no person or party's fault — we’ve fallen into this trap of short-term election cycles and budget cycles and everything's about the immediate return. Complicated issues need thoughtful, strategic solutions. And when we subject these things to the forces of the political winds, where people think about them for 10 seconds at a time, we're probably not going to arrive at the right answers.

Right now, there are five Canadians working for every retiree and that's going to fall by almost half to 2.7 by 2030. What does that mean for the average Canadian and the Canadian economy?

There has to be a balance between those who are generating revenue for the government and those who are consuming or contributing to the expenditure line of government. And when that ratio starts to fall, I think everybody has reason to be concerned.

But I would even flip that on its head and say, "How do we turn that into an opportunity?" Crisis often creates opportunity. So if we're entering into an age where we simply can't do things that we were doing before, then why not really critically examine the value for dollar that we're getting? And I firmly believe that if we pursue a quality agenda, we can actually deliver better care for less money.

And I say this with some confidence because we see jurisdictions in Europe do this by working to de-hospitalize the health-care system and invest more in home care solutions.

So sometimes it takes a big wake-up call like that to say this isn't just about fighting over how much the feds are going to pay and how much the provinces are going to pay, but rather what is it we're actually paying for, and what kind of outcomes do we want to get. It may shake us into thinking about some of the more radical changes we need to make to make this better.

What do we have to do to ensure that our health-care system and our social safety net still exists when Gen-Xers and millennials reach retirement age?

Even the most optimistic among us would say nobody's going to be able to fix this over one budgetary cycle or even one election cycle. We have to do course correction, where the next 20 years the course that we set is fundamentally different than the status quo course.

And we think that a focus on senior care is a way to fix the entire health-care system. That's where most of the dollars are being spent and we think we could do a whole lot better or for less money but it requires a plan. We spend $220 billion a year on health care in this country [but] nobody's in charge, there's no plan, there's no accountability really to speak of.

How can we possibly expect any kind of performance out of the system when we’re just kind of muddling through as elegantly as we can? With 13 different political jurisdictions, all completely different from each other, there's nobody that would sit back and look at that and say, “This makes sense."

On any number of issues, it seems difficult to make any national decisions because everybody's doing different things.

People often say we're a country of pilot projects. There are little pockets of excellence everywhere and I can certainly attest to that, having been to every province and territory over the last year. You see some really good stuff and cool things happening, you come away really inspired. But there's no method to scale these things up.

It sounds like if we don’t do anything in 20 years, the current health-care system that we all love will collapse.

Yeah, it always sounds kind of catastrophic to say stuff like that, but I think it is true. The way it would happen would be very gradually. Nobody would wake up one morning and say, "Oh no, the health-care system has collapsed." But it would be that in 20 years, we'd look back and we’d say, "We really missed an opportunity here to do it a lot better than we did."

Q&A continues after slideshow:

How do we deal with palliative care, hospices, that kind of thing?

If you're currently 65, you can expect to live on average another 20 years, with 18 of those years in relative good health. We have painted the picture of a healthy elderly population but there’s those last two years that are really high consumers of health-care resources.

We have to have conversations: what constitutes futile care? How are we going to deliver palliative care? How are we going to be a little bit smarter about staying away from these high-tech Hail Mary interventions that don't really do anything meaningful for these people at all?

In the big picture, when you look back in hindsight after somebody's passed away — and I know this as a clinician myself — we often say, "We spent a whole lotta money, and put this patient through a whole lotta grief and pain for nothing." Like really literally nothing. The challenge is how do you recognize that in advance and how do we have these critical conversations so we can avoid all that.

What's the CMA position on medically assisted death?

About three years ago, we had a pretty firm stance against it. But we’ve since taken a real leadership role in society on medically aided dying. We did cross-country town halls where we talked to thousands of Canadians and their families. We were an intervener in the Carter decision, at the Supreme Court level. And we've taken the position that we want to support our patients who would seek medically aided dying once it becomes legalized.

What do we need to change to deal with the increase of dementia patients over the next 20 years?

When a patient progresses from mild to moderate to severe dementia, there's a lot of heartache, a lot of worry and a lot of safety concerns for these patients. Canadian families spend a lot more of their own time caring for dementia patients without really good adequate support to help people cope with a pretty difficult situation that has a trajectory of several years.

So one of the things we really don’t want to neglect in a national senior strategy is this kind of support that the informal caregivers need, in order to play their part in the care of these patients. That can be everything from tax breaks to more lenient employment situations and a franker recognition in the loss of productivity that creates in the work force.

That has a real impact on the economy, let alone a human toll and the worry and the stress of all this.

One of the things that's often neglected in the context of dementia is how do we really empower families — financially, economically, emotionally — and give them the right tools to play the role that they want to play, caring for their parents that have dementia and keeping them home for as long as they can.

We have parental leave. Do we need an equivalent that allows adult children to take time off work to take care of their parents and have it subsidized by the government?

That's certainly one direction we could go. The [Conservative] government did make some positive moves in terms of caregiver tax credits, but they weren't refundable. It was quite cumbersome, and by our calculations only about three per cent of Canadians who were eligible applied for it. And there was only a couple hundred bucks. It was a token, it didn’t provide any meaningful benefit.

But if you project ahead and say what would a really progressive caregiver package look like? I think it would have lots of protections. Job protection, opportunity for time off, similar to parental leave. We shouldn't be so rigid about making these kinds of things eligible for people who are in the last six months of their life. It should be for anybody who has intense care needs. All of these things are doable, it’s just a question of whether governments are going to be bold and say let’s try it out and if it doesn’t work, then we fail fast and we try something new.

But the status quo is simply not good. It’s bad for productivity and the economy if there are so many people looking after their elderly parents. We simply can’t ignore it.

So to sum up, what would you like to see in a national seniors strategy?

What I would like to do is move away from this notion of disease-based silos. What they need is support in everything, from prevention to primary care to acute hospital-based care to chronic disease management, palliative care, and end-of-life care.

The other really critical thing is that a good senior strategy isn't just about health care, it's not just about doctor care and hospital care. It’s about social and economic circumstances, because we know the social determinants of health are critical determinants of the health and the income of seniors, and everybody for that manner.

What we want is partnerships, mature discussions between all three levels of government. Organizations like mine, frankly we want to step up as well. We don’t want to just be standing at the sidelines, sniping at the government and saying this is someone else's problem. We really want to be part of the solution, too.

It can be done but we have to stop just talking about money and who's going to pay for what. We've got to talk about what is it we want to accomplish, we have to be willing to be held accountable for those outcomes and we have to do it together.

So how do we get the next government to take these steps?

We need leadership from them, and we need to be willing to stand behind them when they stick their necks out. So whichever party forms the next government, there are lots of different ways you can skin this cat and we're ready to work with them if they're willing to be brave.

Joshua Ostroff is a senior editor for HuffPost Canada.