Don’t Blame the Elderly for Increasing Healthcare Costs
Victoria, BC – April 11, 2011 – There is a growing concern, as expressed in terms such as the Grey Tsunami or Apocalyptic Demography, that the aging population will bankrupt our healthcare system. In a groundbreaking new paper, health policy researchers Neena Chappell and Marcus Hollander say that it ain’t necessarily so. They state that the aging of the population will have a less negative cost impact than is thought, and that the primary factors in increasing healthcare costs are technology and increased service provision to people of all ages. They also note that there are significant savings which can be achieved through better organization and management of health services for seniors. Contrary to the general perception that there is little data to inform decisions, that solutions are elusive, and that increasing costs are inevitable, they show that there are significant opportunities for cost savings, while maintaining quality care. The authors state that “in a more integrated system of care delivery it is possible to both save money and increase the quality of care at the same time.”
The paper entitled “An Evidence-Based Policy Prescription for an Aging Population” recently published in HealthcarePapers lays out a plan to increase value for money in our healthcare system. Eleven commentaries were written by leading experts across Canada to respond to the lead paper by Chappell and Hollander, who also wrote a response to the commentaries. Taken together, these 13 papers, and the Guest Editorial by the Canadian Health Services Research Foundation, provide a unique insight into the issues faced by federal and provincial governments as they try to hold the line on costs while ensuring that seniors receive appropriate healthcare.
Rather than current systems where services such as home care and nursing homes may be in separate organizations, the authors call for an integrated system of care delivery to provide lower cost, seamless care for seniors across a wide range of health and supportive services. Such services would include community services such as meals on wheels, non-professional supportive services, professional home care services, supportive housing, long term care facilities and specialized geriatric assessment and treatment units in hospitals. All services would be in one system, with one overall budget, and care would be coordinated by professional case managers who can assess needs, develop customized care plans, and authorize access to any of the services in the integrated system. They would also coordinate care with other parts of the health system such as hospitals.
The authors note that, where appropriate, significant efficiencies can be achieved within an integrated system by substituting lower cost home care for higher cost nursing home care while maintaining choice for clients and family members, and a comparable, or better, quality of care. They also state that current policy appears to have led to an increasing cost spiral. Budgets for long term supportive care which allows people to remain in their homes have been frozen or reduced, resulting in additional pressures on hospitals and nursing home beds as people are cut from basic supportive care and can no longer cope at home. This results in deteriorating health and a more rapid move to hospital or nursing home care. The authors point out that what may not be fully appreciated is that while seniors who need assistance do have legitimate health conditions, and need some professional care, the appropriate response to these conditions is primarily non-professional supportive care such as feeding, bathing, ensuring a clean living environment, and so on.
In addition to calling for the development of integrated care, the authors’ policy prescription also includes calls to: reduce the debilitating effects of age discrimination; facilitate the development of healthy communities at the local level; evaluate promising preventive initiatives; and provide enhanced support to unpaid caregivers (family and friends) who actually provide most of the care for older persons.
Finally, the authors point out that, if fully implemented, an integrated system of care for the elderly and people with disabilities would be the third largest component of our healthcare system, in terms of public expenditures, and that this approach deserves a greater policy focus from senior decision makers.
Neena L. Chappell, PhD, FRSC
Canada Research Chair in Social Gerontology
Professor, Centre on Aging & Dept. of Sociology
University of Victoria
PO Box 1700 STN CSC
Victoria, BC V8W 2Y2
Marcus Hollander, PhD
Hollander Analytical Services Ltd.
300-895 Fort Street
Victoria, BC V8W 1H7