Dr. Samir K. Sinha MD, DPhil, FRCPC, AGSFPeter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Sinai Health System and the University Health Network, TorontoProvincial Lead, Ontario Seniors StrategyAssociate Professor of Medicine, University of Toronto and Assistant Professor of Medicine, Johns Hopkins University School of Medicine

Canadian Physiotherapy Association27 June, 2019 @DrSamirSinha

How Physiotherapists Can Lead the Promotion of Healthy Ageing within a National Seniors Strategy

Triumph or Tsunami?

Triumph or Tsunami? According to the 2015 Global AgeWatch Index – Canada ranks 5/96

as the best country to age in. Health and Finances are the primary concerns for Older Canadians. While 97% of Canadians receive a pension…the average CPP

Benefit is 6,800 per year. While Canadians have one of the longest life-expectancies…

79% are concerned about having access to quality acute, primryand long-term care services.

16.9% = 65+

42%

CANADIAN HOSPITALIZATIONS |

59%

OVERALL DAYS IN HOSPITAL |

10% = 60% $$$ OLDER USERS OF HEALTHCARE |

7,500HOSPITAL

CANADIANS STUCK EACH DAY IN HOSPITAL|

$2.4 Billion HOSPITAL

ANNUAL COST OF WAITING TO GO ELSEWHERE |

How Ready Are We?

Only a small proportion of older adults are consistently extensive users of hospital services (Wolinsky, 1995)

Ageing and Hospital Utilization in the 70+

42.6%

6.8% 4.8%

24.6%

Consistently Low Users No Hospital Episodes

Consistently High UsersInconsistently High Users

What Defines our Highest Users? Polymorbidity Functional Impairments Social Frailty

The Top 5 System Barriers to Integrating Care for Older AdultsIssue 1: We Do Little to Empower Patients and Caregivers with the Information

They Need to Navigate the System.Issue 2: We Don’t Require Any Current or Future Health or Social Care

Professional to Learn About Care of the Elderly.Issue 3: We Don’t Talk to Each Other Well Within and Between Sectors and

Professions. Issue 4: We Work in Silos and Not as a System.Issue 5: We Plan for Today and Not for Tomorrow with Regards to Understanding

the Mix of Services we Should Invest In to Support Sustainability.

Our Future Will Cost Us More…

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4

15-1

9

20-2

4

25-2

9

30-3

4

30-3

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35-3

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40-4

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50-5

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55-5

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60-6

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65-6

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70-7

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75-7

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80-8

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4.0

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$Bill

ions $24 billion

2030

2010(Ontario Health Care Spending Predictions, MOHLTC).

Our DilemmaThe way in which our cities, communities, and our health care systems are currently designed, resourced, organised and delivered, often disadvantages especially older Canadians with chronic health and functional issues.

As Canadians, our Care Needs, Preferences and Values are evolving as a society, with increasing numbers of us wanting to age in place.

Enabling A Provincial Approach…

Why Develop a Provincial Strategy? In 2011, the province announced a new vision to make Ontario,

Canada the best place to grow up and grow old in North America.

Given our current and future challenges, the development of Ontario’s Seniors Strategy began in 2012 to establish sustainable best practices and policies at a provincial level.

With a focus on ensuring equity, quality, access, value and choice, recommendations were developed that could support older Ontarians to stay healthy and independent for as long as possible.

Living Longer, Living Well (Sinha 2012) Supporting the Development of Elder Friendly Communities Promoting Health and Wellness Strengthening Primary Care for Older Ontarians Enhancing the Provision of Home and Community Care Services Improving Acute Care for Elders Enhancing Ontario’s Long-Term Care Environments Addressing the Specialized Care Needs of Older Ontarians Medications and Older Ontarians Caring for Caregivers Addressing Ageism and Elder Abuse Addressing the Unique Needs of Older Aboriginal Peoples Necessary Enablers to Support a Seniors Strategy for Ontario

The Province Responds… In early 2013, the Government of Ontario responds to Living Longer,

Living Well with its subsequent Action Plan for Seniors with a focus on three core areas:

Age-Friendly Communities Healthy Older Ontarians Promoting the Safety and Security of Older Ontarians

To enable this bold new agenda, the Government of Ontario soon after appointed its first stand-alone Minister of Seniors Affairs.

What Defines an Age Friendly Community?A community that recognizes the great diversity amongst older persons, promotes their inclusion and contributions in all areas of community life, respectstheir decisions and lifestyle choices, and anticipatesand responds flexibly to aging-related needs and preferences. (Aging and Life Course (ALC) World Health Organization, 2009)

Why Does Mr. W Prefer this Park Bench?

Our Future Requires Choices…

Hospitals34.5%

Drugs7.6%

Long-Term Care Homes8.0%

Community Care6.2%

Capital2.5%

Other14.6%

Doctors23.0%

(Ontario Health Care Spending, MOHLTC).

Spending on Home and Long-Term Care Across OECD Nations

We Have Choices and Options… One Day in Hospital Costs ~ $1000 One Day in Long-Term Care Costs ~ $177 One Day of Supportive Housing or Home and Community Care Costs ~ $65 Denmark avoided building any new LTC beds over two decades, and

actually saw the closure of thousands of hospital beds, by strategically investing more in its home and community care services.

The Ontario government while freezing its hospital and physician budgets has committed to at least an annual 5% increase in the Home and Community Care Budget from 2011 through to 2021.

How We Are Enabling Living Longer, Living Well in Ontario Investments in Health Promotion and Prevention in Older Ontarians

(eg. Healthy Ageing Fairs, Exercise and Falls Prevention Classes, Vaccinations). Free Exercise and Falls Prevention Classes have been launched in over 2000 locations

across Ontario and serve over 100,000 clients annually. Improving access to Primary and Home-Based Primary Care In Ontario over half of its Primary Care Providers are now performing over 365,000

House Calls. Enhanced Access to Publicly Funded Physiotherapy Services The number of Designated Physiotherapy Clinics has increased from 69 to over 200 and

increased funding for home-based physiotherapy has been provided. Family Health Teams can now add physiotherapists to their interprofessional teams. Nursing Homes have more flexibility in the way they provide physiotherapy services.

Spending on Home and Long-Term Care Across OECD NationsWe Have Choices and Options…Home Care vs. LTC for High Needs Seniors

Its Time to Go National…

Do We Need A National Seniors Strategy?Recent CMA Surveys of Canadians determined that: 93% believe we need a pan-Canadian Seniors Strategy 89% believe this will require cooperation at all levels of government. 78% believe the federal government has an important role to play in its

development. 63% believe the most important focus needs to be strengthening home

and community care. 60% indicated they would switch parties if their current political party

failed to make older Canadians a priority in the next federal election campaign.

Its Time for a National Seniors Strategy Older Canadians are increasingly becoming concerned about how they

will manage their health, finances, transportation and housing needs to support ageing in the place of their choice.

Implementing a National Seniors Strategy could provides us exactly the focus and commitment we need to ensure Canada can become the best country in which to grow up and grow old.

Older Canadians have the highest voter participation rates…and successful politicians understand this.

And 15,000 physiotherapists and assistants have an important voice that needs to be heard.

www.nationalseniorsstrategy.ca

From GOALS, to LEVERS, to ACTION!INDEPENDENT, PRODUCTIVE AND ENGAGED CITIZENSGOAL: Ensuring older Canadians don’t live in poverty can be achieved by making enhancements to the current Canadian Pension Plan and other Federal Income Support Programs. LEVERS: The Federal Government already has income support and poverty reduction levers in place: ie Canada Pension Plan (CPP), Old Age Security (OAS), Guaranteed Income Supplement (GIS) and RRSPs.ACTION!: The new federal government has announced enhancements to CPP, lowering the OAS Qualification Age back to 65, doubling the GIS top-up for the lowest income seniors, and study a Seniors Price Index to adjust payouts.

From GOALS, to LEVERS, to ACTION!QUALITY AND INTEGRATED CARE CLOSER TO HOMEGOAL: Older Canadians should have access to high quality home and community care, nursing home care and palliative and end-of life services when and wherever needed can become a focus and priority of a new Canada Health Transfer.LEVERS: The Federal Government oversees the Canada Health Transfer which still provides 25% of the public dollars used to fund the provision of health care services in Canada.ACTION: The Government as part of a renegotiated CHT has committed $6B specifically to increase the provision of more home and community care.

From GOALS, to LEVERS, to ACTION!CAREGIVERS ARE ACKNOWLEDGED AND SUPPORTEDGOAL: Canadians caregivers should not be unnecessarily financially penalized for taking on caregiving roles can be further supported through enhanced job protection measures, caregiver tax credits and enhanced CPP contribution allowances.LEVERS: The Federal Government has implemented small and non-refundable Caregivers Tax Credits. ACTION: Budget 2017 announces new unified and Income-tested $6,883 Canada Caregiver Credit and enhanced Compassionate Care and new Family Caregiver Leave EI Supports.

What I have learnt… A lack of skills, knowledge, and training opportunities affects one’s

confidence and comfort in working with certain populations. Education and Training doesn’t stop in school – as professionals

need to be involved in lifelong learning. The future of care will largely rely on unpaid caregivers, PSWs,

Nurses and Therapists – we need to do better for these groups…especially those working in the community

When we don’t acknowledge or celebrate the achievements of a group – it can be seen as a devaluing of the work force and its potential contributions.

Where PTs Can and Should Lead… Ensuring Canadians and Decision Makers UNDERSTAND what

Physiotherapy is and how it uniquely contributes to helping people stay healthy and independent.

Establishing New Therapist-Led Models of Care Inpatient, Outpatient and Community-Based etc.

Encouraging Evidence-Based Practices and Guidelines Early Mobilization, ReAblement, Falls Prevention…

Enhancing Education and Training Opportunities Establishing Mandatory and Relevant Course Content Establishing more Community and Geriatric Placements

Advancing our National AGEnda… We have achieved much over the last 5 years but much more still needs

to be done. Increasingly – all levels of government are considering and acting on

ageing-related issues within their remits.

More than ever – we need to remain opportunistic and ready to demonstrate how better supporting and caring for older adults is a solution and an opportunity and how Canadian physiotherapists can be a key part of it!

Advancing our National AGEnda… The federal government has not come out YET and announced its

support for a National Seniors Strategy It did re-instate the Federal Minister of Seniors Role last year. A National Dementia Strategy was launched earlier this month and the

current MAID Legislation is being reviewed. In October – Canadians will be going to the POLLs once again…and

Seniors Issues will likely once again be front and centre again…its time for Physiotherapists to help to shape the agenda…

Is Canada ready to meet the needs of its ageing population?

This is Our Time to Lead

Thank You

Samir K. Sinha MD, DPhil, FRCPC, AGSFDirector of Geriatrics Sinai Health System and the University Health Network

Architect of Ontario’s Seniors Strategy

samir.sinha@sinaihealthsystem.ca@DrSamirSinha