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Ralph Sultan: Caregivers need to be given a break as society ages

Demand grows and grows but the health care system is lagging
Former B.C. cabinet minister Ralph Sultan argues the health care system cannot accommodate the aging population without some relief for caregivers.

The Boomers are Aging. Their Kids aren't Ready.

That's a recent American headline. It could be written in Canada.  Public policy debate focuses on crime, housing costs, inflation, and access to medical care.  Missing from the list is our aging society.

When Premier Christy Clark appointed me British Columbia Minister of State for Seniors, maybe with an eye on the seniors vote. I visited about a hundred seniors care facilities across BC, ranging from admirable to deplorable. Cracks were appearing in the system even then. Dementia was coming on strong. How would our seniors care system cope? I posed the question, "What's our plan to handle the influx?" to the director of one of the largest government care facilities in Vancouver. I will always remember her answer: "I'm retiring next year!"

To be fair, the government of the day was proactive.  For example, we announced the "Better at Home" program.  As they age, most seniors want to stay living right where they are. Moving into a care facility is not first choice. Our program -- an accelerated focus on community nursing and visitation -- helped seniors stay right where they already were, at home -- but with some government assistance. And that program successfully operates today.

Benefits are obvious. A visiting nurse with a car is a lot less expensive than building a long-term care semi-hospital, funded by your tax dollars.

However, demand grows and grows. The proportion of seniors in our population climbs year by year, thanks to healthier living, improved health care and better education. Seven years ago, the proportion of our North Shore population aged 75 and older was 9.5 per cent.  Five years later, that proportion had grown to 12.9 per cent. If it keeps growing at that rate -- and what's to stop it? -- then more than 16 per cent of our North Shore population could be aged 75 and older by 2026. 

And as we grow older, more and more of us suffer from dementia. One national organization says over 10 per cent of British Columbians aged 75 and older suffer from some degree of dementia. And the incidence of dementia climbs with age.

Here are two case studies involving personal friends and relatives. One case involves a 56-year-old man who developed premature dementia. His wife is the breadwinner, and somehow managed both his care and her own career -- until his dementia became too much to manage. So, he was hospitalized.  He awaits disposition into a government-subsidized long-term care home. A bed will become available when one of the current residents dies. A sort of death watch, you might say. Evidence of no slack in the system.

Another case involves a 75-year-old woman who lived in a trailer park on the North Shore. Relatives dropped in frequently as her own ability to look after herself declined, but relatives also had their own lives to live. They researched long-term, private-pay care, not taxpayer-subsidized, and it was indeed available at an annual cost of $135,000. She joined the government-pay queue and her relatives soldiered on.

The common denominator here is a person being looked after by family members who, at some point, decide they cannot carry on. Demands are too great. Too stressful. Too energy consuming. In other words, "Better at Home" runs out of steam.

What is our capacity to cope with all of this? On the North Shore where I live, we have on the supply side in the range of 1,000 government-subsidized long term care beds. And maybe half that number again in the private pay category.  On the demand side, we have 18,000 people aged 75 and older living on the North Shore. So, the government can house perhaps five per cent of them.  What about the other 95 per cent? Here's the unwelcome speech I used to give when I was Seniors Minister: "We're mostly on our own folks!"

What makes "at home" possible is seniors care by partners, family and loved ones.  We call them "caregivers." And that's what most seniors prefer.

But there is a problem with this happy solution: caregiver burnout. Faced with dementia, limited mobility, even diapers and bedpans, often on top of existing careers, many caregivers say, "I'm sorry, I can't do this anymore."

How can we forestall this?   A smart strategy is to give at-home caregivers an occasional break. Allowing them to simply relax, or take a charter flight to Baja, or spend more time with their own family. But who will look after their loved one during their period of respite (caregiver respite that is)?

Fortunately, we have an organization dedicated to respite care: the North Shore Family Respite Centre, which will soon break ground for a special purpose short-term care facility at the foot of Lonsdale in North Vancouver. It will be like a short-term stay hotel for seniors. The sponsoring organization is Care BC, which used to operate under the name Victorian Order of Nurses. It is an organization of visiting community nurses.

Here is the arithmetic: their new Respite Centre will offer 18 overnight respite beds. If a loved one is admitted for, say, 10 days, while their caregivers take a much-needed break, about 650 clients can be served each year at the new centre. That is equivalent to adding about 650 permanent care beds to our North Shore capacity, simply by forestalling caregiver burnout. In other words, a gearing ratio of about 35, in which one respite bed gets you 35 clients looked after at home, and it's “Better at Home.” This single project could effectively grow long term care capacity on the North Shore by 50 per cent.

Dr. Inge Schamborzki is Executive Director of Care BC , the non-profit society providing at-home services for seniors and respite care (in Vancouver). She is raising the $15 million needed to complete a respite project for the North Shore. It is close to ground-breaking.  

(Inge is organizing a fund-raising gala at the  Pinnacle Waterfront Vancouver on Saturday, October 28.  You can donate to the North Shore Family Respite Centre through or contact Inge at 604-733-9177. Helping make a tax-deductible contribution to the Care BC Foundation is a high-leverage way a younger generation can prepare for the aging boomers who, on present trends, will swamp our already stressed long-term care system.)

Ralph Sultan is the former BC Liberal MLA for West Vancouver-Capilano and former Minister for Seniors.