discussion: Health Care

ACUTE ILLNESS & INJURY

• In recent years, governments are not listening to what seniors want.
• Ageism appears to be widespread within the health care system.

• Universality is being eroded by patients having to pay for more and more things.
• A shortage of services encourages people to bypass universality, thinking, for example, "I would rather pay than wait on a long waiting list."
• Seniors remember how difficult it was before we had universal medicare.

• Federal government cut health care transfers to provinces. This has resulted in poorer service.
• Ontario government has made cuts to hospitals, municipalities, and communities.
• Governments have jumped ahead with policies that are not thought out.
• Preventive health care is much needed, but is being ignored.
• Overall, there is not enough money in the health care system.

• Co-payment for medications is onerous for some seniors, opening the door to full payment.
• Many medications have been removed from the Drug Benefit list. A few have been added.
• Over-medication continues to be a serious problem, and it is not being addressed.

• CCACs started out as an excellent idea: one-stop shopping for all your health care needs. Unfortunately, the CCACs are Ontario’s best kept secret. The general public simply does not know about them. Further, they do nothing to encourage people knowing about them.
• CCACs are very much underfunded, and their mandate is much too narrow.
• CCACs have to tender services, and this appears to have resulted in poorer quality services.
• Money saved from closing hospitals was supposed to be reinvested in community care, but that has not happened.
• Closing of hospitals has reduced beds, which has led to some inadequate care.

• Homecare has been reduced at a time when it is more needed than ever to 1) allow people to stay in their homes longer, and 2) care for patients who are being discharged from hospitals early.
• CCACs are allowed to set their own priorities for spending to some degree to respond to local needs. But this has resulted in services offered and criteria to get service being quite different, even across Toronto.
• Who gets what services through CCACs seems to be quite haphazard.
• Many kinds of service are not available (e.g., cancer treatment).
• Many services have been cut, or patients have to pay for them now.
• Some doctors are charging "patient fees."

LONG TERM CARE

• About 90,000 people in Ontario (slightly higher % in Toronto) live in long term care homes. Average age of residents is 86. This percentage is likely to rise in the future.
• Pressure from acute care sector not to extend services to longer term care patients is causing stress. Patients who are not acute receive much less care.
• It is fairly rare for people to move from long term care homes to community living.
• There are long waiting lists for nursing homes: 3 years in Toronto. This varies across Ontario.
• A big part of the huge need for nursing homes is because 1) retirement homes are too expensive for many seniors, and 2) home care is badly underfunded through the CCACs.

• Recently, all new long term homes have been awarded to for-profit companies. This raises concerns about care.
• Many residents have little money of their own. About half live on the comfort allowance of $112 monthly that was set 16 years ago. Costs have risen but allowance has not.
• Transportation is a large problem. There are few outings and no funds for this.
• Homes are often short of money. Many are charging residents (or their families) for many things that used to be provided (e.g., diapers, medications, personal care products, hair cuts, dispensing fees for drugs). Also, some drugs, hearing aids, wheelchairs, walkers and other assistive devices, eyeglasses and dentures are removed from the approved list or are not as available as before.
• Some residents are being charged more for things in such places as shops and laundry rooms than they would pay in the community.
• Co-payment fee is set by the Ontario government every year in August — this is the source of some instability in long term planning both for residents and facilities.

• Retirement homes have, in recent years, become backup to nursing homes, because beds are not available.
• These are not regulated, and may need to be.
• There are large differences in standards among retirement homes.

• Now have compliance officers for nursing homes. They give 2-3 weeks notice before visiting.

• There may be a need to narrow the Substitute Decisions Act.
• Ontario long term care residents have a legal right to form a residence council if any 3 residents want it. The administration has to support councils. Councils have the right to examine finances.

• Many long term care residents volunteer. About one-quarter have charitable projects.
• Some organizations (e.g., Residence Councils) take a role in governance of homes.

FOCUS GROUP DISCUSSIONS

• cultural issues
• health care
• housing
• income

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