“Long-term care is a critical and precious resource,” said Liberal health minister Eric Hoskins. “It’s something we don’t want to get to the point of being unable to provide to older Ontarians.”
Hoskins was referring to the $8.3 billion the province is spending each year on long-term care, but he left much out. Ontario has its longest-living population ever, while its most-expensive social program is in the throes of a long-running financial crisis that is forcing it to cut funding for nursing homes and homes for the disabled. Older Ontarians, with their fixed incomes and other expenses, are hardest hit.
This problem is exacerbated by an aging population: 25 per cent of Ontarians will be 60 years old or older by 2036. But not only does Ontario have a growing population, the province of nearly 17 million people has nearly the same number of people over 65 — and that’s going to get bigger. As more people live longer with chronic diseases, there is a need for more people in nursing homes and specialized disability care. But state budgets are declining; the number of people who actually visit the hospital each year is declining. Nursing homes and specialized disability care are the last resort.
Which brings us to the current state of affairs: Even as Ontario’s government looks to reduce its own expenditures, it continues to cut its funding to its oldest citizens. According to the long-term care bill approved in the budget, the province will spend, on average, $130 less per person on health care for residents of nursing homes. About 11,000 people will leave the homes next year, without even a single cent to pay for their care. By 2031, it could be as many as 14,000. And like most aspects of the former Liberal government, its costly initiatives don’t create any employment for young people.
Funding for long-term care and disability services in Ontario is going down every year, but overall spending will continue to go up. Next year, this will be expected to total about $40 billion — with about $2 billion going toward a Liberal “vision” that includes subsidizing resident care to low-income families. That doesn’t include the nearly $8 billion it will spend on transferring people from the state to the private sector.
These moves are wholly unaffordable. According to the Liberal government’s own projection, the total cost of providing care for older people and for people with disabilities will exceed $27 billion by 2036. In the last five years, the average contribution toward care for people who are older than 60 has been about half that — less than half a billion dollars.
If Ontario succeeds in moving its elderly into the private sector, the province will hand millions of dollars to caregivers — which, from experience, has an inadequate skill base. It will need to keep a large supply of care workers to support the growing number of elderly people in its long-term care program. The present system also trains thousands of people every year in nursing homes to staff some of the most sophisticated facilities in the country. The present system doesn’t actually train anyone to work as a nurse.
If Ontario does manage to create a diverse and affordable workforce for long-term care, it would mark a rare achievement. But this won’t happen without major investment in prevention. The province could start by, for example, helping to prevent the onset of older-onset chronic disease by screening people for pre-diabetes and treating chronic conditions early. The management of these illnesses is the most cost-effective method of staying in the safety net of care during the middle years of a person’s life. Research shows that preventing chronic diseases instead of treating them after they have become acute is what really improves outcomes and keeps patients healthy. But the government has invested less than one per cent of its health-care budget in prevention.
Ontario has just begun to tackle its long-term care crisis. But its ambitious reforms are likely to unravel in the face of even greater pressures. You would do well to watch this money crisis unravel as well.
Jaanvik Parthasarathy is a specialist physician in rehabilitation at Kingston General Hospital. She is a global health specialist at the University of Toronto and a Fellow at the John F. Kennedy Memorial Foundation, based in Boston. This article appeared in The New York Times.