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Author: Pat Armstrong, Distinguished Research Professor of Sociology, York University, Canada
Original article: https://theconversation.com/why-seniors-care-should-have-been-on-the-election-agenda-255220
I was hopeful that when the COVID-19 pandemic drew attention to the plight of senior citizens, the attention might result in meaningful change. Instead, seniors seem to be getting blamed for high costs and high living.
Let me set some context. The Canada Health Act is a remarkable document. It is simple and clear. Provinces must adhere to the principles of universal, reasonable access to comprehensive hospital and doctor care throughout Canada, without charge for medically necessary care and with funding from a publicly administered, non-profit health insurance plan.
Those with a health-care card can go to any hospital or doctor and do not have to worry about health-care bankruptcy or losing health-care coverage if they change jobs or travel across Canada. Because the rich use the same beds as everyone else, they have a vested interest in all beds being high quality.
A good start with good principles
The CHA and the public insurance programs that preceded it dramatically improved access to quality care, quality jobs and — not incidentally in these times — it promoted solidarity across ages, classes and genders through what became Canada’s best loved social program.
Of course, it was not perfect or perfectly equitable, but it was a good start with good principles.
However, there are three basic problems with it. First, it was supposed to be the first step towards a system that covered home care, long-term care, eye, dental and pharmaceutical care, but it stalled there until very recently. Second, the principles depended on the federal government using its spending power for enforcement. And third, it failed to prohibit for-profit services being paid public money or doctors from operating in private practices.
So when the federal government started tinkering with funding, changing from providing cash to match half provincial costs and instead offering provinces tax room, that made both federal contributions and provincial spending harder to track. When Ottawa then failed to keep up funding, provinces and territories started defining hospital and doctor care more and more narrowly, moving care out of the hospitals where the principles no longer applied.
Increasingly, more necessary care had user fees or lacked public financial support. More of it was for-profit; more of it provided lower quality jobs and lower quality care, undermining solidarity in the process. This is especially the case for seniors, whose care needs are increasingly defined as chronic rather than acute and therefore not requiring hospital care. Racialized and immigrant older women are especially likely to have low incomes, making them unable to buy care.
Seniors’ election issues
Which brings me to this federal election and seniors, and to issues that are being swamped by a focus on assembling cars and making tax cuts.
There are gaping holes in access to care at home and in long-term care as well as to hospital care and primary care services. And equally important, there is less access to good jobs providing this care.
We hear a lot about how care at home is everyone’s first choice, but staying at home often requires skilled care, special facilities and support for things like food, cleaning and maintenance, as well as help with dressing and walking. Too often, what we mean by care at home is 24/7 care by female relatives, untrained and unpaid for the work, too often doing so to the detriment of their own health and economic future.
Too often it is about shifting costs and labour to families and individuals, not about choice or overall cost savings. Too often there is no choice.
There has been new federal money for health care, a significant amount of which is unconditional and thus available for home care. But we have seen little effective expansion.
The recently appointed Health Workforce Canada seems primarily focused on getting better data and more migrants to provide care, rather than improving the conditions of work that are vital to attracting and keeping the staff.
If we are serious about home as the place to be, we need to provide the public support for the option, support that needs to go well beyond a few more temporary work permits for care providers.
(Shutterstock)
Nursing homes
Which takes me to nursing homes. At the same time as home care is talked about as the first choice, nursing homes are presented as the last and worst choice. We forget though that many people do not have homes, many homes are unsafe physically and/or in terms of abuse, many homes are isolating, and many people have 24-hour extensive care needs that cannot be accommodated in a private home.
When we ask residents about whether there is anything better about nursing homes compared to their private home, many say yes; they feel safe, there is company, there are activities, and women especially say there is someone to clean the bathroom and make the meals. Of course, we can and should make nursing homes better for people to live, work and visit in them, but we can’t forget that we need them and significantly more of them as well as more people to work in them.
The federal government did fund the development of new standards for nursing homes but then it has done little with those standards. We need more beds, more staff and enforced standards. As with hospital care, the federal government could use its spending power to play a critical role, doing so through the promised safe long-term care act.
And we need more community care clinics providing the full range of services. Here too the federal government has signed some targeted funding agreements but we need more and we need to severely limit private practice that contributes to fragmented care.
Care vs. profit
And in all these areas, we need to ensure the money goes to care rather than to profit.
Of course good and fair health care costs money. But we have to remember that investments in care are an investment in the economy, in equity and in solidarity. The money does not go into a hole. It circulates in the economy. And investments in providing good conditions of work can save money at the same time as they promote care, given that the conditions of work are the conditions of care.
We need to put senior care back on the agenda in the aftermath of this election.
Pat Armstrong receives funding from SSHRC
I am a Board member of the Canadian Health Coalition and a member of the economic subgroup of the Ottawa Council on Aging
