There have been fewer than the usual suspects applauding the release of Living Longer, Living Well, Dr. Samir Sinha’s anticipated recommendations for a new seniors strategy for Ontario. In the early days of 2013, maybe nobody is yet paying attention.
Appointed provincial lead last year by Health Minister Deb Matthews, Sinha spent much of 2012 travelling the province and consulting with everyone it seems but organized labour (not that we’re bitter).
Promised for December, the subsequent report did not linger long in the Minister’s office before the highlights were released publicly yesterday. The full report is expected in the next few weeks.
Like last January’s provincial strategic plan, Dr. Sinha’s strategy seems to be long on lofty recommendations and somewhat short on logistics about how this all gets done, especially in an environment of considerable restraint.
Depending on where you sit on the political spectrum, you’ll likely find recommendations you like and recommendations that seem completely off the wall.
Regardless, the key recommendation around resources does leave much to be desired, suggesting the province should “at least” continue the present 4 per cent annual increase in spending on home and community care planned for the next three years.
Not all recommendations involve spending by the Ministry of Health, but there are no references to other departments kicking it up a notch.
Given these are not big budget sectors compared to primary care or hospitals, the government could likely afford to be more generous without blowing the bank if it truly believes Sinha has the answers. The underlying theme is that with these additional resources, there could be savings on other points in the health system, although little evidence is offered.
Much has been made of his argument for more long-term care beds – Sinha told the Toronto Star that the numbers need to be tripled over the next 20 years. We should note that the highlights document does not actually make that specific recommendation – instead it speaks more vaguely about funding as resources become available. That could take a long time – just ask Ontario Children’s Advocate Irwin Elman how agencies have been waiting for funding to implement hundreds of inquest recommendations from the Coroner’s office. Given Sinha suggests that these problems are on a clock, the laissez-faire approach to funding seems badly misplaced.
Never-the-less, the CCACs must be cheering given the government’s recent restraint on adding new nursing home bed capacity has left them under considerable pressure. When Dr. Sinha spoke at last November’s OHA conference, one unnamed CCAC executive practically begged him to recommend an increase in nursing home bed capacity.
More controversial is the recommendation Health Minister Deb Matthews seems much more interested in – making wealthier seniors pay for more of their home care and support services. By wealthy, the province defined those seniors earning more than $100,000 a year individually or $160,000 a year as a couple when it came to implementing a similar “make the rich pay” scheme for the provincial seniors drug plan. That was not a slight rattling of the cup either – the plan to be implemented in August 2014 will take three per cent of the net income of so-called rich seniors earning a combined $160,000 or more per year. How much more would the province be adding to that bill for home care costs?
While “make the rich pay” is a popular mantra these days, most would not necessarily consider these incomes as rich, especially if you are still paying down a mortgage in the City of Toronto. The other problem with such fixed parameters is that inflation can erode these figures well into the core middle class within a relatively short number of years. Just look at the masses of ordinary workers who have been thrust into the similarly unadjusted Sunshine List.
As Derrell Dular, managing director of the Older Canadians Network says, we already have a means-testing system for funding care – it’s called the tax system.
Sinha follows Dr. David Walker’s lead in recommending greater access to physiotherapy for Ontarians over 65, albeit clinic-based and not in the home. Like the “make the rich seniors pay” recommendation, Sinha suggests that enhanced access to clinic-based physiotherapy services should be “especially for those on limited incomes who often forego this therapy when prescribed due to their financial means.”
Given the rapid rate publicly funded physiotherapy is disappearing in Ontario, this is at least something to cling to, although this was not one of the Minister’s talking points yesterday.
Short on specifics for new care models, Sinha instead punts the football downfield to a proposed provincial working group to develop. That group includes geriatricians, care of the elderly family physicians, specialist nurses, allied health professionals, and others. He follows a similar path with regards to an aboriginal seniors strategy.
Coordination of health services has been the buzzword for the last number of years, so it is therefore difficult to understand Sinha’s almost conflicting recommendation that nurse-led outreach teams go into long-term care homes to meet the more complex needs of residents, while “exploring” the idea of having the long term care homes serve as community hubs that could provide “community-oriented services, including home care.” Did the CCACs miss that in their applause for Sinha?
Much of the rest of the recommendations are shop-worn ideas that have been around for years with only mixed success, from transportation and housing support to elder abuse programs and enhanced education programs for front-line providers.
Maybe we need to wait for the long player version of this report, but overall the seniors strategy appears to be a vague muddle with little coherent strategy to make it happen. To read the 21-page highlight document, click here.