HEALTH ISSUES FOR OLDER WOMEN (and everyone else)
Is our public health care sustainable, now that people are living so much longer?
The belief that our health care is costing too much and will be facing increasing costs as our population ages really is a myth. The ones repeating this myth ad nauseam are those in the medical establishment that wish to water down public, universal health care by bringing in private medical care. Why, they ask, should people who can afford to pay for care and get it NOW not be allowed to do so? Let poor people wait and those with money go to the front of the line (while private doctors charge what the market will bear).
In the first place, it is simply not true that as people get older they must necessarily be a drain on the public health care system. The very fact that the fastest-growing segment of our population are those 85+ years old shows that people are not sicker because they are older, but are living longer because they are not sick. The advances in medical technology and medicines that are keeping the 85+ healthier are already available to the generations coming behind at an earlier age, so it is reasonable to expect that they may live even longer than their parents’ generation.
The most wasteful part of our public system is its minimal investment in health promotion and disease prevention — another case of not looking forward with clear vision.
The strains in our health care financing show themselves first in hospitals — there are too many people in Alternate Level of Care (ALC) beds who are not acutely ill any more but still not well enough to go home or into a long-term care home. This means thats people who need admission to the hospital for an acute condition must wait too long. However, the simplest cure for this problem is being ignored.
Home care is much less expensive than hospital care, and if it was adequately supported, around 38% of those in ALC beds could go home. Additionally, if sub-acute care departments were opened in hospitals (as the Health Services Restructuring Commission recommended over a decade ago), patients who need more help than could be practically offered at home could be cared for economically by nurses with less than registered status, supervised by a registered nurse or a nurse practitioner. This system has worked well in the U.S. and many other countries.
In fact, the intelligent response to the aging of our population is to recognize that acute care hospitals should no longer be the center of our health system. In future, there will be less acute illness and many more persons with chronic conditions who can best be cared for in the community with enhanced primary care and enhanced home care. AGING AT HOME is beginning to be recognized as the virtually universal desire of our older adults. For this dream to be realized requires a number of programs, services and policy decisions:
- • Supportive services
• Home care
• Adult day programs
• Integrated community care
• Foster care for seniors
• Sub-acute hospital beds
While post-acute home care can go a long way to reduce the bottlenecks in our hospitals, it is supportive care that can make it possible for seniors with age-related functional disabilities to remain at home. One doesn’t have to be sick to be in danger of having to go into an institution. If you can’t take a bath without help, if you can’t shop for groceries without help, if you need help in preparing meals or keeping a reasonably clean and orderly household — any of these disabilities can force you into an institution when you would much prefer to stay in your own home. This kind of help is called supportive. It is not medical, though it may include reminding seniors when to take their medicines. It is not therapeutic — physiotherapy and other kinds of therapy must be arranged through the Community Access Centers.
Supports which allow older persons to remain in their own homes and communities may be the most precious help that can be offered to them.
by Ethel Meade, December 2010
MORE ABOUT HOME CARE
Though it is not said out loud very often, 85-90% of care for Canada’s elderly is provided by informal (unpaid) caregivers — family, friends or neighbours. Without them, our cherished public health care system would collapse. Despite the heavy load they carry, family caregivers are given neither respect, recognition nor any other kind of support. That is why the big majority of residents in our Long Term Care Homes are women who have seen their husbands through, at a heavy cost to their own health.
Widows outnumber widowers five to one, not just because women tend to marry men older than themselves. Our society still sees caregiving (for the young and the old) as “women’s work.” Still, with elderly spouses, husbands do often step up to the plate and care for their wives, especially if their wives have Alzheimer’s disease.
A number of governmental measures, at both provincial and federal level, could go a long way toward alleviating these problems. For example, a young employed parent (father or mother) is eligible for Employment Insurance for one year to care for a new infant, and equally important, the parent’s job (or an equivalent one) will be held open. The federal government could extend this kind of leave to an employee who must take time off to care for an elderly parent. At present, this leave may be applied for only if a doctor testifies that the elderly person is expected to die within six months.
The second option that could be implemented by the federal government is pension years credit. If you stay at home to care for a child under seven years of age, the years you are out of the labour force are counted as pensionable years when you retire. But if you stay out of the labour force to care for an elderly family member, those years are not counted.
What could a province do to help and support family caregivers? A project undertaken by Care Watch Toronto found that the first item on caregivers’ wish lists was respite: if you are on duty 24 hours a day, seven days a week, you need a break — to go out for dinner, to a movie, to visit a friend. The only break now available in Ontario is a few hours a week of what is called home-making — i.e. vacuuming, scrubbing floors, etc. But if you are caring for an elderly patient with Alzheimer’s or any other form of dementia, or a younger family member with an acquired brain injury, you can’t use these housekeeping hours — unless the person sent to do housekeeping has been specially trained in caring for such “difficult” care recipients. The main problem here is that few persons want this training, since they would then be sure to get all the most difficult assignments and be paid not one cent more than someone who did only routine duties.
For years, OWN and other seniors’ community organizations have lobbied for health care workers to be paid according to their qualifications rather than their place of employment. A health care worker (including nurses) is paid the highest if she gets a job in a hospital, less if she gets a job in a Long Term Care Home, and still less if she works for a Community Care Access Centre. You are paid based not on your qualifications, but on the government’s idea of which situation is the most important.
Finally, there is a way to offer support to family caregivers — by volunteers. A volunteer could give a few hours respite, once a week, once a month or whatever. Another kind of support by vounteers is by elder-sitting while the caregiver meets with a few others who are in the same situation. This kind of project can be initiated and maintained by social workers and social work agencies.
We have a long way to go to achieve a society where family caregivers are recognized for the important work they do, and where more options for helping them are made available. But these are some of the changes that we can keep pushing for.
by Ethel Meade, April 2011
Available June 15, 2011, is a comprehensive report on Ontario women’s health, with recommendations, issued by Echo, an agency of the Ministry of Health and Long-Term Care which collaborates with diverse stakeholders and acts as the provincial advisor on women’s health to the Government of Ontario. See also the impressive background report (325 pages) by following a link on the page above.
Breaking News…
Links to health-related posts on our “front page”:
Rally to Safeguard Public Health Care, Sep. 13
Three new publications about health matters
Page last updated Mar. 29, 2012
