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were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.

Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.

"Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.

A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.

A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.

We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."

THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.

136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.

9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.

After decorating Halloween cookies together, Han brings his own masterpiece, smothered in smarties and sprinkles, to Clark and encourages her to try it. Few words are exchanged, but smiles and giggles are constant at the intergenerational program at Youville Residence, a long-term care facility for seniors in Vancouver. Han Jr. is among a half dozen children visiting this day from the Montessori Children's Community - a daycare located on the same site as Youville, at 33rd and Heather.

Montessori Children's Community administrator Kristina Yang said it's a win-win situation. "Even if there is not a lot of communication with words you can see the beautiful smiles on everyone's face. Many of the children come to know a lot of the seniors and when they pass by our window they'll be excited waving and saying 'Hi ,'" Yang said.

Youville occupational therapist Sheralyn Manning said the children's visits are a big part of the seniors'day. Besides planned events, such as doing crafts together, every so often the children will visit when the weather is bad and they are not able to play outdoors. Manning pointed out the friendship between Clark and Han has been particularly touching to watch and Clark has a recent craft project Han gave her prominently displayed in her room. When most people think of nursing homes the image that comes to mind is a stand-alone building offering residential care only for the aged.

It's a place seldom visited unless you are a family member, friend or volunteer. But these days more homes are trying to build bridges to the wider community. Of B. C.'s 460 government and private nursing homes, only a handful have daycares or doctor's offices on site, said Daniel Fontaine, CEO of the B. C. Care Providers Association, which represents 60 per cent of the privately-operated homes. But none are attached to a facility that offers a large variety of community services. One of the best Canadian examples of a nursing home that achieves just that, said Fontaine, is Niverville Heritage Centre, near Winnipeg. It is home to 116 seniors but is also a gathering place for major community events.

The centre hosts 100 weddings each year. As well, about 50,000 visitors drop in at the centre annually to access their doctor's office, dentist and pharmacist or visit the full-service restaurant and pub. "We found seniors don't want to be retired to a quiet part of the community and left to live out their lives. They want to live in an active community and retreat back to their suite when they want that peace and quiet ," said Niverville Heritage Centre's CEO Steven Neufeld.

Before the centre opened in 2007, he said, members from the non-profit board that operates the centre visited traditional nursing homes and discovered that the lounges that were built for seniors were seldom used. "I remember going to one place where there was a screened-in porch that was packed. The seniors were all there wanting to watch the soccer game of the school next door ," he said. Having services like doctors'offices, dentists, a daycare, a full-service restaurant, and hair styling shop on site fulfil the centre's mission of being an "inter-generational meeting place which fosters personal and community well-being." Fontaine said it's worth noting that Niverville was able to "pull all of this together in a community with a population of less than 5,000 people." He hopes more B. C. nursing homes follow Niverville's lead.

Elim Village in Surrey, which offers all levels of residential senior care on its 25-acre site, is on that track. There are 250 independent living units, 109 assisted living units and 193 traditional nursing home beds. The village also has a 500-seat auditorium, located in the centre of the village, that hosts weddings and is available for rent for other public events. Elim Village also rents out space in one of its 10 buildings to a school, which allows inter-generational programs to take place easily between students and seniors. Another "continuing care hub " at Menno Place, in Abbotsford, has a public restaurant called Fireside Cafe, popular with staff from nearby Abbotsford Regional Hospital and Cancer Centre. There's also a pharmacy and hairdresser on its 11-acre "campus " site but these services are available only to the 700 residents and staff. "We purposely try to involve the community as much as possible ," said Menno Place CEO Karen Baillie. "It's Niverville on a smaller scale." She said Menno Place partners with high schools and church groups and hundreds of volunteers visit regularly. "Seniors are often challenged with isolation and fight depression. That's why we have different programs to encourage them to socialize ," she said.

Research shows 44 per cent of seniors in residential care in Canada have been diagnosed with depression, and one in four seniors live with a mental health problem, such as depression or anxiety, whether they live in their own home or are in residential care. A 2014 report by the National Seniors Council found socially isolated seniors are at a higher risk for negative health behaviours including drinking, smoking, not eating well and being sedentary. The report also found social isolation is a predictor of mortality from coronary disease and stroke, and socially isolated seniors are four to five times more likely to be hospitalized.

Since more seniors now remain in their own homes longer those who move into care homes are often more frail and need a higher level of assistance, said Menno Place director of communications and marketing Sharon Simpson. Seniors with dementia, in particular, can be socially isolated as friends and family often find it more difficult to visit them as they decline, she said. But Simpson said an intergenerational dance program, run by ballet teacher Lee Kwidzinski, has been a wonderful opportunity for seniors with dementia to be connected to the community. The program is also offered in four other nursing homes in the Fraser Valley. "For them it's an opportunity to see children. You can see the seniors come to life, smiling and giggling at the girls'antics. It's very engaging ," she said. "Some may not be verbal but they are still able to connect. They feel their emotions and they know whether someone is good to them. They feel these girls and become vibrantly alive. It's one of the most powerful things I've ever seen."

Creating community connections is key as Providence Health begins its planning stage to replace some of its older nursing homes in Vancouver, said David Thompson, who is responsible for the Elder Care Program and Palliative Services. Providence Health operates five long-term-care homes for approximately 700 residents at four different sites in the city. "It's always been our vision to create a campus of care on the land ," said Thompson, of the six acres owned by Providence Health where Youville is located.

He said the plan is to build another facility nearby, with 320 traditional nursing home beds. One of the ways to partly fund the cost is to include facilities that could be rented out by the larger community, which would be a benefit to the seniors as well, he said. There is already child care on site, and future plans to help draw in the community include a restaurant, retail space and an art gallery. He said another idea is to partner with nearby Eric Hamber Secondary School by providing a music room for students to practise.

"Cambie is at our doorsteps. If you have people coming in (to a residential care facility) it brings vibrancy and liveliness ," Thompson said

Our report shows that while demand for seniors' housing in B.C. is outpacing supply as more seniors opt for homes in independent living communities , not enough is being done to understand their longer-term health and housing needs. In the next 25 years, seniors will make up 25 per cent of B.C.'s population. We think it's time for the provincial and municipal governments to sit down with us and come up with a new plan to support the development of more independent housing and assisted living as a cost-effective alternative to residential care.

We also need improved planning and implementation of home health services provided by the Ministry of Health and the health authorities to residents of independent living communities to allow them to remain in the communities for as long as possible. There are approximately 355,700 people in B.C. over the age of 75, of which 8.2 per cent live in seniors' residences. Improved utilization and expansion of B.C.'s independent living and assisted living sectors to accommodate residents with a broader range of health and social needs could reduce reliance on residential care.

In the past, residential care was the primary option for people who needed additional care and support, but increasing costs and a shortage of publicly subsidized residential care facilities led to the development of publicly subsidized assisted living facilities. Since 2004, there has been a dramatic increase in the number of both independent living and assisted living units, which are often located in the same development and provide many benefits for their residents. But the time has come to take a fresh look at the services available to seniors and how we provide them. For example, the Ministry of Health could explore options to allow registered assisted living facilities to offer a more flexible approach to what and how services are provided to residents. Expanding the range of services could allow residents to return from hospital sooner and free up beds for other patients, or delay their admission to residential care facilities .

Not everyone has the resources to look after their own care and housing needs in their senior years, but the public resources to help are not unlimited. That means we have to be smart how we develop and implement policies for our seniors. Carole Holmes is president of the B.C. Seniors Living Association. Elder care in B.C.

Private-pay and publicly subsidized housing and care options for seniors in B.C. include: Independent living: A combination of housing and hospitality services for functionally independent seniors. Assisted living: A semiindependent type of housing regulated under the Community Care and Assisted Living Act and includes housing, hospitality services and at least one, but not more than two prescribed services for people who require regular help with daily activities. Residential care: 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence.

“Although the impact of population aging on health costs has remained relatively stable over time, health care planners and providers are rightfully looking at ways to meet the needs of a growing senior population,” says John Wright, CIHI’s President and CEO.

opportunities for the health system to meet these changing needs, including improved integration across the health care continuum, an increased focus on prevention and more efficient adoption and use of new technologies

seniors spend more time in emergency departments than their younger counterparts before being admitted to hospital (3.7 hours compared with 2.7 hours in 2009–2010)

Seniors account for 85% of all ALC patients—approximately 85,000 cases a year. CIHI data shows that nearly half of all senior ALC patients (47%) were waiting to be moved to a long-term care facility.

in 2009, 1 out of 10 Canadian seniors was taking a drug from the Beers list, an internationally recognized list of prescription drugs identified as potentially inappropriate for use by seniors

In 2009, almost two out of three (63%) Canadians age 65 and older took 5 or more prescription drugs from different drug classes, with close to one-quarter (23%) taking 10 or more—up from 59% and 20%, respectively, in 2002.

76% of seniors reported at least 1 of 11 major chronic conditions in 2008

1 out of every 11 emergency department visits by seniors is for a chronic condition that can potentially be managed in the community

In 2008–2009, nearly half (44%) of Canada’s seniors had not had a dental check-up in the previous year.

Preventing falls is another important strategy to keep seniors healthy.

The vast majority (93%) of Canadian seniors live at home

Politicians are generally supportive on issues affecting seniors. "Their hearts are in the right place," Simpson said this week. "We want them to start talking about it in the context of an election campaign." Simpson told The Canadian Press that Liberal Leader Justin Trudeau has promised to call a first ministers' meeting on health care and seniors within six months of being elected. The Conservatives have talked of a national dementia strategy, and the New Democrats and Green party have both been "strongly supportive" of a national strategy on seniors. All that is fine, as far as it goes. But whichever party forms the next government will have to respond with more than just talk. Decisive steps are required to deliver an effective strategy. "What we need now is some action," Simpson said.

Pointing in the right direction, the medical association urged federal officials on Monday to make tax incentives and financial supports more available to people caring for elderly family members. Existing tax incentives, for example, are available only to caregivers who are actually living with an aged relative. More than 75 per cent of the care provided to older Canadians is supplied by unpaid, informal caregivers, according to the medical association. "A national seniors strategy," it says, "should take into consideration both the financial needs of individuals who provide this invaluable service and the stress and burnout they often feel." There's no doubt we've fallen behind on care for seniors. A crisis looms. How Canada handles the growing tide of elderly people, and the pressure of their immense medical needs, could well make - or break - this country's health care system. Crafting a bold national strategy to address the problem is a vital first step, not just in helping seniors, but in safeguarding medicare for all Canadians.

Today, the program is partially dismantled. Half of the provinces have scaled back their seniors' drug benefits. The rest of the system looks shaky. There has been no nationwide analysis and very little public commentary, just snippets from individual provinces. Now a Montreal think-tank has pulled it all together. The Institute for Research on Public Policy has just released an informative study, "Are Income-Based Public Drug Programs Fit for an Aging Population?"

The institute commissioned three health-care specialists - two from the University of British Columbia and one from Harvard - to track the retrenchment, analyze its impact and offer advice to the provinces that haven't ratcheted back seniors' drug benefits. The authors acknowledge that financial pressures the provinces face are real. Canada's population is aging, drug expenditures are escalating and the economy is no longer robust enough to accommodate rising costs.

What they question is the wisdom of restricting access to medicine for the highest-needs segment of the population

Former B.C. premier Gordon Campbell was the first Canadian politician to curtail drug coverage for seniors. Shortly after taking power in 2001 he imposed a three-year budget freeze on his province's health ministry. The following year, he raised the co-payment on seniors' prescriptions to $25. In 2003, he implemented an income-tested plan - "Fair PharmaCare" - requiring better-off seniors to contribute up to 3 per cent of their annual income to the cost of their medications.

Over the next decade, four of his counterparts followed his lead, imposing restrictions on seniors' drug benefits. In 2012, former Ontario premier Dalton McGuinty went part-way. He reduced public drug coverage for seniors with incomes over $100,000. They are now required to pay the first $100 of their annual drug bill and a $6.11 co-payment (triple the standard seniors' fee of $2) for each prescription. In 2013, Alberta indicated it was considering the B.C. model. That is where things now stand.

The appeal of eliminating universal drug coverage is obvious. It reduces the burden on the public purse. It makes medicare more sustainable. It targets benefits to those who really need them. What's not to like? Three things, the authors say:

It is detrimental to the health of seniors. The more financial barriers governments put in front of elderly residents, the less likely they are to fill their prescriptions. Seniors in B.C. forgo drug treatment at twice the rate of their Ontario counterparts. Although they pay the highest price, taxpayers lose, too. Providing older people with medically necessary drugs is much cheaper than paying their hospital bills when their conditions become unmanageable.

It penalizes Canadians over 65 with chronic conditions or serious disabilities. "In effect the deductibles under income-based programs are tantamount to imposing a specific income tax on people with the highest medical needs," the authors say. This violates the spirit of medicare. And it is financially inefficient. By unloading the cost of medications on seniors and private insurers, governments reduce their leverage in the pharmaceutical marketplace. The fewer citizens they buy for, the less bargaining power they have.

There is a fourth drawback the authors don't mention. The premiers are pushing a full-fledged pharmacare plan out of reach, in defiance of the will of their citizens. Public opinion polls consistently show that 75 to 90 per cent of Canadians want medically necessary drugs brought into medicare. That was part of the vision forged by Saskatchewan premier Tommy Douglas and chief justice Emmett Hall, chair of the Royal Commission on Health Services half a century ago. They recommended that the cost of hospitalization be lifted from families' shoulders first; physicians' fees would be covered next; and finally prescription drugs would be publicly insured.

Today Canada is the only country in the developed world with a universal public health-care system that excludes coverage of prescription drugs. Policy-makers were inching in the right direction until the turn of the millennium. As of 2000, seniors, social assistance recipients and aboriginal people had full drug coverage.

Now the premiers are moving backward, creating an inequitable patchwork of drug coverage for seniors and lowering the likelihood of pharmacare for everyone else. The short-term savings may look appealing. The long-term costs will add up in ways Canadians haven't begun to contemplate.

Carol Goar'

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."

"We need to do better as a nation to prepare for the growing needs of our seniors in long-term care," said Candace Chartier, Chair of CALTC. "Too often the answer we hear from governments across Canada is that 'we'll invest in home care or prevention strategies.' The reality is that our seniors who live in long-term care homes require care 24 hours a day. They can no longer live at home."

When asked to choose between delaying additional investments until government's budget woes improve or to invest now, almost 80% believe that due to the aging population that we need to invest immediately.

"All of the long-term care leaders meeting today are frustrated that none of the political parties in the middle of this election campaign are talking about the challenges facing our seniors in long-term care," said Chartier. "We're calling on them to start talking about what's important to Canadians."

93% are concerned or somewhat concerned that patients are waiting too long for placement in a long-term care home.

91% are concerned or somewhat concerned that homes are not being properly staffed to meet the needs of seniors;

91% are concerned or somewhat concerned that there won't be enough long term care beds to the meet the future needs.

Only 2 in 10 believe there will enough staff to provide care to seniors when they need it.

Less than 2 in 10 are confident that hospitals and long-term care homes will be to handle the needs of Canada's aging population.

1.5 in 10 are confident that long-term care homes will be prepared for the rising number of Canadians living with dementia.

93% believe for the federal government to work with the provinces to ensure that Canadians have access to the same level and quality of long term care regardless of where they live in Canada.

92% believe the federal government should ensure that long-term care homes are prepared for the rising number of seniors with dementia.

89% believe the federal government should lead a national long term care strategy with benchmarks to address inequities in access and funding for long term care.

85% believe the federal government should lead the development of a comprehensive, national dementia strategy.

About 17,500 people - one in five seniors - use the Shelter Aid for Elderly Renters which can provide $180 per month to people with incomes below $22,000. The money is available only to those who rent their homes, which is an estimated 20 per cent of B.C. seniors, according to Mackenzie's office. Seniors in Metro Vancouver were more likely to know about the grant, but it's used most within the boundaries of the Interior Health Authority, where half of the seniors surveyed received it. Those who are homeowners can defer property taxes until their home is sold (or until death) via the province's Property Tax Deferment Program. Yet only 40 per cent of senior homeowners with household incomes below $30,000 were aware of the program, compared with 75 per cent of homeowners with incomes greater than $60,000.

Seniors make up 17 per cent of the population, a figure that's expected to double during the next two decades. The B.C. Seniors survey, conducted in conjunction with the B.C. Vital Statistics Office and HealthLink B.C., says its margin of error is plus or minus 4.38 per cent. Susan Moore, director of an information and referral centre run by the West End Senior's Network in Vancouver, said she sees people scrimp on food and medications because they have never asked the government for anything and they don't know there is help available. The full report is available at seniorsadvocatebc.ca.

They said seniors living in special care homes are left with $135 per month from their pensions and pay for an average of nine prescriptions per month at a cost of $9.05 per dispensing fee. Those seniors are left with only $53.55 for personal expenses.According to the groups, in 2010, 119,000 citizens in New Brunswick were ages 65 and up, representing 16 per cent of the population. Of that number, 55,000 seniors received the Guaranteed Income Supplement, with 48,000 participating in the prescription drug program.

The four groups called for Dubé to cancel the proposed changes, identify why the cost of drugs in the province has increased so much and examine how other provinces have dealt with the issue.Seniors in Nova Scotia have prescription premiums waived if they receive Guaranteed Income Supplements, while Quebec and Alberta provide free prescription coverage for anyone age 65 and up.The four groups said yesterday that the province should come up with a drug cost reduction strategy in consultation with various stakeholders and consider the New Brunswick Pharmacists' Association's proposal to speed up the approval of generic drugs that the association says would save the province millions.Another option floated was the implementation of a provincial public auto insurance plan, which would create jobs and provide revenue to the province, the groups said.Finally, a study that said Canada could save billions by creating a universal pharmacare plan rather than the assortment of public and private plans available across the country was also cited.

The federal government has made a start with the creation of the Employer Panel for Caregivers and the Family Caregiver Tax Credit. However, it must do more to make a meaningful difference in the lives of Canadians caring for family members. For example, making the caregiver tax credit refundable would help mitigate care costs such as paying out of pocket for prescriptions, groceries and personal care items or taking time off work for medical appointments. Until all levels of government come together to form a comprehensive pan-Canadian seniors strategy, piecemeal initiatives will have a limited impact.

In a way, our generation has become a victim of our own success. Progress and innovation in medicine mean Canadians are living longer. At the same time, more people are living with chronic diseases that complicate both their health status and the treatment they need. Treatment of chronic diseases consumes 67 per cent of all direct health-care costs. Chronic disease is the main reason seniors require health care. In 2011, between 74 and 90 per cent of Canada's seniors suffered from at least one chronic condition, while nearly one-quarter had two or more. These conditions jeopardize a person's ability to live independently at home.

On any given day in Canada, "alternative level of care" patients - that is, patients approved for hospital discharge who cannot access appropriate post-hospital care - occupy about 7,500 beds. Hospitals are routinely forced into a state of overcapacity called "code gridlock" in which patient flow grinds to a halt, elective surgeries are cancelled and transfers are put on hold. If you are in a car accident or have a heart attack, our health-care system can effectively mobilize world-class acute health-care services. But the system is woefully inadequate and under-resourced to properly prevent, manage or treat the long-term and chronic health problems facing most of our over 65 population.

Too often, seniors who could and should be getting better are languishing in hospitals when more efficient and effective care could be delivered in their homes or in a long-term care facility. It costs $1,000 to keep a person in a hospital bed for a day. Long-term care costs $130 a day. Home care (excluding the economic costs of caregivers looking after relatives) costs $55. That translates to approximately $2.3 billion a year that could be better spent in the health-care system with some strategic thinking and investing. This country as we know it today was, in fact, built by our seniors - by our own mothers and fathers, aunts and uncles and grandparents. Canada's health-care providers are determined and committed to prioritizing and improving their health. We expect the same of our country's leaders. As the premiers gather just blocks from Parliament Hill, we ask that a comprehensive healthy aging and seniors care strategy be at the top of their agenda.

Christopher Simpson, MD, is president of the Canadian Medical Association. Morel Caissie is president of the Canadian Association of Social Workers. Karima Velji is president of the Canadian Nurses Association.

seniors represent 14 per cent of the population, but they use 40 per cent of hospital services and account for about 45 per cent of health spending of provincial and territorial government

an acute-care bed costs about $1,100 a day. In comparison, Turnbull estimated it costs a quarter of that to care for the same senior in the community.

services include traditional health-care services such as nursing and physiotherapy as well as transportation or help with household chores

93 per cent of seniors who live at home

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

To make aging at home a reality for all Canadians, we must redesign the delivery of home care to make it more accessible, accountable and affordable.

As government funding continues to decline, unpaid caregivers — typically a spouse or child — are having to fill the gap or pay out of pocket to hire care privately. In 2007, approximately 3.1 million Canadians, largely women between the ages of 45–64 years old (44%) (StatsCan 2012), were estimated to act as an informal caregiver to their loved ones, providing over 1.5 billion hours of care annually.

These caregivers provide 10 times the number of care hours by formal services, which is not only taxing on their personal well-being and their relationship with their recipient, but also on Canada’s economy — the cost to businesses from absenteeism and turnover related to unpaid care was estimated to be $1.28 billion in 2007.

The Caring Economy is made up of for-profit marketplaces that serve the needs of others. Like the Sharing Economy, it is a marketplace that empowers neighbours to care for neighbours— removing the need for corporations to intervene. Through the latest mobile technology, businesses in the caring economy connect the supply of care to the demand for care.

In the Caring Economy, there are two key end users: the demand side that needs to hire care and are willing to pay and the supply side that has time and is looking to help. Demand side users can build their own personalized team of care providers, communicate directly within the platform, and pay on demand via mobile payments — a seamless, convenient and transparent process. This is made possible through a peer-to-peer marketplace that uses mobile technology to efficiently manage the relationships between paid care-workers to primary caregivers and their loved ones — on demand. Simply put, it is Uber for home care.

At its core, this model redesigns how care is delivered to make ‘aging in place’ a reality. The model’s objective is threefold — to help seniors age with dignity, to unburden their family caregivers, and to turn compassionate people and Personal Support Workers (PSWs) into ‘micro-entrepreneurs’ — providing them with an opportunity to earn a 20–30% higher wage- a win, win, win.

The Uplift® smartphone platform delivers on-demand home care services — at the touch of a button. As a company, we are laser focused on harnessing the latest mobile technology and analytical problem solving to deliver a superior user experience that fulfills the aging population’s demand for higher quality care. We are setting the new standard.Our app is an affordable solution to expensive agency fees. We offer 30–50% lower fees than private agencies. We are also an innovative substitute to long-term care.As an organization, we are devoted to making a positive impact in the world. Moreover, we are a pioneer of the ‘caring economy’ — where neighbours can care for neighbours and caregivers are empowered.

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 longterm 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." In fact, both polls showed that voters want the federal government to take a leadership role on seniors' care, but they also realize this has to be done in conjunction with the provinces.

In the survey conducted for the CMA, 89 per cent said the next prime minister needs to make addressing the health needs of Canada's aging population an "urgent priority," while 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. A significant number of those surveyed, 57 per cent, said that how they vote in the Oct. 19 federal election will depend, at least in part, on which party has the best plan to address seniors' health care. Seniors now represent 15 per cent of the population, up from 8 per cent in 1971. By the time all of the baby boomers have reached 65, they will make up an estimated 25 per cent of the population.

While this demographic shift is having an enormous impact on demand for services, the health system has been slow to adjust and is struggling to keep pace. The result is seen, among other things, in the rationing of home care, ever-worsening shortages of nursing home and longterm care spots, hospital beds filling up with frail seniors with nowhere else to go, inadequate hospice and palliative-care services, and stubbornly long wait times for surgery.

Dr. Simpson stressed that the answer to these woes is not necessarily more money but delivering care differently by, for example, shifting spending from institutional care to home care, and placing much more emphasis on prevention. "Seniors today want to age well at home and in the community, and health-care professionals (and politicians) need to tune in to those aspirations," he said. The CMA poll, conducted by Ipsos Reid, surveyed 2,008 Canadian adults between July 20 and 24. It is considered accurate to within 2.5 percentage points, 19 times out of 20. The CALTC poll, conducted by Nanos, surveyed 1,000 Canadian between June 18 and 20. It is considered accurate to within 3.1 percentage points, 19 times out of 20.

There are many other health issues begging for more attention. Advocates of pharmacare and physician-assisted suicide are pushing hard to get their concerns front and centre. But there has been little discussion so far about health care during the campaign, despite the fact that time and time again it ranks as the top issue of concern among voters. The exception is Green Party Leader Elizabeth May. On Wednesday, she announced her party's strategy for seniors, including a universal drug program and a guaranteed livable income.

Meantime, health-care professionals like Sinha are left to deal with the fallout from the widening cracks in the system. "The issue my patients struggle with the most is getting access to home and community care services. I spend way too much of my time trying to navigate the complicated system on behalf of my patients to make sure we can cobble together what they may need," he said. Physicians are equally worried. More than 500 members of the Canadian Medical Association gathered last week for their annual meeting in Halifax where they reiterated their call for the creation of a national seniors' strategy.

Outgoing president Dr. Chris Simpson told the gathering that there is widespread public support for a seniors strategy to meet the growing health needs of an aging population, but that politicians have been disappointingly silent on the issue. In his closing speech, Simpson warned that doctors are not going to let politicians off the hook. "We will be tracking commitments made by the parties, and we'll publish the results at the end of the campaign so that Canadians who are worried about seniors can make an informed decision when they're at the ballot box." Alan Freeman, Senior Fellow at the University of Ottawa's Graduate School of Public and International Affairs, isn't surprised that the issue of health care has not received much attention.

Any substantive discussion would involve mention of transfer payments and equalization formulas - complicated topics that make people's eyes glaze over. That absence of debate serves Conservative Leader Stephen Harper just fine, Freeman contended. "This works out quite well from the federal government's point of view, especially Harper's point of view, in that he's not interested in an activist role for the federal government in health care," Freeman said.

A similar sentiment was expressed in a recent editorial in the Canadian Medical Association Journal. Deputy editor Dr. Matthew Stanbrook wrote that the federal government seems to be trying to get out of the health-care business. "Recent years have seen Canada's health-care system race to the bottom of quality rankings compared with other nations that have prudently invested in maintaining a strong social safety net," he wrote, warning that the most complex problems in the health-care system cannot be solved without federal leadership.

Ontario Health Minister Eric Hoskins agrees that Ottawa's hands-off approach is hurting the health system. He's specifically concerned about the Conservative government's plan to reduce the rate of increases in health transfers to the provinces. "As Canadians, we owe it to ourselves and to our children to begin a frank and earnest conversation about the state of our health-care system and what a modern health-care system should look like in 2015 and beyond," Hoskins said in an email to the Star. "It's up to all of us - both political leaders and the citizens we represent - to speak up and ensure it has a place in that electoral debate." Conservative party spokesperson Stephen Lecce noted that just Stephen Harper promised to maintain funding for the Canadian Partnership Against Cancer, an agency devoted to combating the disease.

"Since 2006, under prime minister Harper's leadership, health transfers have increased by 70 per cent while balancing the budget and keeping taxes low. Federal funding is a record levels, and will reach $40 billion annually by end of decade, providing certainty and stability, and an enhanced quality of life for Canadians," he said. Barry Kay, a political science professor at Wilfrid Laurier University, expects that in a long campaign, the parties are biding their time before getting into substantive debates.

"I think the leaders are holding their fire till later on when the campaign moves beyond the 'spring training' phase and more people are watching," he said.

Calls for a Canadian national seniors’ strategy intensified in 2015 – everyone from the CMA to the IRPP held consultations across the country, identifying key issues and laying impressive groundwork for a future strategy. Lack of political will, however, holds us back – discussion of a national seniors’ strategy during the federal election was very limited, and it is still a political black box. An effective seniors’ strategy would provide a framework for all of the issues I have described – access, affordability and advance planning.

A national senior’s strategy will be essential to improving seniors’ quality of life, supporting families and caregivers, and planning for Canada’s rapidly aging population. Canada currently has one geriatrician for every 15,000 Canadians, and there are significant gaps across the country in the quality, cost and access to care.

The long-term-care sector will be a critical partner for implementing, supporting and evaluating assisted-dying requests when the proposed legislation becomes law. Home-care workers and health-care providers in long-term-care facilities, alongside family members, are often the last to care for dying patients outside hospital settings. For many Canadians, long waiting lists to access limited long-term-care spaces are a significant barrier. Regional disparities in access, quality and affordability also exist, and multiple advocacy organizations have emphasized the need for national leadership on issues of elder abuse and neglect in long-term-care facilities.

May 24, 2016 

ith Canada’s assisted-dying dying legislation currently before Parliament, it becomes increasingly urgent for the Liberal government to make substantive commitments to policies and programs that will support this sea change in the health-care system.