The gods help those who help themselves
By Carolyn Inch
For years, I thought that the Bible spawned the dictum, “The gods help those who help themselves.” While it does tacitly support the idea, this motto of self-reliance, according to Wikipedia, is attributed first to the ancient Greeks. Regardless, a group of residents in Old Ottawa South, Old Ottawa East and the Glebe have taken it to heart. What these intrepid neighbours and friends have decided to do is to make our communities “age friendly.”
Getting to an age-friendly community
Seniors Watch Old Ottawa South (SWOOS), a committee of the Old Ottawa South Community Association (OSCA), started the ball rolling in their pursuit of seniors’ issues related to safety, walkability, health, housing and social connections. Over the last couple of years, we have done community surveys and consultations and worked closely with local politicians, developers, community organizations, church groups and service providers. Our outreach included Old Ottawa East and the Glebe, and now our team members are drawn from all three neighbourhoods.
Family doctors have retired in higher numbers due to the stress of the pandemic. Family medicine graduates often choose to work in walk-in clinics that provide administrative support. They restrict patients to presenting one symptom per visit to maximize their income. But older people with multiple chronic and episodic conditions want all their issues dealt with in a single visit.
Starting in January, a project team led by Anna Cuylits has been examining the issue. We are bringing these concerns to the authorities and are also working with community organizations and agencies to explore innovative possibilities such as a community health hub, attracting family practitioners, use of nurse practitioners, community health nurses, expansion of pharmacy services and paramedic home visits.
Home care/community support services/informal caregivers
Provincial governments are spending far less proportionately on care in the home than they are on emergency rooms and long-term hospital and residential care.
As Dr. Samir Sinha, director of health policy research at the National Institute on Aging, told a parliamentary committee last May: “Our research shows that Canada spends 30 per cent less than the average OECD country on the provision of long-term care, and close to 90 per cent of our public LTC dollars on institutionalizing people rather than caring for them in their own homes, where they want to be.”
Our project team, led by Maura Giuliani, plans to work with providers and community organizations to explore innovations such as service clusters and cooperatives, learning from experiences like OASIS in Kingston and from the way other countries organize and pay for services.
We also want to look closely at the situation of informal caregivers – family and friends – who play such a vital role in home care.
We hope to engage with community organizations through a group known informally as Community Pillars to assess this situation. We have also engaged with the Saint Paul University School of Social Innovation to begin an inventory of available services.
In March, CBC’s Marketplace aired an eye-opening exposé titled “Inside the home care crisis: Exposing a broken system.” It is available on YouTube.
Seniors care technology
Technology can be used for diagnostics, monitoring, preventive and rehabilitative services, home care assistance, domestic support and service provision. This project team, led by Peter Heyck and Pat Eakins, wants to support and test appropriate technology to encourage its development and speed the process where warranted. At the same time, we want to ensure it does not increase social isolation, stress or other physical or psychological risks.
Housing and accommodation
Most people want to stay in their homes until they die. They might need help with modifications and maintenance services. Even then, some won’t be able to, and others won’t want to. Some wish to live in proximity to others for social contact and cooperative living.
The housing team, led by Terrance Hunsley and Angela Davis, is exploring innovative housing options and other forms of co-housing or cooperative living. We would like to develop properties in a way that the increase in value over time accrues to the community. We will explore the potential for a community property trust. Our first focus is on an Abbeyfield home or similar concept.
Wrapping research and evaluation around innovation or an age-friendly community
Improvements should all be piloted and tested for cost-effectiveness, because government budgets are going to be stretched to the breaking point. A project team led by Terrance Hunsley seeks help from academics, research institutions and service agencies to find out if the costs of innovations can be offset by longer-term savings in institutional costs (hospitals, ER visits, long-term care, more expensive professions), improved community economies and accumulation of capital assets. We also feel that the public sector promotion of age-friendly communities would be strengthened if our experience as a community catalyst in social innovation is evaluated positively.
Please contact us with questions on the specific projects or if you are interested in helping in our quest to become a model age-friendly community. Email SWOOSadmin@oldottawasouth.ca.
Carolyn Inch is a member of SWOOS, Coordinator of the Health Project and long-time resident of OOS.
What comes next?
Thinking about in-home services for older folk who want to ‘age in place’
By Maura Giuliani
Drat! I’m getting old. (“No, Mom,” my kids would say, “you are old.”)
I am only in my early eighties and reasonably healthy, but I do worry because I am alone. How long will I be able to get the kitchen floor washed each week, hang up my laundry and drag that vacuum around? Will I be able to stay in my house, tend my garden and walk around this neighbourhood forever? I know most of my neighbours, and almost everything I want is close by – great bike paths, Central Park, the Cattle Castle, my favourite pub.
I can still drive, but that might not last. If I really want to stay here, I should probably be looking into the possibility of getting help. Even though I like shopping for food, grocery stores will deliver. In truth, I don’t know what help might be available if my health deteriorates.
What if I broke a hip? That has happened to friends. Will Public Health offer something? Can I afford a private agency? I realize that I need to think about these things before I truly need them.
Senior Watch Old Ottawa South (SWOOS), a committee of Ottawa South Community Association, has just formed a small group to look at the availability of in-home services for older adults in our area who want to age in place. It’s not an ideal time, when resources are skewed by COVID. Many of the established private agencies are experiencing staff shortages, as are public health services.
We would like to begin by informally soliciting information from others in central Ottawa about their experiences. In the last couple of years, have you been able to find the help you need to avoid moving into some form of assisted living? How did you go about it? What were your experiences, negative or positive? What advice would you offer?
Please email us: firstname.lastname@example.org. It would help us enormously to hear real life experiences.
Maura Giuliani is a member of Senior Watch Old Ottawa South (SWOOS) and has lived in Old Ottawa South longer than she wants to admit.
Canada still needs a national seniors strategy
By Terrance Hunsley
The 2020 report by the National Institute on Ageing (NIA), called An Evidence Informed National Seniors Strategy for Canada, follows a 2015 seniors’ strategy. It starts with some stark data:
- Canadians over 65 account for about 17.5 per cent of the population and represent almost 44 per cent of public health care expenditures.
- By 2035, they will be 25 per cent of the population.
- Despite a total COVID-19 mortality rate lower than other OECD countries, more than 80 per cent of deaths by the summer of 2020 were older Canadians in long-term care residences, compared to an OECD average of 42 per cent. That’s a shameful exposure of substandard care, which eventually cost the lives of more than 16,000 people.
From 1920 to 2020, our life expectancy increased from around 60 to over 82 years.
Our health care system is built on the Medical Care Act of 1966 when the median age was 25.5 years. It focused on providing physician services and acute hospital-based health care.
What is clear is that Canada’s health care system was not built to focus on the needs of Canadians living into their late 70s and 80s with chronic health issues and greater levels of social isolation, which are now established and growing realities. The issues affecting older adults and an aging population must be liberated from government department silos.
The NIA has been pleading with the Ontario and federal governments for years to take their heads out of the sand and reorient the health care system for an aging population.
This report says “the array of policies in relation to older adults still represents a patchwork of ideas. While an older population will continue to need physicians and hospital care, it will also need a more comprehensive health care system that emphasizes preventive care, pharmacare and long-term care, which includes home, community and nursing home care…Furthermore, to meet the growing need for publicly funded long-term (residential) care over the next three decades, the costs of doing so are expected to rise from $22 billion to at least $71 billion.”
With that kind of financial pressure, you can see why governments agree with seniors that they should age at home. They want communities to be “age-friendly,” providing social supports, inclusive and healthy activities, good diets, exercise and other valuable services. But this report is clear that there is much to do before a community is actually age-friendly, and much of it has to be done with the support of federal and provincial governments
What improvements does the NIA recommend?
- Community support and health services tailored to seniors’ needs. These include geriatric primary care with home- or community-based access to an interdisciplinary team which can respond to chronic conditions, psychosocial problems, needs for prevention, health maintenance and rehabilitation. Seniors’ needs are not met by walk-in clinics where patients get to discuss one symptom per visit. Amazingly, even with the aging population being discussed for the past 40 years, our medical schools still don’t focus on turning out doctors with geriatric training!
“In 2018, there were approximately 304 geriatricians serving 6.6 million older adults in Canada, while at the same time, 2,887 pediatricians served 8.1 million children and adolescents under the age of 20. No Ontario medical school, for example, currently offers core training in geriatrics, but every school offers core training in pediatrics, despite that the majority of patients in the health system are likely to be older people.” Ageism in the medical community?
- Supporting informal caregivers, who face increasingly complex needs of loved ones. They already report serious impacts on their personal health, psychological well-being and finances, and they themselves are aging. A crisis in the making.
- Improving a broader range of formal and long-term care services in the home. Inadequate home care leads to failing health and higher costs for institutional care. They suggest that Ontario could save up to $268,000 in capital costs for every residential care bed it does not need to provide.
- Ensuring that seniors have access to appropriate and affordable housing, with “universal design standards.” Innovative housing models include home-sharing, communal living, co-housing and “life-lease” rental purchases.
- Providing an inclusive and accessible transportation system that meets seniors’ transportation needs.
- Eliminating ageism, elder abuse and poverty.
- Providing opportunities for participation in social, cultural, leisure and spiritual activities, as well as employment and volunteerism. “Socially isolated older adults are four to five times more likely to be admitted to hospital than older adults in general…social isolation has been identified as one of the top four predictors for placement into more costly nursing home settings.”
- Increasing prevention to improve health and decrease health care costs. “Falls amongst older Canadians not only threaten their independence and overall well-being, they also account for an estimated $2.3 billion annually in related health care spending across Canada. Furthermore, Canadians who are hospitalized for falls remain hospitalized for an average of 14.3 days…In Canada, between 20 to 30% of older adults fall annually, making it one of the most common preventable health care issues for older Canadians.”
This comprehensive report is in good company with others that have been generated over the last several decades by social policy and medical planners. The fact is that very little has been done to change an outdated system. Senior Watch of Old Ottawa South (SWOOS) is trying to bring about the kind of services that are recommended, as summarized in an article in this issue of the Glebe Report by Carolyn Inch.
Terrance Hunsley is a co-chair of Senior Watch of Old Ottawa South (SWOOS) and an OSCA board member. The full report is available online on the National Institute on Ageing website at nia-ryerson.ca.