Ageing At Home: Is It An Affordable Option?
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18 October, 2021 Ageing At Home: Is It An Affordable Option?
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October 2021
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October 18, 2021

The Empire Club of Canada Presents

Ageing at Home: Is It An Affordable Option?

Chairman: Kelly Jackson, President, The Empire Club of Canada; Associate Vice-President, Humber College

b>Moderator
Peter Mansbridge, Canadian Journalist and Author

Panelists
Dr. Samir K. Sinha, Director of Geriatrics at Sinai Health System and the University Health Network
Dr. Bonnie-Jeanne MacDonald, Director of Financial Security Research, National Institute on Ageing
Laura Tamblyn Watts, CEO, CanAge: Canada’s National Seniors’ Advocacy Organization

Distinguished Guest Speaker
Yvonne Ziomecki, Executive Vice-President, Marketing & Sales, CMO, HomeEquity Bank

Introduction
It is a great honour for me to be here at the Empire Club of Canada today, which is arguably the most famous and historically relevant speaker’s podium to have ever existed in Canada. It has offered its podium to such international luminaries as Winston Churchill, Ronald Reagan, Audrey Hepburn, the Dalai Lama, Indira Gandhi, and closer to home, from Pierre Trudeau to Justin Trudeau. Literally generations of our great nation's leaders, alongside with those of the world's top international diplomats, heads of state, and business and thought leaders.

It is a real honour and distinct privilege to be invited to speak to the Empire Club of Canada, which has been welcoming international diplomats, leaders in business, and in science, and in politics. When they stand at that podium, they speak not only to the entire country, but they can speak to the entire world.

Welcome Address by Kelly Jackson, President, The Empire Club of Canada
Good afternoon fellow directors, past presidents, members, and guests. Welcome to the 118th season of the Empire Club of Canada. My name is Kelly Jackson. I am the President of the Board of Directors of the Empire Club of Canada, and Associate Vice-President at Humber College. I'm your host for today's virtual event, discussing the affordability of ageing at home.

I'd like to begin this afternoon with an acknowledgement that I'm hosting this event within the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wyandot Peoples. In acknowledging Traditional Territories, I do so from a place of understanding the privilege my ancestors and I have had in this country, since they first arrived here in the 1830’s. I want to recognize that a few weeks ago, across the country, many dedicated time on the first National Day of Truth and Reconciliation, to learn more about the experiences of Indigenous children who were forced to attend Residential Schools. Many of those individual stories are untold, buried with them in the land; and many survivors who tried to tell those stories were not believed. I hope we continue to find ways throughout the year, to honour survivors, and to hear their stories. As we connect past actions to present realities, listening and learning from each other is so important. We encourage everyone tuning in today to learn more about the Traditional Territory on which you work and live.

I now want to take a moment to recognize our sponsors, who generously support the Empire Club and make these events possible, and complimentary, for our supporters to attend. Thank you to our exclusive lead event sponsor, HomeEquity Bank, and thank you also to our season sponsors, Canadian Bankers Association, LiUNA and Waste Connections of Canada.

I'd like to remind everybody who's participating today, that this is an interactive event. And to those attending live, we encourage you to engage with our speakers, by taking advantage of the question box; you can find it below on your on-screen video player. We'll try to incorporate as many questions as possible throughout the discussion. If you require technical assistance, please start a conversation with our team, using the chat button on the right-hand side of your screen. We invite you to share your thoughts as well on social media, using the hashtags displayed on the screen throughout the event. And to those watching on demand at a later date, and to those tuning in on the podcast, welcome.

It is now my pleasure to call this virtual meeting to order. I am delighted to welcome Peter Mansbridge, Dr. Dr. Bonnie-Jeanne MacDonald, and Laura Tamblyn Watts to the Empire Club's virtual stage for the first time, and I am thrilled to welcome back Dr. Samir Sinha once again. Peter Mansbridge is an award-winning journalist, best known for his work for many years as Chief Correspondent of CBC News and the anchor of The National; Dr. Dr. Bonnie-Jeanne MacDonald is Director of Financial Security Research at the National Institute on Ageing; Dr. Samir Sinha is Director of Geriatrics at Sinai Health, and the University Health Network; and Laura Tamblyn Watts is CEO of CanAge, Canada’s National Seniors’ Advocacy Organization. Poll after poll shows that Canadians overwhelmingly would prefer to age at home. However, for many, being able to afford the cost of living safely and independently in their own home as they age is a huge concern. Today's panel will discuss a broad range of solutions and strategies needed to improve the affordability of ageing at home, from public policy reforms to specific initiatives that can help individuals plan and prepare financially for their senior years. This is a critical conversation impacting families and communities now, and looking at the demographic trends, the impact of this issue is only going to grow, with more than a quarter of the population projected to be over 65 by 2036. I'd like to turn it over to Peter Mansbridge to kick off the discussion. Peter, welcome, and thank you so much for joining us today.

Opening Remarks by Peter Mansbridge, Canadian Journalist and Author
Thank you, Kelly, it's an honour for me to be here. It's also an exciting moment for me to be here, because there's some degree of self-interest in having this discussion, and me being a part of it. You know, I've gone beyond just looking after and worrying about those who are older than I am on this question, because I'm getting older, so the very fact that ageing has entered into my life, and to my considerations, has made me very interested in the conversation that we're about to have. Let me just set it up very briefly, because there are a lot of facts and figures that come along with this discussion. I want you to just keep one of them in mind as we move forward, and that's that 91%, and in some studies, as many as 97% of seniors want to age at home. That is the stat that I think we all need to keep in mind as we have this discussion. It's a huge number, and behind every one of those numbers is a person. You know it may be your grandmother, it may be your father, it may be you. So, while we have this conversation, I want to make sure that our panelists, and our audience remembers that number; it's an important one. Bonnie-Jeanne, I'd like to start with you. What's the what's the biggest obstacle to Canadians ageing at home? And when I say the biggest obstacle, I mean that, I mean there are a lot of obstacles on this issue. But for you, what's the biggest one?

Dr. Bonnie-Jeanne MacDonald, Director of Financial Security Research, National Institute on Ageing
Yeah, Peter. So, thank you for having me, of course. When it comes to Canada, Canadians ageing at home, I'd say that the reality is that they're really facing a perfect storm. So, it is a combination of obstacles, as you said. There's a trend away from workplace pension plans, there's historically low interest rates, and this is going to result in a reduced retirement income for many Canadians. So, we can see income is going to go down for retired Canadians, but the price tag of retirement is actually going up, and that is because people are living longer than they ever have before; but at the same time, family size has decreased to a historical low, because baby boomers were really the first generation to have relatively few children. And adult children have really traditionally in Canada, and around the world, done most of the care for seniors in their homes. So, without the support of adult children, retiring Canadians are now going to have to finance a longer period of time, with less money, and higher expenses. And now, layered on top of that we have a severely problematic and underfunded public homecare program. So, with ageing population, this is going to really squeeze the public purse even further. So, when we put this all together, what we can say is seniors are really just facing a perfect storm, when it comes to ageing at home.

Peter Mansbridge
And I imagine, Laura, there are some things we don't usually think of in terms of obstacles, that are in fact real, and ones that we need to consider.

Laura Tamblyn Watts, CEO, CanAge: Canada’s National Seniors’ Advocacy Organization
Of course, when we're thinking about ageing at home, we have to think about the built environment. So, if you're trying to traipse up and down stairs on that hip that is a real challenge for you, we know that that's a problem. And so, we don't build structures and build communities to allow people to age at place, but homecare can be torturous for people to access. And people think that homecare is included, that they will get their homecare needs met, until they go through the process of actually trying to get it done. And then they find out that really, often only a fraction of what their care needs would be covered under the public plan, and people really need to find ways to get that care. And that comes sometimes by happenstance, we know that adult children, as Bonnie-Jeanne was saying, has been a great provider of support and care, but we know that rural communities are especially vulnerable. I'm coming to you from a community of Sandycove, Nova Scotia; 80 people, and the closest long-term care home is 100 kilometres away, and homecare is essentially impossible to get. Also, there are people who have systemic barriers, so, different cultural groups have real challenges, members of the LGBTQ+ community may not have those natural family blood bonds, and so can have greater social exclusion, we know that people with disabilities are ageing differently, and they may have different care needs that again, are not met. We know that—Peter, you've been very involved in the conversation around Indigenous communities, and we know that our northern and Indigenous communities are nowhere near having even basic seniors care met, let alone water in many cases. And lastly, of course, newcomers and refugees often do not have access to the public care services that we think of, sometimes up to 40 years before you get access to some of the financial security that would qualify you for care. So, there's a lot of hidden issues. And of course, low-income people are always struggling with trying to make ends meet, and that doesn't get easier as they get older.

Peter Mansbridge
Well, as you say, a lot of hidden issues, and as Bonnie-Jeanne mentioned, a lot of issues that are right up there out in front. What we're going to hope to do over this next little while is not just talking about the obstacles. We've got to be aware of them, and we are being aware of them, but we're looking for solutions as well. But still on the issues that are confronting those directly in the medical practice area, Samir, we know about the physical health costs of ageing, but from a mental health perspective, what are the advantages of ageing at home?

Dr. Samir K. Sinha
Well, I think, you know, why do people want to age in their homes? Why are Canadians so determined to do that? Because first of all, it's where you chose to live at some age, you like the location, you like the neighbourhood, you've actually come to know your neighbours, it's your place, it's with your stuff. And I think this is the challenge, I think for people who want to stay in their own homes with their things, be in their own communities, let alone—I think this from, you know, from an identity standpoint, from a social health and well-being standpoint—I think this is why we have such a strong desire, number one to just be independent, but also, when we can't be able to maintain that independence, you know, this is where we start becoming worried about and concerned. So, some people say that, you know, is ageing at home right for everybody, because wouldn't these people be isolated on their own? Well, that's an issue unto itself. You know, certainly people aren't well connected in an age-friendly community, we don't have good transport options, we don't have good ways for them to be able to stay engaged in their communities, in their homes. That's a challenge that we can do better around. But by and large, when people are threatened with not being able to stay in their own homes, and having to move to another community away from their family and friends, that can be really devastating. And that's why I think so many people are so determined to stay independent in their own homes, and that from a mental health and well-being standpoint, you can imagine how would you feel if I told you, you now have to move 100 miles away, to go live in a home with people you may not even know?

Peter Mansbridge
You know, Laura, Samir just brings up an interesting point when he says, quite correctly, that, you know, ageing at home isn't an option for everybody. So, who isn't it an option for?

Laura Tamblyn Watts
You've got really heavy care needs. So, you need lifts to get in and out of bed, people who need help with both toileting, as well as often helped with dementia, and mental capacity. And for people who are providing care who just can't manage in either the physical environment, or to have the people around them, it's just going to be a challenge. We're always going to need long-term care. It's just trying to make sure that we only are reserving that for the cases of people who really do need it, and not putting people in long-term care who could stay at home longer.

Peter Mansbridge
Bonnie-Jeanne, you spend a lot of time working and studying seniors, their challenges, and what they want in terms of where they'll be when they're in the latter stages of ageing. What surprises you about working with seniors?

Dr. Bonnie-Jeanne MacDonald
Yeah, since studying this topic, I think the thing that's most surprised me is really the lack of urgency by people who this is going to affect. We have this massive group of baby boomers that make up a quarter of the population, and on the whole, they're healthy now, but over the next decade, they're going to be moving into their 70’s and their 80’s. And the pandemic, it's definitely vividly shown us all the situation of the long-term care system, and this is only going to get worse without major reform. So, don't get me wrong, population ageing, it’s going to affect all of us, and there are certainly champions on this issue, but I just don't sense the widespread urgency that is needed, to take us off this very dangerous path that Canada is heading.

Peter Mansbridge
Wow, that really does point us forward into the discussions that we need to have. Samir, can you give us a sense of what the pandemic has done around this conversation about ageing, and what we've learned about ourselves, and about the seniors who are concerned about where they're going to spend their next stage of life? What we've learned as a result of the pandemic?

Dr. Samir K. Sinha
Well, I think what the pandemic has done, is it's given many Canadians a wake-up call, because I polled my medical trainees this morning, you know, telling them about this talk and saying, “how many of you aspire to end up in a long-term care home?” Of course, nobody raises their hand. And I said, “no, now, you know, in light of the pandemic, any of you?” And I have a fellow here from Québec, and she said, “well, after what happened in Québec never will I ever want to go in.” We know that 60% to 70% of Canadians have now said that their intentions of where they want to age have become more cemented, they're more determined than ever before to stay in their own homes. But I think this also creates a reckoning, because then if you start realizing that, wait a minute, to do that, I actually, I didn't realize that homecare is not covered under the Canada Health Act. I might only get a few hours, and there are 24 hours in the day, so who's going to make up the gap? Especially if I have a child who lives in another country or another province, I think people are now starting to grapple with this reality that if I want to age in place, how am I going to do that? Can I even afford to do that? And so, I think this is why we're having conversations like this today, because I think it's actually made us wake up to realize that we haven't, as Bonnie-Jeanne just said, been making preparations, figuring this out. And now I think people are really worried about, well, how is this generation right now going to be ready to tackle this issue? And how do we look at this issue for ongoing generations in front of us, who will eventually have to tackle these issues as well?

Peter Mansbridge
Well, that's where we get into, and we're gonna get into it now a little bit, the role of government in this, and you know, what they're saying. They've said all kinds of things in the last 20 months about where they were going to position themselves as governments, both federal, and provincial, and municipal, to some degree, of how they're going to help on this question. And the issue for us is, how serious are they? What real sense—have they given us that they are serious? Let me just tell you a quick little anecdote. Back in 2015, after the election of the Trudeau Government, we did a program with Justin Trudeau in his first 100 days. And we brought 10 Canadians from different parts of the country, all with different issues on their mind, for 10 minutes, alone, in the office of the Prime Minister, with Prime Minister Trudeau; and they could say whatever they wanted, they could challenge them on any topic they wished. All he knew about them as where they were from, he didn't know anything more than that on each one. Out of the 10 topics, homecare for seniors was on that list, and it was a woman from Atlantic Canada, who wanted answers on what this new government was going to do about helping seniors age at home. She said every one of her friends wanted to stay, and be cared for if needed, at home. The Prime Minister nodded, he agreed—it's easy when you're only in there 100 days, and you're still learning, right? But he nodded, and he agreed, and now here we are, half a dozen years later, without any real movement in any real substantial way to make ageing at home a viable option for seniors. So, let's go around the horn on this one, and Bonnie-Jeanne, let's start with you. What is the government's actual responsibility at the various levels?

Dr. Bonnie-Jeanne MacDonald
Yeah, I'm from Halifax, so I feel her. I mean, Nova Scotia is like an ageing province within a super ageing country, so we definitely are seeing this very closely here. But in one word, it's really just bold action. It's the same words we're hearing for climate change, and it really does apply here in the same way. Policy discussions, they really do need to take a broader view of future, and really have now the courage to make those fundamental reforms, otherwise the system—I've done the projections—it's not sustainable. At the provincial level, provinces should be not acting alone, we need to take a unilateral response, and the federal government does need to come front and centre of those reforms. But as I can say, we are behind the eight ball, we need to catch up, and we need to do it efficiently and effectively, otherwise the future looks very problematic.

Peter Mansbridge
Well, you know, and also as we know that not everybody looks to government for solutions, they also looked to the private sector for solutions. What's private businesses’ responsibility here, Laura?

Laura Tamblyn Watts
You know, the first rule in business is, love the customer that you have, and don't turn away from the customers who are knocking down your door. And yet, we've seen so much ageism in business, that is actually a few businesses that we can point to that are getting it right. I would say that companies like Kobo, the eBook company, have been front and centre in age tech and making sure that reading is accessible, and viable for people. We see banks, Scotiatrust, as an example, is really getting into many of the different issues that can problem-solve people in their financial, I know RBC is also digging into that very robustly. We see Best Buy, who is our, you know, often local electronic store that you go to when you need a TV, but they are transforming healthcare, and technology. So, we're starting to see some really name brand companies get into this area. But remember, in Silicon Valley, if we're thinking about where so much of this industry and investment comes from, you know, people start experiencing ageism at 30. And so again, love the customer that you have, and the customer that you have is going to be over 55, and they're the customer that you need.

Peter Mansbridge
So, we got government responsibility, we have private sector responsibility, and as always, we have personal responsibility. Samir, talk to us about personal responsibility.

Dr. Samir K. Sinha
Well, I think it's easy, you know, to say in Canada that okay, well, you know, you better, you know, sort yourself out then, for your homecare costs in future. But I think the problem that we have when it comes to the issue of personal responsibility, is we have not defined for Canadians what the social contract is around ageing in place. So, Canadians are born into a healthcare system that they understand as universal, and pretty much until you're 65 or older, for example, you know, pretty much everything you needed along the way is covered, whether it be primary care, whether it be hospital care, any of that sort of care generally is free at the point of service, and you can make it through. But when you start realizing that long-term care was something we excluded from the Medical Care Act, what we called Medicare in 1966, it was never enshrined in 1984 in our Canada Health Act. For example, all of a sudden people start reaching their golden years, realizing the care that they now come to rely upon, whether it be care in long-term care homes or nursing homes, or homecare, isn't actually covered. And I think this is a problem because we're not making that clear to people, and so it's hard to say, “well, why haven't you saved? Didn’t you know?” We haven't made it clear what people will cover, and as you mentioned, that older lady who spoke to the Prime Minister, if you recall, homecare became a national election issue back in 2015. We actually had the Federal Liberals at that time pledge, I believe, $3 billion for homecare, we had the NDP pledging $1.8 billion for homecare, it actually became a bidding war amongst the federal government, federal parties, when it's actually provincial and territorial jurisdiction. What subsequently happened was $6 billion over 10 years, to try and boost homecare to the provinces. But we are still currently spending 30% less than the average OECD country in providing long-term care funding, publicly funded long-term care services. And because of that, we have 430,000 Canadians on waitlists for homecare services, and we have over 50,000, who are now on waitlists for nursing homes, because we've deliberately underfunded our system. So, personal responsibility is certainly telling me, what do you cover, what are you not making it clear what my responsibility is? And then we can start helping Canadians determine once we’ve agreed on the social contract, what they need to do, and what the government will be there to provide them. And we've never made that clear to anybody, which I think has created a lot of confusion, and put people in a lot of strain at the end.

Peter Mansbridge
Let me just quickly follow up on you. Throughout that answer, you were talking about, “we haven't done this, or you haven't done this,” who is the we, and who is the you?

Dr. Samir K. Sinha
All of us, right? I mean, I don't think that we, as Canadians, have fully understood that we actually have a beloved universal healthcare system that doesn't look like most other universal healthcare systems in the world, because most other good universal systems actually cover long-term care services, whatever they may be, and may me backed by a public long-term care insurance program, so that anybody who might need that 24/7 care, or other supports, can have this right now. We really have a two-tiered system. If you're rich and wealthy, you might be able to afford $25,000-a-month for in-home care, but if you're poor, you're likely going to end up in a publicly funded long-term care system, which ends up costing us all more as taxpayers, than if we actually had more publicly-funded, available homecare. So, we've all created this problem. We actually have the tools and the opportunities to get out of it.

Peter Mansbridge
Bonnie-Jeanne, who should be taking the lead on this, and have you seen any indication? We've been through this calamitous 20 months, that's made us all focus on all aspects of healthcare, and especially for those in the ageing category. Have you seen any movement? Has there been a movement positive movement on this issue, and if there has, where's the lead coming from on that movement?

Dr. Bonnie-Jeanne MacDonald
I would say that there's definitely been pockets of movement, important pockets, but they're often very siloed. And in a way, we're almost stumbling in the dark when it comes to working together, and kind of creating that collective response, because, again, we are quite behind. And in order to catch up, we need to really be more efficient, and more effective. So, we need to leverage from the lessons learned, as Samir mentioned, in other countries, but we need to also look at the wealth and the health side of ageing, in academic research and elsewhere. This is really what we aim to do with the NIA, this is what I'm passionate about. But I don't think there's been—there's been definitely movement from individuals, there's not been a collective movement forward to envision, okay, what is the future of Canada going to look like? How do we ensure that the atrocities we saw during the pandemic don't actually repeat themselves?

Peter Mansbridge
Laura, do you want to add on that?

Laura Tamblyn Watts
I do. I mean, I think one of the pieces that we need to really be thinking about is the seniors’ lens. So, one of the five mega-trends for the World Health Organisation is ageing, in the way that climate changes as well. And so, if we require our governments to put a seniors’ lens on each and every pocket of work that they do, then we will have to force through the thinking, and right now that pocket-based piece that Bonnie-Jeanne was talking about, needs to become an overarching. So, we are really, at CanAge, pushing to provide government with a framework to think through these issues, because it can't be bits and pieces. You know, we talked about the $6 billion in homecare over 10 years—did your homecare get better? Mine didn’t. Because it went into general revenue, it didn't go into tethered supports that had responsibility back in—when I went to law school decades ago, we learned about the division of powers, but it wasn't really so that finger pointing would happen, which is what we have here. And Canadians are fed up with finger pointing; they want real solutions, and they want the governments to work together.

Peter Mansbridge
All right, this is just let you know, we've got eight or nine minutes left before we start to get the questions from the audience, and already there are many, many questions from the audience, which is great to see. So, let me just ask a couple more before we get into that. Samir, how should seniors prepare for ageing at home?

Dr. Samir K. Sinha
You know, I think you're never too young to start thinking that forward. I mean, I purchased my latest home few years ago, and you know, maybe as a geriatrician, I started thinking when I was purchasing, like, is this a home that I could age in? I always like to think, you know, hope for the best, but plan for the worst. So, I'm now on a single-story setup, I have all my door widths, you know, 32 or 36 inches wide, because the international width for wheelchairs and walkers is 32 inches, for example. It's thinking about, you know, what happens if I—if this is a home that I aspire to age in, and this is my dream house, or whatever it might be, or if I might end up living here for the rest of my life, how do I think forward as to what do I want that place to look like? But also thinking about, okay, well, what, you know, if I wanted to, you know, get homecare and services, educating oneself about what's covered, what's not covered, how one might have to save, or what are the options that one can actually do, to actually afford to age in the place in the way they want. I think, for a lot of us, there's that opportunity, when we think about where we are, no matter what age we are, it's thinking about what could that future look like, and how are you best prepared? And most of us just never even bother to even do ask ourselves that question.

Peter Mansbridge
Well, you look at Samir, he looks like 35 to 40 years old, and he's already worried about whether or not you should be in a single, you know, a single-storey home—I mean, that's very impressive, when you say start early. Bonnie-Jeanne, any disagreement on that about starting early, and thinking this way?

Dr. Bonnie-Jeanne MacDonald
Yeah, no, absolutely, I mean, the sooner the better, that goes without saying. But what I'd like to also add is that when we do planning, we really need to shift away from short-term thinking to long-term planning. This is especially true when it comes to retirement, financial planning. Retirement can last 10, 20, 30, even 40 years, and the human brain is just not naturally equipped to think that way. This is especially true, according to the science, when it comes to thinking about bad things that can happen to us in our future; we just, our brain is not very good at imagining those future possibilities. So, there are really two important reasons why it's important to take that long term perspective. Of course, the first is that it gives us more time to plan, and usually we have more options the earlier that we plan; but I think the other reason, and maybe the more important one, and one we don't really talk so much about is that, when we can do long-term planning, it also can dramatically change the way we evaluate our different personal options. And so, for example, one solution that would be tremendously valuable for Canadians, is their option to delay their Canada Pension Plan benefits. So, Canadians, most Canadians don't know this, but they don't need to take their CPP right away, they can wait to age 70. and this would actually more than double this lifetime, worry-free, gold standard pension; there's really no better financial strategy out there, when it comes to getting more secure pension income. But only 1% of Canadians do this, and in fact, 95% of Canadians take it by age 65. So, just to give an idea of what that means, the average Canadian would basically be losing about $100,000 of lifetime income by taking at age 60, rather than age 70. So, we can imagine how valuable that ongoing income would be for someone in their 80’s and their 90’s, to age at home. So, again, taking this long-term perspective, it's important, of course, for policy decisions, but it's also very important for individuals themselves. And for sure, it's hard to do, humans are much better at seeing and solving problems that are right in front of them. But this is a situation where we need to take that long term perspective, it's absolutely crucial to coming up with the right decisions.

Peter Mansbridge
I'm glad you mentioned the CPP, a decision that all Canadians have to make. Because I can remember when that offer first came through to me, and my friends of a similar age, you know, your initial instinct is, they're just trying to save money, they don't think we're going to make it to 70, right? So, they'll never have to pay out anything. But you make the argument, you know, extremely well, about the difference that can make, especially when you consider the different costs you're going to face when you reach that age. Laura, it's not just people individually, making decisions on their own about the future, but it's also how they share the decision-making process with their families. Talk to us about that.

Laura Tamblyn Watts
We have real discomfort talking about ageing generally, and when you were asking Bonnie-Jeanne what was surprising about working with older people, you know, the most surprising thing that I found over these decades is that nobody is old. That is the most surprising thing, you know, old 20 years older than you are. At a certain point in the 90’s, usually people give up and they admit that they're old, but until then they're not. And so, I don't think necessarily always ageing is the way in, it's more contingency planning and family planning, and that's a more optimistic way. So, what was a time where you fell, and you put your foot in the cast, and how did you make your way around that? What did you do one time, when you pulled your back out, you couldn't get to places? So, people can grasp that idea of things that they need to accommodate, much better than they can think necessarily about ageing. And so, if you can break those conversations out and start early, you know, this is a conversation you can have when you have young kids, and say, “how are you going to get to school if mommy's foot is broken in a cast?” And we normalize these conversations around strategic planning. And I think the pandemic has given us an opportunity to have those conversations in a new way. And that tends to make people feel confident and supported, as opposed to just another thing that you're supposed to be doing that you feel upset about.

Peter Mansbridge
You know, a lot of the things we have been talking about here do underline, you know, a shift in the way we think about ageing. And I'm wondering, Samir, perhaps you can help us here, it's a big shift for a lot of people. And I'm wondering if there's the collective will to do this?

Dr. Samir K. Sinha
I think there needs to be the collective will to do this, because within 10 years from now, 1 in 4 Canadians is going to be an older person 65 or better, as I like to say. And I think, you know, while we've been a youth-obsessed culture, we're all into buying anti-ageing products, and these sorts of things, I think the key is, is that, we have to understand that if we're lucky enough to make it to 65—and most of us will be—you're gonna have about 20 years of life expectancy ahead of you. And that's, that's a good thing, we should celebrate that, because if you were born back in 1900, you would only have had a life expectancy of about 51 years of age. So, I think this is now coming up to a lot of people, especially the pandemic, I think, started putting people in uncomfortable situations thinking about, you know, pulling their loved ones out of long-term care homes, for example, or trying to say how do we try and provide more care, you know, to support mom so that she doesn't have to go somewhere else? And I think it started surfacing a lot of issues. But I think, as Laura said, I think the better opportunities we have to celebrate the fact that we are going to live long lives, and how are we going to be prepared to meet the needs of an ageing population, and our and our own selves. I think there's a way a positive way we can frame it, but I think politically, if our governments don't actually start collectively working together instead of finger pointing, I think that we're going to be in a challenge. But luckily, I'm hoping that, with soon one in four Canadians being an older person, if all of them just voted for what they wanted for example, that's more votes than any political party has ever received in Canada; and I feel that that will be our final way to get things done.

QUESTION & ANSWER

Peter Mansbridge
All right. Let's move to questions from the audience. And, you know, that's one of the great things about technology today, that we can even have this discussion as we're having a now on, on this is the Zoom platform, which has changed our lives. Some would argue not for the better; but on a day like this, this is just a tremendous way of moving information around with, you know, three extremely qualified people on this subject. And equally now, we have this opportunity where I can just pick up my smartphone and look at the questions that have been coming in, and ask some of them—we'll get to as many of these we can. First one, and Bonnie-Jeanne, why don't you try this, for an answer on this one? Why is so little attention, resources, public dollars, allocated to home and community care and supports, compared to long-term care homes?

Dr. Bonnie-Jeanne MacDonald
I would say, so I came at this topic from a pension background, so I've been studying the Canada Pension Plan and was involved with the reforms, and Old Age Security. And what I kind of, when I came in and started doing this type of work from that financial economics lens, what was really surprising to me is that there's no central federal responsibility, because it's under, it's in the health domain, to look at long-term care. And this is a little unusual. So, for example, the Canada Pension Plan, we have two federal departments who are devoted to basically looking at the program, projecting to the numbers, deciding you know, what's going to work, what's not going to work, how can we change it, how can we make it better; and because of that, we have one of the best pension plans in the world. Long-term care has never gotten this attention, and this is not normal, because if we look at European countries, they'll do these same types of analysis with their social security pension systems, but they also do with the long-term care systems. So, because of that, I think this lack of attention, when you don't measure something, you can't manage it. So, because we haven't been measuring the fiscal consequences of the path that we're heading on, we've really just been burying our heads. And if we had been doing those numbers, we would have done the interventions that other countries like Denmark have done, and many other countries, where they said, okay, you know what, not only is institutional care what Canadians report to not want, unless they badly need it, what people say is they want community care, and community care in the homes. It's also, generally, a more cost-effective option. So, what's really interesting about this topic is that I think, had the analysis been done, had these conversations really gotten that public policy attention that the primary healthcare system has gotten, that better Canada Pension Plan and our retirement income systems have gotten, we would have had these conversations, and more money would have actually been put into homecare, where it's what both Canadians want, and it's also better in the long run from a fiscal perspective.

Peter Mansbridge
All right, Samir, this one is for you. Jill and Jackie ask, it is less expensive to provide care in the home, to make home modifications, than it is to house people in long-term care. But governments, knowing this, continue to build long-term care homes, with Premier Ford and Ontario investing in more long-term care beds. Can Dr. Samir Sinha talk about ageing at home? Where will the money come from, for caregivers to provide homecare?

Dr. Samir K. Sinha
That’s an excellent question, and so just, and this is the challenge, because I think we're not honest to Canadians. And frankly, you know, I don't think we're being honest to Ontarians about our current long-term care strategies, for example, in Ontario. So, right now, the Ontario government is committed to building 30,000 new nursing home or long-term care beds and renovating another 30,000. And I put out a report for the NIH saying that that actual cost alone to the taxpayers will be $12 to $16 billion in infrastructure costs, just to do that; and that's, forget about the care costs. And caring for an older person in a long-term care home, the Ontario government says about $200 a day; but caring for them in their own home, through publicly funded homecare systems for long-term care eligible people, it’s about $100 a day. So, you know, I do think right now we're seeing a lot of pieces on the news where politicians are having a nice ribbon-cutting, saying, “we're doing something, it's called this building, and this will solve your issues, even though they take years to do;” versus I suggest that, next time I meet with the Ministers is, why don't you stand in front of an older person's home, you know, we can put a ribbon there if you’ll cut it, you can have a ribbon-cutting in front of all these home showing that, for only a little bit of money, you can do a home renovation, you know, buy a piece of equipment, or that a little bit of homecare, and it will actually save a lot more money down the long road. But right now, we're not honest with voters about what their options are, and I think, frankly, I think politicians get seduced by building shiny things that are good for photo ops, rather than what societal need says we need.

Peter Mansbridge
Not going to argue with you on that one, Samir, that's a very good point. Laura, what can help seniors who don't have RRSPs, or pensions from employment? Many Canadians are in this situation.

Laura Tamblyn Watts
I think it's really important to remember, there are a lot of Canadians who are not kind of white, middle-class, married people; that the diversity of Canadians really needs to be looked at. And so, when we're thinking about financial security, we need to think about the ability to earn money into different age groups. So, the idea of 65 is really a made-up number, it’s a historical number created when we died at 67. Many people want and need to be able to create financial security, well into their age. And so, we know that there are a lot of barriers to doing that. I mean, the most obvious one, if you're an employee, is you bump into either mandatory retirement requirements and things like unions, or alternatively, you're stymied because you can't get investments, because people don't want to invest in older people, or they have ageist ideas. So, we really need to work with business, and we need to work with job creation, to allow people to generate their own income, and not be at the hands of our—gold standard, but still very modest—public income replacement system, which is our CPP, and OAS and GIS. The other piece is, we need to make it less expensive for people to just live. And so, thinking about how we can collectivize some of the programs and projects are important. So, one of my favourite ones are naturally occurring retirement communities, NORCs, where folks get together who live in that same area, whether it be an apartment building or a local community, and they self-organize care and support, and they help each other, because we are not having that intergenerational connection that used to help to hold things up, so we need to come together in different communities to share resources and to save money. So, there's lots of things that we can do, but we do need to look as a social planning, as opposed to a medical planning model, in order to meet those needs.

Peter Mansbridge
People are looking for lobbying guidance here, to try and make the situation better. Bonnie-Jeanne, why don't you try this? What steps do we take to lobby our provincial or federal government, so that more attention is paid to senior needs? I mean, it's been right out there; it's been it's been a topic of discussion for, well, as Samir said, for the last, you know, at least half a dozen years. But clearly, there still needs to be more lobbying, so what would you suggest on how to make the case in a better way than we've made it in the past?

Dr. Bonnie-Jeanne MacDonald
Yeah, that's a that's a good question. I mean, let's see.

Laura Tamblyn Watts
Well, that's what I do.

Dr. Bonnie-Jeanne MacDonald
I would talk to Laura.

Laura Tamblyn Watts
I say, Bonnie-Jeanne, a little bit on that one as well. So, I mean, CanAge is Canada's national seniors’ advocacy organization, our works help to improve the well-being of all Canadians as we age, and we work with government to make that case. And what we know is that, if you measure things, and you can point to that local connection with policymakers, you're much more likely to move the needle. You know, policymakers want to know what other countries, and other jurisdictions in Canada are doing, and they want to be able to compare back and forth—and we're doing a report card on dementia right now, we've done what on vaccines—making it really easy for policymakers to move the needles, work on a solutions base. And as an individual—you know, you can join CanAge for free, at canage.ca/join if you want to be part of that—local connection and local community matters to people. And so, instead of thinking about how we're going to pull that lever of power with an organic argument in the amorphous system, you got to make it local. Get your local person engaged and have those conversations to create solutions. We do need to do it, but politicians think in very short periods of time, so you need to give them something that they can move on quickly, in a short period of time. Because they are not themselves going to be able to reframe an entire structure, so if you're gonna move the levers of power, you’ve got to make a big noise, and we’re happy to help you do it.

Peter Mansbridge
Did you want to add to that, Bonnie-Jeanne? I know you were tossing with trying to come up with the your best advice on lobbying, aside from, you know, dialling Laura up.

Dr. Bonnie-Jeanne MacDonald
So that's, I mean, we do, our own lobbying efforts are a little different. So, I mean, in 2018, we and experts across Canada, we basically realized that there's improvements that can be done to the Canadian retirement income system. and we came together, we basically created one of the biggest coalition's and retirement income history, and we wrote a letter to the Federal Minister of Finance at the time, and just outlining how tax and legislation changes had to be made, and the research behind it, and all the reasons why. And then in 2019, they actually put it in the federal budget, so that this lobby effort of ours actually now is being legislated, and it will fundamentally change the way that retirement income system works. So, I think, I mean, what I believe is that there are so many champions in Canada on this topic, and if those champions came together and did actually work together, and collaborated, and also worked with government to kind of take that long-term perspective together, we could, you know, just move away from the short-term fixes to really understand those long-term implications. And I said earlier that the system wasn't sustainable—I wasn't saying that just kind of off the cuff. Another big research we have done is actually we projected the Canadian population forward, using the government's own population, highly sophisticated model, and what we found is that if we continue on this current route, the cost of long-term care is going to go from about $20 billion, up to nearly $100 billion, just in the next couple of decades. So, put into cost perspective, by that time, it's basically a quarter of all federal and provincial income tax revenue. So, this is not a sustainable system. So, when I, you know, emphasize that we really do need to think of ways to bend the cost curve, as well as deliver better quality of care, this is backed up by research and evidence. And it really is going to take the collective will, of not just the people in government, but also people, experts from industry, experts from, you know, various areas of research as well, to come together and kind of bring forward solutions that can then be adopted.

Peter Mansbridge
Okay, we're quickly running out of time, as more and more questions rush in. Samir, try this one, Janet asks, when we look to government, it does not have to be for money. I'd be interested in what you think about other kinds of government actions that would assist, well, seniors to age in place at home?

Dr. Samir K. Sinha
No, I think it's an excellent question, because I think, again, right, knowing that soon enough, within 10 years, 1 in 4 Canadians will be an older Canadian, knowing that we actually have these issues already that are mounting up in terms of a lack of homecare, and that, I think there's just some simple things, again, that we have been lobbying to do. So, part of the work that we've been doing through the NIH is helping to frame these issues, as Bonnie-Jeanne just said, building coalitions, and then working with government to help them show what needs to be done. And when we think about these things, it's raising awareness, helping, you know, Canadians, you know, through events like these, understand that things aren't all rosy moving forward, and that there are things that we need to do ourselves right now, because our government hasn't caught up to our needs. But then how do we educate ourselves, so that we can basically help tell government what we're looking for them to do? And often, many of the things that we want, more abilities to age in place, can actually save the government money. So, a lot of, you know, while this current government Ontario criticizes the previous government for in the previous decade, for not actually building, you know, only a few hundred beds, they neglect to mention that by investing more in homecare, we actually created 30,000 more spaces in our homecare system, to support long-term care eligible people in their own homes, where they wanted to be, and didn't have to spend $12 billion building new physical settings. So, there are actual things that we can do to save money, but a lot of this really comes down to making sure that people know how to get information, know how to access it, know how to navigate. And these are things that government can do that, ironically, can save money, and actually better support people to make the choices that they want you to live independently.

Peter Mansbridge
Bonnie-Jeanne, I like this question that just came in. I understand the issue of affordability, but the issue of availability of support workers is a huge issue. Does Canada have a sufficient number of healthcare workers to support ageing at home?

Dr. Bonnie-Jeanne MacDonald
Yeah, so the labour force market, that's a huge topic in Canada, as well as internationally. I think, historically, Canada has really depended on immigration to solve that problem for labour force supply. But, you know, some research we did last year talking with experts, what we really did find was, one of the number one concerns is that these personal support workers, they're underpaid, they're in a dangerous working condition, and we really saw this play out during the pandemic, exactly what these people are facing. So, labour supply is a huge obstacle; how to train these people quickly enough to meet the demand is going to be another obstacle. So, this is somewhere where, you know, public policy, the education system, really does need to figure out a way to provide that level of support. I'd like to also add that, you know, we have the professional care workers, but as I mentioned, about 75% of care, based on the data numbers we ran, is done by family members. And I think we need to be a little bit more creative in the way that we're financing long-term care. It’s strange that we are paying for professionals to come into people's homes, but we're not coming up with new ways to actually finance people, to make it affordable for them to actually stay home from work and take care of their family members. And oftentimes, in Germany and Netherlands, a lot of other countries, they found that giving people, it’s a structure where people actually can use their long-term care funding to pay their own family members. And this kind of system, it just will take a lot of stress off the unpaid caregiving system. And in my mind, it's a way to hold on to a system that has been so valuable to Canadians—we’re basically getting a 75% discount on long-term care because of the free work the family's been doing, and if we can at least preserve that system, then that's going to give us a lot stronger position going forward, especially as I already mentioned, baby boomers were really the first generation to have relatively few children. So, those fewer children are going to have to do even more. And if they have to do it at the expense of their careers, and at the expense of their own families, that's going to be even more difficult. So, again, labour force comes to pay caregivers, but also ways to better support the families themselves.

Peter Mansbridge
Laura, last question for you. How do we consider the impact of inflation on the funds we have now projected, maybe 20 years from now; if you try and make those plans for a couple of decades from now for yourself, or for others who are close to you, how do you factor in inflation?

Laura Tamblyn Watts
Inflation is one of those double-edged swords, right? We want our investments to have high inflation, because in the sense of you want to have more money coming in, but you don't want to spend it as well. So, really, I think what we need to remember is, if you are in the ability to put money aside for longer periods of time, you're going to need to have a mixed modality of where you put your money. And we've seen crashes happen in the past, we know that they are going to be something that we need to think about in terms of future, but that if you're investing for the long run, these things smooth out over time. You know, inflation is also one of those things that is not well-marked by a government support. So, if you're a poor person, if you're a low-income person, you may be receiving supports that have not been bumped up for cost of living or inflation, and you can see that what would have been appropriate 10 or 15 years ago, now doesn't go very far. So, we need to think about it both in our private resources and what we're going to do for that, we also need to make sure that those amounts that our government give, are tethered to what it really costs to live in today's markets.

Peter Mansbridge
I, you know, I'd like to thank the three of you. It's been a fascinating opportunity to listen to three experts on this subject on a subject, which is, you know, as Samir mentioned, as you've all mentioned, is only going to get more critical in the days, months and years ahead, as the numbers accumulate in a bigger fashion for those who are in that kind of key area of the ageing demographic. So, we appreciate all of your comments and your thoughts on this, and we really appreciate all the questions too, that came in from the audience, really good questions. I know there was a lot of action out there, an audience lined on this panel. So, we, the four of us appreciate your concerns, and your thoughts on what we've had to discuss. And on that, I hand it back to Kelly.

Kelly Jackson
Thank you, Peter. I'd now like to introduce Yvonne Ziomecki, who's the EVP of Marketing and Sales, CMO at HomeEquity Bank, to deliver some appreciation remarks.

Note of Appreciation by Yvonne Ziomecki, Executive Vice-President, Marketing & Sales, CMO, HomeEquity Bank
Thank you very much, Kelly. On behalf of HomeEquity Bank, I wanted to thank the Empire Club for hosting the event today. I want to thank Peter Mansbridge, who managed to squeeze this very important panel into his busy book tour week, and also of course, I want to thank the panelists, Dr. Samir Sinha, Dr. Bonnie-Jeanne McDonald, and Laura Tamblyn Watts. I hope that everybody enjoyed the discussion, and ideas exchanged during the past 45 minutes. The last 18 months have created a lot of uncertainty and anxiety for all Canadians, especially the older Canadians. And while ageing in place is not an easy topic, I would say the pandemic has definitely been a wake-up call, as mentioned on this webinar. And at HomeEquity Bank, we work with Canadians 55 and older; we probably know what they're thinking, what they're feeling, better than many other companies out there in the marketplace. And we know that they've been feeling safe in their own homes, they've been adapting their homes, they've been renovating, and they've been trying to figure out how to stay there longer, and how to find homecare. The reality is, as Dr. Bonnie-Jeanne MacDonald said, there are insufficient savings, they don't have enough income, they have less children than generations before, so we need to find a solution. And it was very interesting to hear Dr. Sinha talk about his home, and the need for fierce independence, because that is exactly what we hear from our customers over and over again. So, I hope we can continue the conversation, and come up with practical and pragmatic ideas to help Canadians age in the safety of their own homes. Thank you, again, to the Empire Club, and over to Kelly.

Concluding Remarks by Kelly Jackson
Thanks, Yvonne, and thanks again to our panel, and everybody joining us today, or tuning in at a later date. Our next event will take place on October 25th, at 12 noon, Eastern Time. Globe and Mail health columnist André Picard will be back at our virtual podium, for an in depth conversation with Matthew Anderson, President and CEO of Ontario Health, all about transforming healthcare beyond the pandemic. More details, and complimentary registration, are available at empireclubofcanada.com. This meeting is now adjourned. Thank you very much. Have a great day and stay safe.

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Ageing At Home: Is It An Affordable Option?


18 October, 2021 Ageing At Home: Is It An Affordable Option?