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Instead, he simply continued existing transfers of money, with annual increases of 6 per cent, to be followed by a reduction, to about 3 per cent, as of 2017. That formula was issued unilaterally, without consulting the provinces. And transfers came with no strings attached, meaning the federal government effectively abandoned leadership in the realm of Canadian health care. It's vital for Ottawa to oversee the evolution of medicare. That's the best way to set shared national priorities and establish universal standards suited to Canadians' 21st-century needs.

Prime Minister Justin Trudeau appears to understand this, with his party campaigning on a pledge to "provide the collaborative federal leadership that has been missing during the Harper decade." Key to this is negotiating a new health accord, including a long-term agreement on funding. Now comes the hard part: actually hammering out a deal. The only immediate commitment made by the Liberals was an investment of $3 billion, over four years, "to deliver more and better home care services for all Canadians." But there was no mention of that in the federal budget this spring, a document notable for its lack of attention to expanding Canada's health-care system.

Health Minister Jane Philpott explained that promised changes to home care are part of ongoing talks toward a health accord. Fair enough. But it's essential for the federal contribution, in any new deal, to go beyond just this. Ottawa's health-care transfers to the provinces and territories totalled $34 billion last year, about 22 per cent of public spending in this area. At one time it was a 50-50 split. And Canada's provincial premiers, as recently as July, have urged the federal government to cover at least 25 per cent. That seems reasonable to expect from a new accord, especially given growing pressure on Canada's health-care system from an expanding, and rapidly aging, population.

One worthwhile change, forcefully advocated by the Canadian Medical Association earlier his week, would be for Ottawa to deliver additional health-care funding through a special "top-up" based on each province's population of seniors. Health transfers are currently issued on a per-capita basis, failing to take into account far heavier costs associated with caring for the aged. This gives provinces with a younger population, such as Alberta, a break while failing to adequately compensate those with more old people, including British Columbia and Ontario.

The Conference Board of Canada made a compelling case for a demographic top-up in a report last fall, calculating that it would cost Ottawa about $8.6 billion over five years. Currently, "there are large discrepancies across the country when it comes to the health-care services available to seniors, particularly in pharmacare, home care, long-term care and palliative care," warn authors of the report. "As Canada's population continues to age, this situation is likely to worsen."

One goal of a national accord is to eliminate, or at least ease, such discrepancies. To that end, it would make a great deal of sense to introduce some form of demographic top-up. This represents just one opportunity inherent in negotiating a new health accord. It remains to be seen if it will actually be delivered. © 2016 Torstar Corporation

I recently caught up with Dr. Samir Sinha, Director of Geriatrics of the Sinai Health System and the University Health Network Hospitals in Toronto, and Assistant Professor at the University of Toronto and the Johns Hopkins University School of Medicine. He is leading an evidence-based approach to develop a National Seniors Strategy for Canada. Dr. Sinha speaks passionately and with infectious optimism about the need for a paradigm shift in our approach to health care for older adults. There are five principles that are at the core of this new paradigm: Access, Equity, Choice, Value, and Quality.

The survey was conducted in October and November last year when 103 organisations checked 52,443 in-patients for infection.

The majority were in NHS hospitals and for the first time, 1,665 patients in private hospitals were included.

Lead author Dr Susan Hopkins, an epidemiologist at the Health Protection Agency

“There have been great results achieved in reducing the levels of MRSA and C. difficile over the last five years in the NHS

"These have been accomplished through national policies and guidelines and changes to infection control.

“In a more integrated system of care delivery, it is possible to both save money and increase the quality of care at the same time.”

Eleven commentaries were written by leading health policy experts across Canada to respond to the lead paper by Chappell and Hollander, who also wrote a response to the commentaries.

One system including community services such as meals on wheels, non-professional supportive services, professional home care services, supportive housing, long-term care facilities and specialized geriatric assessment and treatment units in hospitals would also have one overall budget. Professional case managers would coordinate care and assess needs, develop customized care plans, and authorize access to any of the services in the integrated system. They would also coordinate care with other parts of the health system, such as hospitals

budgets for long-term supportive care that allow people to remain in their homes have been frozen or reduced

While some seniors do need some professional care, say the authors, often their needs can be addressed primarily by non-professional supportive care such as feeding, bathing, and maintaining a clean living environment.

The provincial government's statistics also show the length of stay at nursing homes is getting longer and the average age of residents is getting older.

The cash-strapped province is reviewing a five-year, $400-million infrastructure plan that would have replaced and renovated the stock of nursing homes.

Even nursing home projects that were already approved were reviewed to search for any possible cost savings and the remainder of the plan has been subjected to the internal review.

Social Development Minister Sue Stultz is expected to release the report closer to Nov. 23

The infrastructure challenges being faced by the province's nursing homes are not new. The Department of Social Development's statistics show there were 73 infractions found during nursing home inspections in 2008. That number fell to 63 in 2010.

But the declining state of New Brunswick’s nursing homes burst into the open earlier this year when two facilities were forced to cope with mould outbreaks.

Mill Cove is like many other nursing homes in New Brunswick. It was constructed in the 1960s and it received a series of additions in the last 50 years to meet growing demands. The patchwork of upgrades has led to some of its current problems.

The costs of those ongoing battles to maintain the aging infrastructure, buy new equipment to improve the quality of life for residents and meet the standards of patient care are all adding up. “We are seeing the costs to maintain the facility go up each year,” Dickson said.

The facility’s chief executive officer said the myriad problems facing the nursing home prove a replacement building is not a luxury in an otherwise austere time. “It is a not a 'nice to have,' it is a 'must have' for us right now,” Dickson said.

medicare costs in general aren’t spinning out of control

governments cut back health-care spending growth severely during the recession of the early 1990s, then — because of public pressure — reversed themselves later on

No government is likely to attack medicare head on. They’ve learned that this is political suicide.

My guess is that governments will be looking at ways to privatize even more — from hospitals to specialty clinics — all within the medicare umbrella.

In theory, this could work out. Or, as in Britain today, it could undermine the very nature of the public health-care system. The devil will be in the details.

Bill Moore-Kilgannon of Public Interest Alberta said Horne's plan offers "no response to the real problem" in seniors care."The model that they're talking about lays the foundation for a lot of public dollars going to private corporations to provide the care," he said.

The biggest danger is that eliminating the designations between the various levels of care will trigger a consolidation of laws and repeal the Nursing Homes Act - the only law left to protect health-care standards for seniors, he said.

there are currently 1,683 people waiting for continuing care in acute or sub-acute beds, Mason said, with 675 of those occupying hospital beds

Contrary to the conventional belief that an aging population will overrun hospitals and accelerate growth in health spending, the CIHI reported that elderly-related care actually accounted for a minimal 0.8 percent annual increase in annual costs. An official behind the study, Jean-Marie Berthelot, remarked on how surprisingly marginal the impact of seniors actually is: “Over the past decade, the proportion of health dollars spent on seniors…has remained relatively stable at 44%. This tells us that spending on seniors is not growing faster than spending for the population at large.”

Overall, the vast majority (88%) of care receivers relied on help from family and friends.

Relying on professional services alone was reported by 12%.

Care receivers typically had about seven hours of weekly assistance from family and friends and about two hours of weekly help from professional services.

The most common form of help received from family and friends was transportation, identified by 83% of care recipients. Next was help with cooking and cleaning, at 67%, followed by home maintenance or outdoor work, at 53%.

Bathing is a good example: At what point does caring for the personal hygiene of a patient move from necessity to luxury? Should patients have choice in these matters, or do you have to give up your voice and succumb to the whimsy (and cost controls) of the system? In Quebec, Health Minister Gaetan Barrette said that "black market baths" (those provided by staff of publicly funded longterm homes in their off-hours) were unacceptable, but he defended the one-bath-a-week standard. He added that families unhappy with that level of care could bathe loved ones themselves or hire outside help. Seemingly trivial issues like bathing are essential elements in the care of frail seniors. But how do we regulate these matters?

And how do we offer quality care and choice, while keeping costs affordable, and maintaining equitable access to care? There are roughly 400,000 residents of long-term care facilities, and they live in a mix of privately and publicly owned homes. Eligibility criteria and costs vary between jurisdictions: What you pay can depend on your age, income, medical condition, province of residence, and your ability to navigate Byzantine rules. National data are hard to come by, so let's take Ontario as an example. There are 77,101 long-stay beds.

Getting a spot depends on level of frailty and availability. There were, at last count, 23,436 people waiting for a long-stay bed in the province and the median wait is an excruciating 108 days. For eligible patients, the province pays $137 a day per resident (just over $50,000 a year) - of which $91 goes to nursing and personal care, $11 for therapy and recreational programs, and $8 for food. (It's no wonder that the No. 1 complaint of institutionalized residents is the quality of food.) That costs the province $4-billion a year. In addition, residents and their families are expected to pay their "room and board," but the province sets daily maximums, ranging from $36.85 (for temporary respite) to $80.18 (private long stay). That means residents pay up to $30,000 out of pocket annually, but there are subsidies available for low-income residents. Virtually no one in Canada has long-term care insurance.

On average, patients spend about five years in institutional care, but that number is falling as people go to long-term care later and sicker. Instead, they require home care, which is also costly, and can be a great strain on family caregivers. No one wants to live in longterm care or a nursing home - or so goes the commonly held belief. What people fear is warehousing and loss of dignity, as exemplified by the notion that they won't even get bathed. The reality is that, despite some highly publicized abuses, long-term care homes do not deserve the horrible reputation they are saddled with: Most do a decent job of caring for their charges, given the challenges they face and the resources they have. But the broader problem with long-term care, as with much public policy related to seniors, is that there is no plan. If we're going to deliver necessary, appropriate care for the aging population of baby boomers, we have to start with a cold, hard calculus of the cost of meeting (or not meeting) those needs. If we want quality care, we're going to have to pay for it, individually and collectively. Getting the right mix of private and public spending is key to ensure no one is left out in the cold.

It does not need to be this way. Seniors vote in greater numbers than other demographic age groups. Seniors are the most committed voters; 65 per cent or more of older voters turn out to vote regularly, so there is an opportunity this October for seniors to tell politicians what we want and expect from future federal and provincial governments. Recently representatives from a significant number of national and regional senior organizations, retirees, professional and advocacy groups have formed Seniors Vote. T

A second poll, commissioned by the Canadian Alliance for Long Term Care (CALTC), found that just 18 per cent of citizens believe that hospital and long-term care homes would be able to meet the needs of the aging population, and only 20 per cent think there will be enough trained staff to provide adequate care.

The CALTC survey also showed that the top three concerns about the health-care system are long wait times for surgery, lack of access to long-term care and insufficient home-care services.Candace Chartier, chief executive officer of the Ontario Long Term Care Association, agreed that public angst is growing. “How we are going to care for our aging population is the No. 1 concern of Canadians,” she said. “The public realizes what’s coming down the pipeline and they’re frustrated that governments aren’t reacting.”

the CALTC poll found that 93 per cent believe Ottawa has an obligation to ensure Canadians have equitable access to care, regardless of where they live.

Long-term care: Invest in infrastructure so there is an adequate number of beds, and so they are affordable, particularly for seniors with specialized needs, such as those with dementia. Palliative care: Promote advance-care planning and ensure everyone gets palliative care at the end of life. In a wide-ranging discussion, delegates to the CMA meeting identified a number of specific issues that are hampering the provision of care to seniors with chronic health conditions, such as the lack of electronic health records, the way health-care delivery is siloed in Canada, the absence of pharmacare, physician payment schemes that reward volume rather than quality of care, the lack of training in geriatrics and a lacklustre commitment to patient-centred care.

The overarching theme was that if care is going to be improved for the burgeoning population of seniors, it must begin with better co-ordination. Dr. David Naylor, who headed the federal Advisory Panel on Healthcare Innovation, also stressed this as an essential element of reform. In a keynote address to the CMA meeting, he said that while Canadians love their medicare system - at least in theory - the reality is that "the scope is narrow and performance is middling." Dr. Naylor said the main reason Canadians don't get good value for money when it comes to health spending is a lack of co-ordination of care. "The critical factor is integration of services," he said.

Right now, far too many patients, especially seniors with chronic conditions, are being cared for in hospitals rather than in the community and their care is disjointed, the CMA's report notes. Fixing that will, among other things, require a reorganization of roles between various health professions, including physicians, nurses and pharmacists. "All health-care professionals are going to have to do their bit to deal with this grey tsunami," he said, stressing that many innovative solutions have been put in place across the country, but they are too rarely scaled up.

Dr. Naylor said policy-makers, and federal politicians in particular, need to take a leadership role to ensure this happens. Dr. Simpson of the CMA also called for federal political parties to commit to a seniors' strategy during the current election campaign, and said he is confident they will. "We know they're thinking about it. We know their hearts are in the right place," he said. "Now we want them to start talking about seniors' health care in the context of the election campaign so people can cast their votes accordingly."