The Perfect Storm Facing Canada’s Rapidly Aging Population: An Interview with Bonnie-Jeanne MacDonald, Ph.D.

In an interview in the March/April issue of Plans & Trusts, actuary Bonnie-Jeanne MacDonald, Ph.D., FCIA, FSA, called for new policies and practices to address the multiple challenges and opportunities facing Canada’s long-term care model.

MacDonald, the director of financial security research and a senior research fellow at the National Institute on Ageing at Ryerson University, predicts as dire as all the gaps and problems are today—they pale in comparison to what’s coming down the line. MacDonald talked about the long-term care challenges and potential solutions facing Canada’s rapidly aging population.

Five key health care trends she discussed:

1. Older adults living with chronic illness and disabilities are supported by a mixture of publicly funded programs and privately paid services largely in institutional settings, such as nursing homes. The real backbone of long-term care (LTC) is provided by the voluntary care of friends and families. People who provide senior care are already reporting higher levels of stress and financial burden, and it will only get much more intense.

2. For years experts were trying to address issues with understaffing and quality of care already pervasive in nursing homes, COVID-19 revealed the severity. In addition, hundreds of thousands of Canadian seniors have unmet care needs; they’re living in the community, but not getting the care they want because there aren’t enough nursing home beds, or they don’t yet need 24/7 care provided by nursing homes.

“We have this massive cohort of people, Baby Boomers, who make up a quarter of our population. During the pandemic, some of the politicians have said the reason we’re having all these problems in nursing homes is because of the ageing population—but many Baby Boomers haven’t even reached their 70s! It’s not until their late 70s and 80s that people needed long-term care. Then we’re really going to be in a perfect storm,” MacDonald said.

3. People are not only living longer than ever before, but Baby Boomers were also the first generation to have relatively fewer children. The National Institute on Ageing (NIA) found that 75% of all the care being done for seniors is being done in the home, by family. Providing these services becomes much more difficult when people have fewer children, and those children live farther away.

Not only will there be many more Canadians needing care, but a more significant proportion will also rely on formal care.

4. While the pandemic has made the public aware of all the problems that already exist in long-term care facilities, people are starting to ask how they will be cared for and what programs are available to support them. What are policy makers and legislators doing to address these gaps? “At the federal level, they’re creating national senior LTC nursing standards, which is great, but will still require the full cooperation of the provinces to fully and meaningfully implement,” MacDonald said.

People know what they want, but the question remains, how it will be financed by the government, which doesn’t look promising.

5. Although politicians are focused on building more nursing homes to address the massive shortages today, experts agree helping seniors age at home can be more affordable than nursing homes.

Establishing national long-term care standards would help them stay in their communities, allowing them to age at home, which can be more affordable than nursing homes. MacDonald, among other researchers, wants to move the discourse beyond exclusively thinking about the management and delivery of long-term care in nursing homes and start thinking ahead.

MacDonald hoped we learn from our mistakes instead of just reacting to the crises. “It’s all about planning for the future and creating smarter systems. Otherwise, our systems will become inadequate and increasingly expensive—the worst of both worlds.”

Tim Hennessy
Editor at the International Foundation

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