The New Age of Aging

Amanda: This is the Forefront — I’m Amanda Cupido.  

In this series we're going to be covering topics like city building, digital privacy and food security. When it comes to tackling these issues in Canada, are we on the right track? This Toronto Metropolitan University podcast features ideas and solutions that are making our communities stronger.

Welcome to episode one.

So here’s the problem: More than one in six Canadians are at least 65 years old. Now, getting older in and of itself isn’t a problem, of course. Having the opportunity to age is a privilege. But it starts to become an issue when we look at the fact that...

1. It’s a massive demographic shift that’s unlike anything Canada’s ever seen
2. Society tends to have ageist assumptions about seniors and older people.. and
3. The strains on Canada’s healthcare system and long-term care facilities 

On top of all that, we’re also dealing with a global pandemic where older people are more vulnerable. But we’ll get to that later.

Back to my third point: The costs of long term care in Canada is forecasted to triple in the next 30 years. And, it’s already strained as it is...

Karen: It’s severely understaffed. There aren’t enough people there to do the work. You submit your list of preferred facilities and then you have to wait for someone to pass away before you’re offered a bed. 

Amanda: That’s Karen Cumming. 

Karen: I am a former long time radio and television journalist. And I’m also a teacher and a health promoter.  I went back to school a couple of years ago to study something called workplace wellness health promotion.

Amanda: She’s also a Toronto Metropolitan University radio and television arts grad from the class of ‘84 AND the co-author of the book, The Indispensable Survival Guide to Ontario’s Long-Term Care System. This came after — what she calls — a long and exhaustive experience with trying to get her mom into a long-term care facility. Karen’s mom was named Verna.

Karen: She was born in 1920 so she grew up through the depression and World War II. She studied to become a bookkeeper and she did it well. She kept books throughout her entire life. Well into her mid 90’s she was still keeping a ledger that had all of her accounts on it. And interestingly it wasn’t until really later in her life that she came into contact with some of the things that meant the most to her and with people who became some of her dearest friends. When she wound up having to go into assisted living in Grimsby, in Niagara in Ontario, she met the two best friends of her entire life at the dinner table. They were all the same age, 94, when they first moved there. And they literally became each other's best friends. We called them the three musketeers.  

Amanda: She says her mom was happy there. Karen even said she thought that’s where her mom would live out the rest of her life.

Karen: One day, out of nowhere, my mother woke up and realized that she could no longer walk using her walker. And when you can’t walk any longer that means you can no longer live in an assisted living facility. And that was the beginning of our education on how the long term care system works. And that was just the first step on a very long road. 

Amanda: Karen and her sister ended up having to be there constantly to help their mom, since Personal Support Workers weren’t allowed to help residents walk. After a month of supporting Verna, working and trying to navigate Ontario’s Local Health Integration Network, Karen says she was burnt out.

Karen: Every day you get up and you wonder what problem you’re going to have to confront today. What bureaucrat are you going to call that isn’t going to call you back.  What is it that you’re going to run up against that you’re not going to know how to deal with. It’s completely exhausting.

Amanda: Verna ended up on a crisis list and got into a long term care facility in November 2018. She passed away the following February at the age of 98. But her story is not foreign to many Canadians. In fact, many wait lists for long term care are outliving the patients on them. 

The National Institute on Ageing (or NIA) reports that 40,000 Canadians are on waitlists for nursing homes and there’s another 430,000 Canadians with unmet homecare needs.

Michael Nicin is the executive director of the Toronto Metropolitan University think tank… who oversees this kind of research.

Michael: Starting with the long term care sector, what we realized that the way it is currently set up across Canada is really a product of our history. To put it in perspective for example, our health care system at large was built about fifty years ago, and when it was the average age in Canada was 27 and life expectancy was significantly lower. But of course now, the average age has shot up from 27 to about 40 and we’re living well into our 80’s. But the long term care sector across the board hasn’t necessarily kept up with that reality so in our first report we were able to show that capacity is a major challenge as the baby boomers are getting older. 

Amanda: In addition to the capacity issue, there’s also the mounting fiscal pressure. The NIA’s projections estimate that if we don’t change anything for the next 30 years -- the annual cost of nursing homes and private homes would grow from $22 billion to $71 billion. So what’s the solution?

Michael: To sort of reduce it to a bottom line we need to invest less in facility based care and we really need to find a way to support people where they already live in a community. It’s cheaper, it’s what Canadians want and there’s a number of good examples internationally where countries have done this and they’ve been able to care for their people at a lower cost. So we’re actually working on a set of recommendations on how we could confront our current situation and potentially bend the cost curve while providing care to more people. And we hope to complete that project within the next several months. 

Amanda: One of those international examples is Denmark. They intentionally decided to stop building long term care facilities a couple of decades ago. Instead, they focused on keeping people at home and delivering the care they needed..

Michael: And they’ve been able to meet their needs at a much lower cost than countries like Canada, the US and the UK which are still largely dependent on facility based buildings. If you look at a country like Germany and Japan, on the other hand, they’ve gotten creative about how to pay for long term care. So Germany has mandatory long term care insurance, it works a little bit like our Canada Pension Plan, so employers and employees pay into it from a pay cheque basis but then the end result is if you need long term care services it lets governments off the financial hook a little bit but the money is there for you and it answers some of those questions about will there be funding for me. Well yah, there will be in Germany and Japan because you’ve paid into it. So I think our approach is, and this is the stage we’re at right now, is really looking at some of the best examples from other countries and finding ways to import some of those best ideas into the Canadian context.  

Amanda: And this is something that I’m sure people like Karen would be happy to hear. She knows she wasn’t the only one feeling frustrated with the system we have now.

Karen: We want people to know that they are not alone. So many points along the way, my sister and I felt absolutely and utterly alone. We felt like we had no one to talk to, nowhere to turn to get the guidance, the education and the help that we needed. 

Amanda: But let's shift gears — it’s hard to have this conversation without taking the global pandemic into account. Now, it’s important to note that the NIA is Canada’s first think-tank on aging, it was also tasked with creating a National Seniors Strategy… so what’s top of mind for Michael right now?

Michael: I think right now, you know as a non-clinician, personally as the executive director of the NIA what I’m really observing is a growing callousness by society about the fate of older people. If we’re talking about the economic shut down, we’ve heard the governor of Texas, we’ve heard President Trump say these things and  more and more rumours about the expendability of older people. And then of course in the long term care sector they’re not necessarily getting the same treatment that they would in hospitals and so there’s a little bit of an effect where we’ve pushed aside our older people and so despite reading headlines, we’re all generally concerned about older people, I’m a little bit worried about the fact that we’re not paying enough attention, not only to the care of older people but their humanity and their dignity and the fact that none of us should be expendable. We should be working very hard to save every Canadian life regardless of age. 

Amanda: Staying with the social aspect of ageing now — that’s something the NIA has been looking at since their inception 5 years ago. 

Michael: We often think about older people, and maybe the ageism starts happening in your 50’s and 60’s but of course the research that we’ve seen and that we’ve been engaging in shows that ageism can start as early as your 40’s. And so I think that’s one major issue is that as there is more of us that are older and living longer and we want to stay engaged, I think we need to break down some of those stereotypes that say “You’re too old to do this” or “You’re no longer relevant” or as we’re seeing with COVID, “Get out of the way and make room for younger people” so I think that’s one aspect of this social fabric that was with us before COVID and now unfortunately we’re seeing it in stark contrast with a lot of people, essentially saying that older people are expendable. And so a part of that is related to health and people's concerns about their own financial and economic well being. But another fundamental, almost philosophical quality about it, is that society doesn’t value older people as much as we should and while we might have been able to get away with that in recent decades we’re going to see a huge number of older people coming up and so a part of our job on the social front is to get to get society to catch up to where we are demographically, and then also to value the contributions of older people. Ageism is still one of the few still socially acceptable forms of bigotry. We should be much more careful as a society and individuals of seeing seniors and older people as dispensable. And the unique quality about aging is that with any luck it’ll happen to all of us. 

Amanda: As we wrap up, it’s clear the challenges are real: BUT with Canadians like Karen taking a stand for people navigating the system AND with organizations like the NIA focused on sharing research and advocating for much needed change...I think we’re moving in the right direction. A final word from Michael about Toronto Metropolitan University’s role in all of this… 

Michael: Quite honestly, the NIA couldn’t exist without the support of Toronto Metropolitan University. We don’t see centres like this across Canada. The NIA is unique at the moment in its place in the Canadian landscape and the University landscape and I don’t think that’s an accident.Toronto Metropolitan University is a highly innovative university that thinks differently and it’s clear Toronto Metropolitan University is really the foundation that supports organizations like ours, it gives that bedrock of academic support of credibility, of institutional support for what we’re trying to do. I think that’s fantastic and also the brand and it’s sort of place in the world and academia and Canada is very important.

Amanda: This podcast was created for alumni and friends by the Toronto Metropolitan University Office of University Advancement. Special thanks to our guests on today’s episode: Karen Cumming and Michael Nicin.I’m your host, and proud Toronto Metropolitan University grad, Amanda Cupido. For additional information on this topic, the National Institute on Ageing, and more episodes of this podcast and others, visit torontomu.ca/alumni/podcasts (opens in new window) .