What Canada Must Do to Meet the Needs of Our Aging Population
Canadians have deep expertise and a long history of global success as health innovators – from insulin to the pacemaker. There is a confidence that comes with commercial success that fuels and inspires entrepreneurs, activates policymakers, and promotes investment. However, as Canadians stare down the challenges that come with an unprecedented generational imbalance, we must ensure solutions are not stalled due to infrastructure, policy, or mindset.
Canadian entrepreneurs, funders, and policymakers need to prioritize solutions that support independent living at home, support the friends and families of seniors to fill in the gaps of care for our aging population with a national virtual care strategy, and assume that individuals with acute, chronic, and even complex care needs want to remain in their own homes with healthcare support.
Our Global Population is an Older Population
We are amidst a global trend where the number of older adults is outnumbering our youth. People are living longer and having fewer children. Global life expectancy soared from 34 years in 1913 to 72 years in 2022 and is expected to continue this trajectory for the long term. In Canada, 19% of the population (7 million) is over 65 years of age and 2.5 million will be over 85 by 2046 (3x increase compared to 2022).
The Biological Reality Check
The normal process of aging comes with changes in biological function. The cumulative effects of these changes translate to well-known and common realities with getting older, such as changes in hearing, visual acuity, and muscle strength, as well as the potential onset of age-related chronic disease (heart disease and diabetes ranking as a high probability). Immunosenescence refers to the changes in the immune system as we age, as well as the degradation of interacting cell function—in brief, a decline in protective functions.
Cancer and heart disease remain the two leading causes of death in Canada, accounting for 41.8% of deaths in 2022. Also in the top 10 leading causes were stroke, diabetes mellitus, and Alzheimer’s disease. Effectively, half of the top causes of death in Canada are chronic conditions associated with aging. Notably, many of these have known risk factors that can be managed.
There is a degree of predictability around the aging process, and therefore, in addition to the growing numbers of older individuals, we can hypothesize about the needs of future generations and align with the gaps in current care.
Dying is natural. We can do more to help people have a good life and a good denouement.
Elder Care Challenges Exacerbated with a Decline in Resources
The associated angst with the health impact of aging in Canada has been offset for decades with some comfort in knowing that we will be taken care of. When we needed to talk to a primary care physician, we had one. When in need of attention in the ER, there was a bed. When we required confirmation of a chronic condition by a specialist, CT scan or MRI, our wait time was reasonable. When care needs required a transition to long-term care, there was a bed.
In recent years, these assurances have evaporated.
The void of human healthcare resources is gaping. For example, in a 2020 survey, about 17% of people in Canada reported not having a regular primary care physician. That number increased to greater than 20% in a survey conducted in late 2022, and more than one-third of those respondents were 50 years old or greater. The net summary, millions of older adults in Canada do not have a primary care physician.
We need to develop new options for both delivering and accessing healthcare.
The Invisible Care Economy
One under-reported care solution is the role that family members take on to support their aging loved ones. While we also know that not everyone can rely on the participation or advocacy of family members to fill in the gaps of care, we know that there is a significant commitment made by family members across Canada, the “invisible caregivers,” to provide basic and supportive healthcare for family. Family members who navigate caregiving for their older relatives either rely on having the financial resources and flexibility to do so or sacrifice their personal and professional commitments to deliver care and support. Typically, it is binary.
Canadian statistics published in 2022 underscored the likelihood of caring for older adults in our lives. One-third (33.6%) of individuals aged 55-64 are also balancing a life of unpaid caregiving. A report published in 2018 by the National Institute on Ageing found that 75% of care hours for older Canadians is done by unpaid caregivers.
Released November 2023, “Canada’s Care Economy: A Conceptual Framework” looked at the labour market impact of our aging population and estimates that 2.3 billion people globally will need care by 2030. We cannot assume that the invisible caregivers active in the workforce will be available or be able to solve the growing and pressing care issues without new strategies to facilitate the support.
What is the order of magnitude of need? Well, we only know what is reported.
A National Virtual Care and Remote Patient Monitoring Strategy
A collective national response to the COVID-19 pandemic included the creation of billing codes and, in the cases where they already existed, expanded billing codes for virtual care. These practical solutions were swiftly implemented in weeks.
Innovations that capitalized on available codes were accelerated with hungry enthusiasm and support. Yet, due to a lack of ongoing government support, modalities that were activated and stress tested have since been dialed back, deactivated, or, in the case of unique billing codes for virtual mental healthcare, left to expire.
Post the peak of the pandemic, the Canadian government established the Digital Health and Virtual Care Taskforce to develop a national strategy for publicly funded virtual care in Canada. Included in the taskforce’s recommendations are the following:
Provide a permanent basis for virtual care fee codes within fee schedules.
Provide for remunerating physicians at the same rate whether care is provided virtually or in person.
Virtual care pilot programs exist across the country where technology is facilitating a reduced length of stay and ‘hospital-to-home’ strategy. Patients are not discharged from care; they are moved from hospital to their homes to continue care at home – virtually. While a hospital-at-home option varies significantly based on individual circumstances and severity of condition, the benefit to vulnerable older adults could be substantial (while also freeing up hospital resources). The potential impact of continuing care virtually ranges from eliminating the risk of a hospital acquired infection, improving emotional well-being by being in a familiar environment, to removing the risk of the onset of delirium – all impact mortality.
In addition to virtual care codes, there needs to be specific national billing codes that support remote patient and remote therapeutic monitoring. Solving for the current patchwork of provincial policies, innovators and healthcare practitioners will be empowered to optimize care in the home.
Care is care. Technology innovation will remain stalled until the remuneration pathway is clear and harmonized.
Promote Health and Well-being in the Community
In addition to new virtual and homecare strategies facilitating a transition from hospital to home, acute follow-up care, or clinic care, we can amplify opportunities for prevention, addressing known risk factors that are associated with aging. A key one is maintaining social connections.
Our public healthcare system prioritizes and assumes that as we age, many of us will need the type of care that can only be delivered in long-term care facilities.
What if more resources were allocated to the creation of care communities or to innovative products intentionally facilitating aging in place? What if we nurtured environments where the base assumption is that as we age, we will want connection and activity with our own homes serving as base camp? Rather than downsize, we would want to continue to live in our homes but in environments surrounded by new resources that place value on our inherent desire to remain independent, connected, and active. This is community-based aging reimagined. Independence without isolation.
Here is a short list of specific questions for Canadian healthcare innovators, funders, and policymakers to generate strategies and develop solutions:
How do we get access to more nurse practitioners in the community for acute, chronic, complex, and preventive health needs?
How can we create a community culture based on a frequency of health and well-being checks?
How do we build capacity for more accessible transportation services, picking up/dropping off/escorting from the home, understanding that access to programs in the larger community can be daunting for the elderly?
How do we overcome the challenges associated with getting out of the home? Mobility restrictions have compounding effects that lead to isolation and loneliness and are proven to contribute to cognitive decline.
Coordinated and Collaborative Care
Innovation is the great risk mitigator. Health innovation can facilitate a shift in how care is delivered and immediately address gaps that are amplified by the silver tsunami. But we need the systems, resources, and government support to facilitate risk mitigation and advance access to innovation. We can do more to avoid risks and manage health conditions.
Here’s is a sampling of what to activate:
Nationwide billing codes for remote patient and therapeutic monitoring.
Federal funding for collaborative and synergistic programs that facilitate continuity of care, complex care in the home and a virtual ‘hospital-to-home’ strategy.
Grants for family members coordinating care and providing part time care. Compensate the ‘invisible care economy’.
Grants for community-based health and wellbeing initiatives.
The fractures in care, as well as depleted resources, were amplified by the pandemic. National calls to action rallied groups that typically competed in the private sector to work together and alongside government to deliver critical solutions. Why wait for the next crisis to bring organizations together? Truth be told, we are already facing a crisis in care. Our vulnerable seniors need immediate solutions.
Op-Ed Originally Published @ The Future Economy