Chapter 44: Deja Vu, All Over Again?!
An Open Letter to P.E.I. Premier Robert Ghiz.
Dear Premier Ghiz;
Recently, I attended the annual dinner of Canada’s Public Policy Forum in Toronto, the biggest gathering of policy wonks, lobbyists and advocates in the country. The designated host had cancelled at the 11th hour and you, a practiced and clever speaker, had been brought in as a last-minute saviour. It seemed a fortuitous choice. I found your warm-up entertaining, but it’s when you proposed to give us your take on the “No. 1 challenge facing Canada in the future from a public policy perspective … our aging population … and its implications for our health-care system” that you really got my attention.
As premier of a province at the epicentre of the growing older demographic, you seemed perfectly placed to have a fresh appreciation of this relatively new phenomenon. Instead, I was dismayed to hear you launch into the old refrain about how a rising tide of grey will bankrupt the country. I was hoping for a new view, even inspiration. But all you had was the standard alarm – and some convenient misdirection to support it.
Premier Ghiz, every statistic you cited was accurate, yet virtually every implication you drew from those stats was not. My aim in this letter is to demonstrate the disconnect between the point you thought you were making and the attitude you actually revealed.
1. “We need to deal with an aging population in Canada. Just to give you some statistics: In 1971, eight per cent of Canadians were 65 years or older. By 2011, that number increased to 14.4 per cent, and by 2031, 22.8 per cent of Canadians will be 65 years or older. The case in Atlantic Canada is even worse …”
First, why choose the word “worse” to characterize the fact that there are proportionately more old people in the Maritimes than in the rest of the country? Why not say “more pronounced” or “more challenging”; better still, why not find an opportunity here to turn so-called adversity into advantage? I’m not being a Pollyanna. Your choice of adjective tells me you think of widespread old age as calamitous. In fact, it’s a miracle, the fruit of civilization’s progress in nutrition, sanitation, education, science, medicine and peace. And I’ve got news for you: lots of 80-year-olds playing cards in a food court are not a calamity. As Dr. Samir Sinha, the (young) head of geriatrics at Mt. Sinai Hospital in Toronto, noted recently at the Sanofi Pasteur Healthcare Venture Challenge, the question is whether we regard old age “as a disease, or an achievement.” Nowhere in your remarks do I get the sense that old people in large numbers are anything but a threat. They are and should be P.E.I.’s adornment, one of your province’s unique selling points, perhaps even a core industry that contributes to the greater good.
Second is the tone of impending doom in your analysis. You didn’t actually use the word “tsunami” to characterize the deluge about to hit health-care costs in Canada but you did evoke images of irresistible devastation. It is a powerful but misleading metaphor. Yes, there has been a long and sustained rise in health spending, but it has to do with many more things than just an aging population.
According to a Canadian Institute for Health Information report, Health Care in Canada, 2011 – a Focus on Seniors and Aging, between the years 2002 and 2012, “the rate of spending growth for seniors was actually lower than the rates for non-senior adults,” adding “less than one per cent to public-sector health spending each year.”
The real drivers of this spending are the steady push in the cost of doctors and drugs and the cost creep in technology with its new machines, tests and surgeries. Overall, and on its own, aging adds around 20 per cent to the annual health-care bill, while changes in the cost of treatment for all patients add the remaining 80 per cent1.
Then there’s the “65” thing. By choosing 65, you’re demonstrating that you – and public policy in general – are still stuck in 1916. That’s the year Germany pegged retirement at 65, which was also, not co-incidentally, life expectancy at the time. Today, most of us can look forward to 20-plus years after 65, with 17 of those characterized by good health and productivity. Sixty-five should not be the inflection point from which to declare a health-care crisis; besides, the crisis isn’t what you think it is.
2. “While seniors represent just over 14 per cent of our population, they account for 40 per cent of hospital services and 45 per cent of provincial and territorial spending on health care … Seniors visit their family doctors twice as much as non-senior adults. Eighty-two per cent of home-care clients are 65 and older.”
Right, Premier Ghiz! Those numbers are also correct, but taken bare they convey a distorted message. Sinha encountered the same stats when he trained as a geriatrics resident, but something about them puzzled him: “As a Winnipeg boy doing his medical-school training in Ontario, I thought, wow, Ontario’s really weird because it seems that when you retire, you sell your house and move into a hospital. Sixty per cent of my patients were older people, and [according to the statistics] they seemed to be living there. When I ask my own trainees today what percentage of older people they think is ill, they say the majority.” But it’s simply not true! In 1995, F.D. Wolinsky published a study involving a group of 75-year-old adults he tracked over a period of seven years to discover their hospital and doctor’s office usage. He found that nearly half his study group didn’t go near a hospital in those seven years; they were leading healthy, active lives, travelling, volunteering, taking care of their grandchildren. Another quarter only visited the hospital once in those same seven years; and that trend continues today.
So how is it that your numbers can still be technically correct, Premier Ghiz, even if the majority of 65- to 80-year-olds are healthy? It has to do with a phenomenon that gets far less attention than the stereotypes and the myths. It turns out that the patients who use the greatest proportion of hospital and other intensive treatment resources are those who have multiple chronic health issues or people with functional impairments who have trouble performing basic self-care activities like bathing and preparing food. Both groups are disproportionately likely to be in their last year or two of life. What percentage of seniors do these two groups comprise? Ten per cent. Yet this 10 per cent accounts for 60 per cent of all health-care costs incurred by the so-called over-65s. This means that a sliver of the population, barely 1.5 per cent, accounts for close to 30 per cent of total health-care costs. If there is a crisis, it lies with that sliver, and how we treat that sliver is a measure of our humanity.
3. “Seniors spend 1.5 times more in a hospital stay than non-seniors and require 70 per cent more resources.”
Right again, Premier Ghiz, but why is that? When Tommy Douglas introduced medicare in the 1960s, the average Canadian was 27. So the system was designed to cater to a young population: hospital facilities, procedures and recovery rates were geared toward the physiology and psychology of the young. Is it any wonder that older patients processed through hospitals still following that original design do not respond optimally to it? What would an “elder-friendly” approach to health care look like?
Denmark is today farther along than any country in the world in switching to a medical model geared specifically to an aging society. This means getting as many elderly as possible out of hospitals and back into “aging-in-place” situations. It is known that it costs $1,000 a day for a hospital bed, $150 a day for long-term care and $55 a day for assisted home care. In the past few years, Denmark has been able to cut thousands of hospital beds and save money in the process. They’ve done this by acknowledging that the culprit wasn’t “old” people 65-plus but a system that was no longer appropriate.
4. “This is an issue that I believe needs to be addressed and that I believe in 2015 the premiers will be sure to put on the agenda because if we don’t, it’s going to lead to bigger problems down the road.”
There is no doubt that in the next 20 to 30 years fundamental demographic shifts in society will affect nations and economies. But though aging is often described in the most dour of terms, still the future is brighter than Politicians and Media would have us believe. Many responses are available to the challenges posed, and others will be found in the exciting opportunities that radical change will create. P.E.I. has the capability to lead in these changes by embracing the ongoing paradigm shift.
So, we’re asking you, Premier Ghiz – you and the other premiers you’ll be meeting soon about this issue – to refrain from identifying the 20 to 25 extra years of fruitful existence we’ve gained in the last half century as a bad thing and focus instead on the actual stumbling blocks to health care for seniors. We’re asking you for policies that can both save money and promote an old age that stays rich and full and continues to contribute to society. After all, Premier Ghiz, soon enough you’ll be one of the people you’re warning us about. If you’re lucky.
Moses’ Zoomer Philosophy — which launched in ZOOMER Magazine in October 2009 — is a series of monthly essays on age and aging, and the secrets and the science to living better, longer, healthier and happier lives. The first volume of his collection is now available in e-book format on the Kobo Books website. Click here for more information.