Special Senate Committee on Aging Final Report Canada’s Aging Population: Seizing the Opportunity The Honourable Sharon Carstairs, P.C., Chair The Honourable Wilbert Joseph Keon, Deputy Chair April 2009 This report is dedicated to the seniors who have not had the support they need as our society has tried to come to terms with monumental societal shifts which have inadvertently shunted them to the sidelines. It is dedicated to seniors who have held onto the hope of a better world in which to age. It is dedicated to the seniors, advocates, caregivers, health care workers, academics and other experts who have devoted their lives and energies to bringing about this better world, who have so generously shared their passion with this Committee. For more information, please contact us by e-mail: [email protected] by phone: (613) 990-0088 toll free: 1 800 267-7362 by mail: The Special Senate Committee on Aging The Senate, Ottawa, Ontario, Canada, K1A 0A4 This report can be downloaded at: www.senate-senat.ca/age.asp Ce rapport est également offert en français Special Senate Committee on Aging Final Report Canada’s Aging Population: Seizing the Opportunity The Honourable Sharon Carstairs, P.C., Chair The Honourable Wilbert Joseph Keon, Deputy Chair April 2009 This report is dedicated to the seniors who have not had the support they need as our society has tried to come to terms with monumental societal shifts which have inadvertently shunted them to the sidelines. It is dedicated to seniors who have held onto the hope of a better world in which to age. It is dedicated to the seniors, advocates, caregivers, health care workers, academics and other experts who have devoted their lives and energies to bringing about this better world, who have so generously shared their passion with this Committee. For more information, please contact us by e-mail: [email protected] by phone: (613) 990-0088 toll free: 1 800 267-7362 by mail: The Special Senate Committee on Aging The Senate, Ottawa, Ontario, Canada, K1A 0A4 This report can be downloaded at: www.senate-senat.ca/age.asp Ce rapport est également disponible en français TABLE OF CONTENTS Table of Contents MEMBERSHIP ..................................................................... V ORDER OF REFERENCE .................................................... VII A MESSAGE FROM THE CHAIR ...........................................IX FOREWORD ........................................................................ 1 A FEW WORDS ABOUT DEFINITIONS ..................................... 2 SETTING THE VISION ........................................................ 5 WHAT THE COMMITTEE LEARNED .......................................... 5 IMPLEMENTING THE COMMITTEE’S VISION................................ 9 CHAPTER 1: COUNTERING AGEISM ................................. 11 1.1 DEFINING AGEISM ................................................... 12 1.2 MOVING TOWARD A POSITIVE VIEW OF AGING................... 14 1.3 COMPETENCY ......................................................... 16 1.4 COMPETENCY AND DRIVING: NOT JUST A SENIORS ISSUE ................................................................ 19 1.5 COMPETENCY AND WORK............................................ 22 1.6 ABUSE AND NEGLECT ................................................ 24 CHAPTER 2: INTEGRATING CARE .................................... 33 2.1 A MOVE TO INTEGRATED CARE ..................................... 34 2.2 CONTINUUM OF SERVICES AND CARE FOR AGING IN THE PLACE OF CHOICE ............................................. 41 CHAPTER 3: COMPARABLE ACCESS TO SERVICES ACROSS THE COUNTRY ............................................ 63 3.1 SENIORS AND HEALTH CARE COSTS ............................... 63 3.2 HEALTH PROMOTION EFFORTS CAN HELP REDUCE HEALTH CARE COSTS............................................... 65 3.3 DEMOGRAPHIC PROJECTIONS FOR PROVINCES AND TERRITORIES ........................................................ 67 3.4 A SUPPLEMENTARY PROGRAM TO COMPENSATE FOR UNEVEN AGING ACROSS THE PROVINCES AND TERRITORIES ........................................................ 68 3.5 COMPARABLE ACCESS TO MEDICATIONS: A NATIONAL FORMULARY.......................................................... 70 i Canada's Aging Population: Seizing the Opportunity TABLE OF CONTENTS CHAPTER 4: ACTIVE AGING IN AGE-FRIENDLY CITIES AND RURAL COMMUNITIES .......................... 73 4.1 ACTIVE AGING........................................................ 73 4.2 AGE-FRIENDLY CITIES AND RURAL COMMUNITIES ............... 83 4.3 UNIVERSAL DESIGN.................................................. 86 4.4 TRANSPORTATION .................................................... 88 CHAPTER 5: ELIMINATING POVERTY .............................. 93 5.1 PENSIONS............................................................. 94 5.2 SAVINGS .............................................................. 98 5.3 OLD AGE SECURITY/GUARANTEED INCOME SUPPLEMENT (OAS/GIS) ........................................100 5.4 EARNINGS............................................................106 5.5 THE INCOME SECURITY SYSTEM...................................111 CHAPTER 6: SUPPORTING CAREGIVERS........................ 117 6.1 POLICY SUPPORTS TO HELP CAREGIVERS ........................119 6.2 A NATIONAL CAREGIVER STRATEGY ..............................128 CHAPTER 7: SUPPORTING THE VOLUNTARY SECTOR.................................................................. 131 7.1 SENIORS AND THE VOLUNTARY SECTOR ..........................131 7.2 NEW HORIZONS FOR SENIORS PROGRAM ........................136 CHAPTER 8: THE HEALTH AND SOCIAL CARE WORKFORCE .......................................................... 139 8.1 INCREASING THE SUPPLY OF TRAINED GERONTOLOGISTS AND GERIATRICIANS.........................142 8.2 ADAPTING TRAINING FOR AN AGING POPULATION...............147 8.3 TRAINING OF HOME CARE AND PERSONAL SUPPORT WORKERS...........................................................149 CHAPTER 9: INCORPORATING RESEARCH AND NEW TECHNOLOGY ................................................ 155 9.1 RESEARCH ON AGING...............................................155 9.2 TELEMEDICINE AND TELEHOMECARE ..............................158 9.3 ELECTRONIC HEALTH RECORD .....................................161 CHAPTER 10: FEDERAL POPULATION GROUPS – LEADING BY EXAMPLE ........................................... 165 10.1 DIRECT FEDERAL LEADERSHIP ...................................165 10.2 VETERANS..........................................................165 10.3 FIRST NATIONS AND INUIT.......................................171 ii Canada’s Aging Population: Seizing the Opportunity TABLE OF CONTENTS 10.4 FEDERAL OFFENDERS .............................................178 10.5 NATIONAL LEADERSHIP AND INDIRECT RESPONSIBILITY ...................................................182 10.6 OFFICIAL LANGUAGE MINORITY SENIORS ......................182 10.7 ABORIGINAL SENIORS ............................................187 10.8 THE GOVERNMENT OF CANADA MOVES FORWARD AS LEADER .............................................................190 APPENDIX I: LIST OF RECOMMENDATIONS BY FRAMEWORK ......................................................... 193 APPENDIX II: COMPLETE LIST OF RECOMMENDATIONS ............................................. 203 APPENDIX III: CHECKLIST OF ESSENTIAL FEATURES OF AGE-FRIENDLY CITIES..................... 211 APPENDIX IV: LIST OF WITNESSES SECOND SESSION THIRTY-NINTH PARLIAMENT.................. 215 APPENDIX V: COSTS: COMMUNITY VERSUS FACILITY ............................................................... 233 iii Canada's Aging Population: Seizing the Opportunity MEMBERSHIP Membership The Honourable Sharon Carstairs, P.C., Chair The Honourable Wilbert Joseph Keon, Deputy Chair And The Honourable Senators: Maria Chaput Anne C. Cools Jane Cordy Terry M. Mercer Terry Stratton Ex-officio members of the Committee: The Honourable James Cowan, (or Claudette Tardif) and Marjory LeBreton, P.C., (or Gérald Comeau) Analysts from the Parliamentary Information and Research Service of the Library of Parliament: Julie Cool Havi Echenberg Nancy Miller Chenier Michael Toye Karin Phillips Senate Committees Directorate: Keli Hogan, Clerk of the Committee Monique Régimbald, Administrative Assistant Research Staff: Michelle MacDonald, Special Advisor to the Committee v Canada's Aging Population: Seizing the Opportunity ORDER OF REFERENCE Order of Reference Extract from the Journals of the Senate of Tuesday, February 10, 2009: Resuming debate on the motion of the Honourable Senator Carstairs, P.C., seconded by the Honourable Senator Hubley: That a Special Committee of the Senate be appointed to examine and report upon the implications of an aging society in Canada; That, notwithstanding rule 85(1)(b), the committee be comprised of seven members, namely the Honourable Senators Carstairs, P.C., Chaput, Cools, Cordy, Keon, Mercer, and Stratton, and that three members constitute a quorum; That the committee examine the issue of aging in our society in relation to, but not limited to: • promoting active living and well being; • housing and transportation needs; • financial security and retirement; • abuse and neglect; • health promotion and prevention; and • health care needs, including chronic diseases, medication use, mental health, palliative care, home care and caregiving; That the committee review public programs and services for seniors, the gaps that exist in meeting the needs of seniors, and the implications