Following the Sept.10 release of the National Institute on Ageing (NIA) first report in a series of three – Enabling the Future Provision of Long Term Care in Canada, on October 8 the public received the second report – The Future Cost of Long Term Care. Before you dig into this, I would suggest you set the context for it by reading the first report. What this second report asks us to do, ironically, is look at a thirty-year long-term view of Long Term Care – to the year 2050.
No surprise that given our current forecasts of an aging population in Canada over the next 30 years, there will be an associated greater need for Long Term Care. As the NIA has noted, there is much misunderstanding Canadians have of the “gaps within the current publicly-funded long-term care programs when they, or their family members, require care… being primarily under provincial and territorial jurisdiction.”
It is thus helpful here again to repeat the NIA’s definition of Long Term Care:
“A range of preventive and responsive care and supports, primarily for older adults, that may include assistance with Activities of Daily Living and Instrumental Activities of Daily Living provided by not-for-profit or for-profit providers, or unpaid caregivers in settings that are not location specific and thus include designated buildings, or in home and community-based settings.”
This second NIA report on the future cost is based on projections, which, as they declare, are not the same as predictions and these projections “do not anticipate various potential policy changes, exceptional medical advances or changes in disease treatments that may arise in the future….” Not to forget, another element to consider is – to what degree technology solutions will augment the service delivery in a more efficient way.
Well-highlighted graphics, charts and pop-out statements that spread throughout the easy to read 45 pages, reveal some stunning financial numbers and other statistics, which I won’t detail here, so I do encourage you to get a grasp on these figures by reading the report yourself. However, the one area of interest discussed on page 22, is that which covers the projected number of home care hours from now to 2050.
Here we look at three service areas of home care hours – Publicly Funded, Privately Paid and Unpaid (family, friends & neighbours). What is astonishing is the unpaid hours, which the report says will stay at a constant 75 percent of all home care hours – and to quote:
“Overall, home care hours provided by all three sources are projected to more than double by 2050 – from approximately 300,000 unpaid, 70,000 publicly-funded and 30,000 privately-paid hours in 2019, to approximately 645,0000 unpaid, 150,000 publicly-funded and 75,000 privately-paid hours in 2050.”
Returning to the concern over unpaid caregivers referred to in the NIA first report (rejecting the devaluating term “informal caregiver” as I have long done) this report further underlines the factors that may be a future challenge for unpaid caregiving (if it isn’t so already I would submit). Several social conditions are affecting the “anticipated decline in availability of unpaid caregivers.”
Two examples of these challenges: higher divorce and separation rates of older adults, along with potentially more who are single by choice, is “reducing the potential for unpaid support from spouses” – and the lack of geographic proximity of children to their parents, which plays a major role in their capacity to provide daily care.
The NIA and many other organizations and individual thought leaders in the aging and longevity field have also long focused on the question – what is the economic value of unpaid care hours? Take into account all unpaid care is for far more than just older adults; it includes for instance adults who have children with disabilities and thus the value is much greater. In this study though, on older adults, the NIA asks to consider, “what would be the cost for government to replace unpaid care with formalized paid care?”
Here the “replacement cost” is “set as $30/hour: $18/hour for salary and $12/hour for overhead (including administration and travel times between visits).” Pages 25 to 31 of the report go on to spell out much more interesting analysis. But to wrap things up and put one fine point on it, “The aggregate public sector cost to replace unpaid care with public care in 2019 (at an assumed $30/hour) is just under $9 billion.”
Imagine what that might become over the next 30 years. For by 2050 this whole topic will not be exclusive to Boomers.