Hon. Sharon Carstairs:

Honourable senators, it is indeed my pleasure to begin consideration of the final report of the Special Committee on Aging, entitled Canada's Aging Population: Seizing the Opportunity.

I want to begin by thanking the members of the committee: the deputy chair, Senator Keon, and Senator Chaput, Senator Cools, Senator Cordy, Senator Mercer, Senator Stratton and Senator Murray, who participated in the first part of this study. Each and every one of them worked extremely hard on this committee, despite the fact that we had a federal election and two prorogations, which frequently put us behind the eight ball once again.

Above all, I want to acknowledge the dedication and passion of Canadians who participated in the work of this committee, through our public hearings, expert panels, survey and correspondence. Thank you for sharing your knowledge and expertise with the committee as we challenge ourselves to embrace new ways of thinking and seize the opportunities for building a better, more inclusive Canada for the future.

Canadians are, on average, living longer. The proportion of persons aged 65 or over in Canada was 8 per cent in 1971. It is 13 per cent today, and it is projected that by the year 2031, 25 per cent of Canadians — one in four — will be over the age of 65. The proportion of our oldest seniors — those 80 years of age or over — is also projected to increase sharply. By 2056, an estimated one out of ten Canadians will be 80 years of age or over, compared with about one in thirty today.

Population aging is a success story, but the committee has identified gaps in services and programs that are not meeting the needs of our aging population and must be addressed.

In November 2006, the Senate authorized this special study on the aging of the population with a mandate to review the programs and services we provide to seniors, the gaps that exist in meeting the needs of seniors, and the implications for future service delivery as the population ages. In considering the appropriate role of the federal government in helping Canadians age well, the committee was given a mandate to examine the issue of aging in relation to, but not limited to, promoting active aging and living well; 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, of course palliative care, home care and caregiving.

To fulfill its mandate, your committee has undertaken a three-phase study. This final report is the culmination of the work of the committee and builds upon its two interim reports from March 2007 and March 2008.

This final report builds upon what we learned concerning the gaps that exist in meeting the needs of our aging population, and creates a framework for seizing the opportunities that exist to build multi-jurisdictional responses aimed at creating a better, more inclusive approach to aging well in Canada.

This report recognizes that the challenge of an aging population goes far beyond the responsibilities of the federal level of government as defined in the Constitution. The needs of our aging population must be a concern for every Canadian, for every province, territory and municipality, for every business large and small, and for every volunteer organization and non-governmental organization.

The federal government, however, has a strong role to play in meeting the challenges of an aging population. In the committee's view, the federal government has three main roles: to provide leadership and coordination for multi-jurisdictional approaches; to provide support for research, education and the dissemination of knowledge and best practices; and to provide direct services to certain population groups for which it has a direct responsibility.

Although the recommendations in the final report are addressed largely to the federal government, the committee recognizes and emphasizes the need for a multi-jurisdictional approach.

The committee has identified five overarching recommendations, which are essential underpinnings of our plan to seize the opportunity of an aging population. These recommendations provide a framework for the committee's vision.

We recommend that the federal government: promote active and healthy aging and to combat ageism; provide leadership and coordination through initiatives such as a national integrated care initiative, a national caregiver strategy, a national pharmacare program, and a federal transfer to address the needs of provinces with the highest proportion of aging population; ensure the financial security of Canadians by addressing the needs of older workers, pension reform and income security reform; facilitate the desire of Canadians to age in their place of choice, with adequate housing, transportation, and integrated health and social care services; and act immediately to implement changes for those population groups for which it has specific direct responsibilities — veterans and Aboriginal people — and in relation to Canada's official language communities.

The report makes an additional 32 recommendations, which all fall under one of these five broad framework recommendations. Permit me to address each of these areas in turn.

The committee has heard compelling evidence that remaining physically and mentally active are instrumental to the well-being of senior Canadians. The health of seniors is intricately linked to experiences throughout their lives. One of the keys to maintaining health and quality of life is to sustain the ability of seniors to participate in meaningful activities and social networks. Opportunities for lifelong learning and volunteering can play an important role in helping seniors remain active.

Ageist attitudes, however, contribute to systemic barriers and stereotypes. The committee recommends an immediate public relations campaign aimed at all Canadians to portray healthy aging and encourage active aging through volunteer work, continuous learning and physical activity.

The committee also heard how seniors are often unjustly stripped of their rights — their right to control their personal finances, the right to choose where they will live, the right to continue driving or the right to continue working. Currently, declaring someone incompetent is too often an all-or-nothing proposition, which does not reflect the intricacies of mental capacity and mental competency.

The committee recommends that the Canadian Institutes of Health Research fund research on mental capacity, mental competency and mental capability to provide evidence-based research upon which to create public policy in these areas.

Closely related to the issue of competency is the issue of abuse and neglect of seniors. The committee recommends increased support for research into abuse and neglect, as well as the need to work closely with community organizations on this issue and to educate staff on how to spot abuse and neglect in their dealings with seniors.

The committee heard repeatedly that health is fundamental to quality of life for Canadian seniors. We heard that Canadians are not only living longer but many of them are also living longer in good health. Yet, seniors remain significant users of the health care system. This use includes primary care, such as hospitals and clinics, as well as prescriptions, mental health services, chronic disease management, caregiving, home care, long-term care and palliative care. However, we learned that illogical care decisions are made because frequently we do not provide the right service at the right time.

The committee recommends that the federal government develop a national integrated care initiative that would support the provinces' move towards an integrated model of care.

An integrated care initiative would include the integration of a broad domain of services including, but not limited to, health care, case management, home and community services, and residential care services; improved access to comprehensive care; increased emphasis on health promotion, disease prevention and chronic disease management; expanded multi-disciplinary teams so the most appropriate care is provided by the most appropriate provider; increased emphasis on one-stop shopping for seniors and their families; and improved portability of services between provinces, including reciprocal agreements to eliminate waiting periods for services.

As part of a national integrated care initiative, the committee was also convinced of the need for a national pharmacare program to make sure Canadians have equal access to the pharmaceuticals they need.

Over different stages of life, seniors can be both caregivers as well as recipients of care. As informal caregivers, they can help care for friends and family, including aging parents, an ailing spouse or grandchildren. As recipients of care, they can require both informal support and formal services such as community support services, home care, continuing care, long-term care and palliative care. The committee learned that current supports for caregivers are insufficient, and often Canadians are forced to choose between keeping their jobs and caring for their loved ones. The committee recommends that a national caregiving strategy form part of a national integrated care strategy.

The committee also learned that the unequal rate of aging of the population across the country creates challenges for provinces to provide a comparable range of services. Labour force mobility has exacerbated the aging of the population in some jurisdictions, particularly Atlantic Canada. The committee recommends that the federal government create a supplementary transfer program to assist provinces and territories that have an older population meet the increased health care needs of their seniors.

One of the most significant areas of federal government intervention related to seniors is income support, through programs such as Old Age Security pensions, the Guaranteed Income Supplement, and the Canada Pension Plan. These programs have helped reduce the rate of poverty among seniors over the past 30 years. Many Canadians also have income from private pensions and savings. However, despite this, some groups of seniors are more likely to experience poverty, such as unattached seniors, older women and immigrant seniors. The committee has learned that current income security measures for our poorest seniors are not meeting their basic needs.

The committee recommends that the federal government increase the Guaranteed Income Supplement to ensure that economic households are not below the low income cut-off lines.

The committee also recommends that in its next triennial review of the CPP the federal government examine measures aimed at increasing the financial security of senior Canadians.

Most seniors express a strong preference for staying in their homes as they age. Sometimes supports are required to allow seniors to age in the place of their choice. Currently, the labour force is structured in such a way that family members and friends often have great difficulty balancing work and care for the frail elderly. Formal supports can supplement the support of family members, yet there are significant differences across the country in the formal supports to seniors.

Housing and transportation are two fundamental needs of all Canadians. For seniors in particular, the combination of flexible housing designs, home and community support services, assisted living and transportation options can help seniors maximize their independence and quality of life as they age. Inadequate housing is especially serious among Inuit seniors, seniors with disabilities, recent senior immigrants and the broader Aboriginal senior population.

The committee learned that some seniors live in isolation or in inappropriate homes because of inadequate housing and transportation. Housing, transportation and social services are primarily areas of provincial jurisdiction. Witnesses before the committee have emphasized the need for greater integration between the health and social support systems in provinces and territories. Witnesses have expressed this integration as necessary both to combat climbing health care costs and to fulfill the desire of seniors to age in the place of their choice.

The committee recommends that the federal government work in partnership with provinces to increase the stock of affordable housing, including supportive housing, and that this housing be barrier free. The committee also recommends that a seniors' independence program, modeled on the excellent Veterans Independence Program administered by Veterans Affairs Canada, form part of a national integrated care initiative.

Similarly, as palliative care is an essential component of the continuum of care, the committee makes several recommendations about improving palliative and end-of-life care, including the need for additional research, for the application of the gold standards of care and for a national-provincial partnership to promote integrated quality end-of-life care.

One of the roles of the federal government is to provide direct services to certain population groups for which it has a direct responsibility, including veterans, First Nations and Inuit, and federal offenders. The committee learned that the federal government is both a leader and a laggard in providing care to seniors under their jurisdictional responsibility. Especially in regards to First Nations and Inuit, the federal government has a fiduciary responsibility. Federal resources for First Nation and Inuit communities must, at a minimum, provide a level of care comparable to other communities.

The committee recommends that the federal government address the need of First Nations and Inuit seniors and their communities, including the need for more and improved housing; increased attention to safe drinking water, diet, foot care, and other diabetic needs; measures to ensure wage parity among providers; increased home care and hospice palliative care services; more support for informal caregivers; the removal of the funding cap for the Non-Insured Health Benefits Program; and measures to fully integrate the range of programs currently available to seniors on First Nations reserves and in Inuit communities —

The Hon. the Speaker pro tempore: Is the Honourable Senator Carstairs requesting more time?

Senator Carstairs: Five minutes, please, honourable senators.

Hon. Senators: Agreed.

Senator Carstairs: — into a seamless system comparable to that employed by Veterans Affairs Canada.

Population aging is a success story, and seniors are a rich and vibrant part of our country. At the same time, it is necessary to provide the services and supports that will allow citizens to live with dignity and in good health.

The impending reality of population aging presents a wide variety of complex challenges, ranging from financial security and retirement, to housing and transportation issues, to chronic diseases and health care needs. These challenges are multi-jurisdictional in nature and will require efforts from all quarters to address them.

However, aging is not a disease. It is a natural life-long process and requires policy options that recognize this fact.

Seizing the opportunity of an aging population requires the federal government to promote active aging and healthy aging and to combat ageism; to provide leadership and coordination through initiatives such as a national integrated care initiative; to ensure the financial security of senior Canadians; to facilitate the desire of Canadians to age in their place of choice with adequate housing, transportation, and integrated health and social services; and to act immediately to implement changes for those population groups for which the federal government has specific, direct service responsibility.

The aging population will change the way we do things. We can allow this change to happen to us, or we can anticipate it and meet the challenge by design. This is the committee's vision for meeting the challenges of an aging population.

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