2.  How well is the health care system serving seniors?

Areas identified for action

In terms of the health care system's accessibility, comprehensiveness, effectiveness, appropriateness and the degree of satisfaction of users, the 2001 Report Card had observed that there was not yet sufficient information to assess how well the health care system was serving seniors. This situation has been changing. Due to recent federal, provincial and territorial initiatives to improve the accountability of the health care system, new studies are shedding light on seniors' access to health care and their satisfaction with the care they receive. Evidence is available regarding the appropriateness of prescription drug use. Also reported is information concerning accessibility of geriatric specialist care, the cost of prescription drugs and the accessibility and comprehensiveness of home care.

New or updated information

• In 2001, a very high proportion of seniors (95.9%) reported having a regular family physician and their access to a physician exceeded the average for all Canadians (87.7%).⁵

• Fewer seniors than Canadians aged 15-64 complained about waiting too long for care in 2000-01 (see Chart 2).⁶

• A very high 90.2% of seniors rated the overall quality of the health care services they received during the previous 12 months as excellent or very good. This was the highest of all age groups, with Canadians aged 45-64 next highest at 87.2%.⁷

• In 2000, there were 144 geriatricians ⁸ in Canada, although an estimated 481 were needed. By 2006, the forecast is that there will be 198 geriatricians, but a need for 538. ⁹ Canada has 0.44 geriatricians per 100,000 population compared with 2.1 in Israel and 3.4 in the United States (the Royal College of Physicians of London, England, promotes a standard of about two per 100,000).¹⁰

• Seniors spend more for drugs than other age groups, despite coverage by drug benefit plans; for instance, Manitoba drug use data show that seniors in that province spent four times more per person for prescribed drugs in 1999-2000 than younger residents: $708 vs $177. ¹¹

• Although much of the higher drug costs of seniors results from having to take more medications, part of it also comes from higher drug prices: the retail prices of prescription drugs have risen every year since 1997. ¹²

• Seniors relying on formal sources only for home care support received considerably fewer hours of assistance than those who relied on informal support or on a combination of formal and informalsupport.¹³  In 1996, seniors who relied exclusively on formal sources of support reported only 1.8 hours a week of assistance compared to 3.5 hours per week reported by those assisted by informal sources and 6.5 hours per week by seniors who received both formal and informal assistance (see Chart 3).¹⁴  The more seniors relied on formal support, the greater their unmet needs for assistance with activities of daily living.¹⁵

• Withdrawal of housekeeping services from home care clients with low-level needs in British Columbia resulted in a decline in the health of these persons, as measured by increased hospitalization, admission to residential care and deaths.¹⁶

Observations

• The great majority of seniors consider the basic physician and hospital care they receive to be accessible and of good quality. But subjective ratings say nothing about the appropriateness of care, nor its effectiveness. These criteria can only be assessed by examining the care given in comparison to accepted standards of best practice and to the outcomes of treatment. By "best practice standard," many drugs are not being appropriately or effectively prescribed.

• Objective studies of home care confirm long-standing complaints from many recipients, providers and observers - access to home care services has been limited, with disturbing consequences for many seniors, and the services provided may not fully meet care needs.

• Many seniors are paying more than before for needed prescription drugs. Increases in out-of-pocket payments for medication can have negative health consequences for seniors with low and modest incomes.¹⁷ Of particular concern is the growing cost burden of drugs for near-seniors, people 55-64, who have increasing health problems requiring medication but who are not covered by either public or private drug insurance plans.

• A worrisome trend is the shortage of physicians specialized in the care of seniors with complex health needs. This concern is shared by the Canadian Medical Association and Canadian Nurses Association who have expressed concern with the projected dearth of physicians and nurses in general to provide care to an aging population.

Emerging areas of promise and concern

• The 2003 First Ministers Accord on Health Care Renewal provides some much-needed direction and new investments in primary health care, catastrophic drug coverage, and core services for short-term acute home care, including mental health services and end-of-life care. The infusion of new funds should allow provinces and territories to devote more resources to long term chronic home care, which serves predominantly seniors. Council will be watching for improvements in this sector of home care.

• Reports have been increasing about government underfunding and shoddy care in long-term care institutions, at the same time as the charges to residents for care have been rising in some jurisdictions. NACA will explore this issue further in the next Report Card.

Chart 2. Fewer seniors than younger Canadians said they waited too long for most health care services, 2001

Source: Health Analysis and Measurement Group. "Access to Health Care
Services in Canada, 2001". Ottawa: Statistics Canada, 2002. Cat. No. 82-575-XIE.

Chart 3. Seniors who received only formal home care services in 1996 had the least hours of assistance

Source: Lafrenière, Sylvie, Carrière, Yves, Martel, Laurent and Bélanger, Alain. "Dependent seniors at home - formal and informal help". Health Reports. Vol, 14, No. 4. Statistics Canada: 2003.

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