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July 11, 2016

Living with Dignity

Reuel S. Amdur

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Dying with dignity is coming into its own. We have already had a first case, in which a woman with Lou Gehrig's disease was given court clearance for medically assisted death. Dying with dignity is one thing, but what about living with dignity? We are after all an aging population.

Older people, like all people, have a variety of needs, depending on their health, income, social engagements, and personal preferences.  Let’s touch on a number of areas.

More older people are choosing to remain in the workforce, either because of necessity or preference.  That is a good thing, as the aging population means that there are fewer young people to replace retirees.  Yet, the tax system penalizes those who continue to work by clawing back their Old Age Security. 

To encourage older workers to continue and to see OAS as a right, why not stop the claw-back and simply tax it along with all other income?  Now there is a double taxation, on the OAS and again on earnings and other revenue. 

Not all seniors remain in the workforce.  Many choose to retire, even before age 65.  Seniors retiring often find themselves with limited income.  That is why there has been a call for some kind of top-up for the Canada Pension Plan/Régie des rentes du Québec.  Ontario is ready to move on this, but they are holding back to see what Ottawa will do.  The Harper government was not interested in doing anything.

The question of private pensions is disturbing. 

Employers are moving from defined benefit plans to defined contribution plans, leaving people at the mercy of financial markets.  Such plans leave people with no guaranteed security in retirement. 

An additional factor is the growing movement to irregular employment, often with few benefits and no pension.  Irregular employment includes work that is part-time, short-term, seasonal, and contract.  This area of employment requires government action, to move people into career paths and regular employment.  But rather than taking action to bring in remedies for the situation, government itself is one of the worst offenders.

Living situations are another consideration. 

When people find their houses too difficult or too expensive to maintain, there is a need for alternatives.  While there is a glut on the market for high-end retirement homes, moderate cost homes are in short supply.  There is a role for government in meeting this need.

When we move to supportive living options, long-term care in Canada does not have an especially rosy reputation, especially homes in the for-profit sector.  Budgets are tight, staff are sometimes overwhelmed, inadequately trained, poorly paid, and not given secure employment. 

By contrast, such facilities in Scandinavian countries have what is often missing in Canada.  There such work is seen as a career, and people enter full training programs in preparation.  Staffing is adequate.  Facilities are adequate and personalized. 

The lack of a Scandinavian approach means that untoward behavioral incidents are more frequent, as is inappropriate medication, either too little or too much, with medicine used as a method of restraint in some cases. 

Dr. Hugh Armstrong, a sociologist who has studied care of the elderly, commented that the treatment of staff in long-term care facilities determines the treatment of the residents.

Home care is often possible as an alternative to long-term care.  While such a program is less expensive than long-term care and often preferred by seniors, there is a serious shortage of home care.  As well, there is insufficient help and respite for the often overworked family caregivers. 

Lack of home care and long-term care beds not infrequently means a blockage of hospital beds, poorly suited to the needs of the senior and causing overcrowding and waiting lists for hospital services. 

For people needing care in their final days, there is a need for palliative care, either at home or in a hospice.  Even for those suffering severely at the end, most will prefer palliative care to assisted dying.  Yet, palliative care is in extremely short supply. 

If Scandinavians can afford to do it and can do it, why can’t we?  Their population is even older than ours.  We pretend to care about the aged, but there is a big gap between the lip-service and the reality.

When we look at the general health care situation in Canada, the unmet needs are clear: mental health, home care, and palliative care.  So what are we doing?  We are building new hospitals.  Whose needs are being met?

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