Physicians want action on seniors’ care ========================================= * Roger Collier Canada’s health care system is not designed to meet the needs of a growing seniors population. Change is needed. This is the message the Canadian Medical Association (CMA) has pushed hard all year. Well, Canada’s doctors have heard that message and they agree. Now they want less talk and more action. “The themes are not new and you’ve heard them before,” Dr. Chris Simpson, outgoing CMA president, told some 500 attendees at the CMA’s annual meeting in Halifax on Aug. 24. “Some of the feedback we heard [at a workshop] yesterday was, ‘Listen, we know all this stuff. We are all on board. We need some action now. It’s time to stop talking and we need some action.’ And that’s exactly what we are trying to do in the context of this federal election campaign.” The workshop participants explored the role physicians have in improving seniors’ care — and the challenges they face. “Number one was a lack of widely available electronic health care plans, making sure everyone is on the same page, is sharing the information, so no matter where the patient is in the health care system, everyone knows what’s going on,” said Dr. Cindy Forbes, incoming CMA president, who presented highlights from the workshop. Other challenges include a lack of mandatory training in geriatrics for medical students and residents, poor coordination between doctors and pharmacists, fragmented care provided in silos, inadequate community care resources and payment models that don’t reflect the increasing costs of caring for an aging population. There was “recognition that compensation plans are often not aligned for practising physicians, and that can be a barrier to facilitate seniors care,” said Forbes. Four delegates’ motions adding measures to the national seniors’ strategy were overwhelmingly approved at the meeting. They included improving telemonitoring to help seniors remain in their homes longer, incorporating evidence-based hospital practices into a national seniors strategy, providing seamless transition through the continuum of care and providing better financial support for caregivers of family members without requiring cohabitation. ![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/187/13/E405/F1.medium.gif) [Figure1](http://www.cmaj.ca/content/187/13/E405/F1) Canadian doctors agree that improving health care for seniors is a priority, said outgoing CMA President Dr. Chris Simpson. Image courtesy of CMA/Mark Holleron ## A year-long effort The push for the creation of a national strategy on health care for seniors has been one of the CMA’s major advocacy efforts over the past 12 months. This came as no surprise. At last August’s CMA meeting, when Simpson assumed the role of president, he made it clear that pressuring the federal government to improve seniors’ care was going to be a top priority. “Show us that you are nation-builders and that you believe in a Canada that is greater than the sum of its parts,” he [said at the meeting](https://www.cma.ca/En/Pages/Incoming-president-throws-down-gauntlet-on-seniors-care-issues.aspx). “Commit to the development of a national seniors’ care strategy.” Seniors’ care was also the focus of the CMA’s [14th Annual National Report Card on Health Care](https://www.cma.ca/En/Lists/Medias/2014_Report_Card-e.pdf), which was released at last year’s annual meeting. The report presented the results of a survey of 1000 Canadians aged 45 and older. It found that 95% of respondents agreed that Canada needs a national strategy on health care for seniors and 91% agreed that such a strategy would improve the entire health system by helping seniors live at home longer. Only 38% declared they were confident that hospitals and long-term care facilities could address all the needs of the elderly population. Also last August, the CMA made its case for improving seniors’ care in a pre-budget consultation [submission to the House of Commons Standing Committee on Finance](https://www.cma.ca/Assets/assets-library/document/en/advocacy/submissions/cma2015-pre-budget-submission-e.pdf). The report recommended that the 2014/15 federal budget invest in several key areas of health, including the creation of a pan-Canadian strategy to address the health needs of an aging population, the promotion of healthy aging initiatives, support for family caregivers and improved access to assisted-living units and long-term care facilities. “The aging of Canada’s population is the most pressing policy imperative of our time,” warned the report. It didn’t take long for other health organizations to join the cause. On Aug. 27, 2014, a week after last year’s annual meeting, the CMA announced that it was [partnering with the Canadian Association of Retired Persons](https://www.cma.ca/En/Pages/cma-partners-with-carp-on-seniors-care.aspx) to promote a strategy for seniors’ care to provincial and territorial premiers. On Jan. 29 of this year, in a [Toronto Star op-ed](http://www.thestar.com/opinion/commentary/2015/01/29/canada-needs-a-national-seniors-strategy.html), Simpson again called for premiers to put a national seniors’ care strategy “at the top of their agenda,” this time joined by the presidents of the Canadian Association of Social Workers and the Canadian Nurses Association. ## Demand a Plan By April, these efforts culminated in the launching of [Demand a Plan](http://www.demandaplan.ca/), a campaign to gather public support for a national seniors strategy. The project is the work of the CMA and an alliance of more than [50 other organizations](http://www.demandaplan.ca/about), including the National Pensioners Federation, Osteoporosis Canada, the Congress of Aboriginal Peoples and the Canadian Hospice Care Association. So far, about 23 000 Canadians have pledged their support for the campaign. The campaign’s website lays out the rationale behind the push for a national seniors strategy. In a nutshell: the Canadian population is aging rapidly and caring for more and more seniors in acute care is not sustainable. By 2036, people over age 65 will make up a quarter of Canada’s population (up from 14% today) and consume 62% of health costs (up from about half today). Caring for a senior in a hospital can cost about $1000 a day, the website notes, compared to about $130 a day for long-term care and $55 a day for home care. According to the campaign, Canada’s health system, established half a century ago, was set up for a relatively young population (average age of 27) and has not evolved enough to address how health needs have changed as that population aged (average age now 47). The CMA continues to pressure governments to pay more attention to seniors’ health. It is pushing to make seniors’ care a ballot box issue in this year’s federal election, releasing an [election toolkit for physicians](https://www.cma.ca/Assets/assets-library/document/en/advocacy/election-toolkit-members-e.pdf) and another [for the public](https://www.cma.ca/Assets/assets-library/document/en/advocacy/election-toolkit-members-public-e.pdf). This year’s [national report card](https://www.cma.ca/En/Lists/Medias/cma-national-report-card-2015.pdf) from the CMA, like last year’s, focuses on seniors’ care. It found that 89% of Canadians agree that the winner of the upcoming election needs to address the health care needs of an aging population, 67% believe the federal government has a role to play in developing a national seniors strategy and 76% thinks cooperation among governments is required to improve seniors’ care. To keep abreast of what political parties are promising for seniors’ care, Demand a Plan has [launched a “promise tracker](http://www.demandaplan.ca/promise_tracker?hootPostID=cf756a491e682bec9f0246653dcf5c44).” According to this online tool, the Liberal party has promised to provide more flexible employment insurance benefits to Canadians caring for a seriously ill family member, and the Green party has promised a national pharmacare plan. If you click on the logo of the Conservative, NDP or Bloc Québécois parties, however, you will see only three words: “No promises yet.”