opinion: we need a national shift to ensure canadians age with 'zest and dignity'

the impact of covid-19 has been tragic for seniors and their families. deaths in long-term care facilities have been staggering. the pandemic has also exposed many broader issues beyond ltc facilities that affect our ability to lead fulfilling and dignified lives in our senior years. these have been well articulated by drummond and sinclair, estabrooks (the royal society report), mackenzie (seniors advocate, b.c.) and in andre picard’s recent book, neglected no more.the majority of seniors do not want to be in ltc facilities but sadly often find themselves with no other choice. financial inability to access services at home often pushes seniors into ltc facilities. yet this makes little sense as a recent canadian medical association report estimates the cost of caring is about 40 per cent lower in home care than in ltc facilities ($95 versus $150 per day). much of the support for seniors in their homes is provided by family members and other unpaid caregivers and this is not sustainable. demands on ltc facilities will increase unless we take action now.the authors of this article represent a group of retired leaders from health and public services. we are advocating for a big shift to alter the course of aging that focuses on well-being and not just health care.where do we start? we believe starting with seniors’ feelings on aging — loss of control, personal value, loneliness and defeatism. actions are needed to enable seniors to retain autonomy, respect, dignity and a zest for life.we believe the current aging journey is badly out of line with the expectations of canadians: the vast majority of seniors want to stay in their homes but most don’t think it will be possible to do so; between 20-50 per cent of seniors in ltc facilities could be at home if supports were available; and canada spends about 80 per cent of its resources on elder care on ltc facilities versus 20 per cent on community-based services. the pattern is reversed in countries that have more positive experiences for seniors. a new future for aging in canada could result in a much better quality of life for seniors and lesser cost growth for governments if services were aligned to the choices preferred by canadians.this big shift will require concerted efforts by all levels of government. a new future for aging must be anchored on a fundamental principle that seniors should be supported in a home setting as long as possible. this means providing seniors with more autonomy, respect and dignity and ensuring high-quality health care when it is required.we propose five pillars upon which to build this new future:

• enable measures to increase financial security for seniors;
• foster socialization and active living for seniors — meaningful activities that add purpose to their lives;
• incentivize individuals and community organizations to provide social supports to seniors in their homes;
• make neighbourhood and housing options available to suit the individual needs of seniors;
• ensure quality person-centred care that maintains zest and dignity in both home settings and ltc facilities.

to make this big shift, commitment is needed from our political leaders and each of us. people 40 to 70 years old have an opportunity now to forge a new future for their senior years.the challenges around aging and elder care are complex. most significant is how society supports seniors even before they require care. how we respond will avert or significantly delay admissions to ltc facilities.we support using the canada pension plan to create financial security by adding a new elder-care benefit, building on work done by prof. carolyn tuohy at the university of toronto. we also support increased investments by governments to make the big shift.the importance of building a culture of mutual respect and support at the community level to foster services that enable seniors to live in their own homes cannot be overemphasized. this is where the most effective interventions can occur that directly impact the daily lives of seniors as shown in recent studies of norcs, naturally occurring retirement communities. these models have seniors identify their needs and build mutual support arrangements.much has been said by others for several years about the need for expanded home care. home-care programs are presently very restricted in terms of hours of care and scope of services, largely focused on specific medical needs. services are usually rigidly scheduled and often provided by different care workers, thereby affording little opportunity to build an ongoing supportive relationship with the client.in a new future for aging, we envisage support services that go beyond health care and therefore we do not see expanding the canada health act as the solution.we believe a future of zest and dignity for aging requires new national legislation, a “canada aging act,” such as now being pursued in australia, which would set out a national framework to:

1. assert the federal government’s commitment to reshaping the future of aging in canada and in establishing national standards;
2. embed key principles such as supporting seniors in their homes as long as possible to enable greater autonomy, respect and dignity;
3. recognize the five pillars to support a new future for aging as outlined above;
4. create a new avenue for targeted funding to the provinces and territories with accountability mechanisms;
5. identify processes for collaboration with the provinces and territories to plan and implement new initiatives on standards, performance targets, outcome measures, accountability (possibly under the oversight of the federal/provincial/territorial committee on seniors).

in summary, we see the need for a big shift in priorities and policies to create a new future for aging that supports seniors in their homes. we recognize that many of these directions have been talked about for over two decades and governments will argue they are moving in that direction. much work has already been done to identify changes that are needed. some new initiatives are underway in provinces and territories and the recent federal budget has added others, ltc standards and the age well at home initiative. but progress is too slow to meet the demographic changes occurring in canada. we need to make the big shift now!the immediate challenge is to create the will among governments, political parties, families, community organizations, academics, advocacy groups and citizens at large to make the big shift to forge this new future.we believe the tragic impact of the pandemic on seniors and their families provides a window of opportunity. let us not put all the responsibility for making these changes on governments and politicians. each of us has a role to play as it is citizens and communities at large that shape the agenda for our political leaders. we need to advocate by making our elected officials aware of our support for a big shift and sharing our experiences with senior’s issues. let’s not waste this precious opportunity. the time for action is now to make the big shift to add zest and dignity to aging in canada.don philippon is professor emeritus at the university of alberta, former deputy minister of health in alberta, former vice-president of the capital health authority and founding co-chair of the canadian health leadership network.alex mcpherson is professor emeritus at the university of alberta and former deputy minister of hospitals and medical care in alberta, former president of the alberta and canadian medical associations, former deputy commissioner of the premier’s commission on future of health care in alberta and former president of biomira inc.ken fyke is former deputy minister of health in british columbia and saskatchewan, former commissioner for commission of medicare in saskatchewan, former president of the capital health region in british columbia and founding chair of canadian blood services.marg johnson is a former president of royal alexandra hospital in edmonton and former chair of the health disciplines board.don juzwishin is former executive director of the health council of canada, editor-in-chief of the healthcare management forum and work package lead for age-well.wayne mckendrick is former assistant deputy minister of alberta health and former operational vice-president for extendicare (canada).ken mark is a former senior manager at deloitte business development and owner of a private health consulting business.axel meisen is a former president of memorial university, newfoundland and labrador, former dean of applied science at the university of british columbia and continues to be involved in a wide range of consulting projects related to energy development.linda miller is a former deputy minister of health in alberta, former leader in the development of electronic provincial health records and former strategic consultant with deloitte canada.rick roger is a former president of vancouver island health, capital health, victoria and vancouver/richmond health and former vice-chair of worksafe bc.all are members of the schurman cogitators circle.