- Patchy palliative care system puts pressure on emergency rooms: Ont. study
- Countries face challenges from aging populations: report
- Report warns of health care 'spending disease'
By Beatrice Fantoni, Postmedia News May 19, 2011
A comparison of end-of-life care services for elderly lung cancer patients in Ontario and the United States found that more than 40 per cent of Ontario patients died in hospital compared to a little more than 20 per cent of American patients between 1999 and 2003.
The study, published Wednesday in the online edition of the Journal of the National Cancer Institute, concludes that a lack of a structured hospice program in Ontario may have contributed to the higher rate of emergency room visits and hospital deaths despite statistics showing the majority of terminal cancer patients in Canada say they would prefer to die at home.
Palliative care for elderly patients is publicly funded in both the U.S. and Ontario, but differences in how the systems are structured could be one reason for the variation in in-hospital deaths, the study says.
"We are seeing a higher reliance on hospitals and emergency rooms," says Dr. Lisa Barbera, a doctor at Toronto's Sunnybrook Health Sciences Centre, who co-authored the paper with U.S. researchers. Increasing the number of palliative care doctors and nurses, and ensuring patients are referred to palliative care earlier could help keep people out of acute-care settings, she says.
"Hospice palliative care is not well-integrated into the health-care system," says Sharon Baxter, director of the Canadian Hospice Palliative Care Association. Aside from later referrals, geography affects the availability of home-care services, she says.
According to the findings of a 2010 Senate report, 16-30 per cent of Canadians can access palliative care, depending on their location. Those who don't have access can end up in the emergency room in the late stages of their lives, Baxter says, and that is often not the best care available to them.
Health-care systems in Canada are still focused on acute care, says Doug Angus — a professor in health economics and policy at the University of Ottawa — even though palliative care has been shown to improve quality of life and is more cost-efficient than visits to the emergency room. Given the aging population and increasing rates of chronic disease, Angus says, Canada's health-care system needs to put in place a solid support system that includes palliative care.
The study compared data from more than 21,000 patients — aged 65 and older — who died with a specific type of lung cancer between 1999 and 2003. While a greater proportion of Ontario patients were admitted to hospital, American patients showed significantly higher rates of chemotherapy treatment in the five months before death.
Barbera says it is difficult to say whether the results point to a broader national trend. Because health care is administered provincially, cross-provincial data of this kind does not exist. However, she said she expects to see similar results for other types of cancers.
By Carmen Chai, Postmedia News May 18, 2011
Nations need to improve on their long-term care strategies to accommodate a growing demand for eldercare services as the world's population of seniors steadily increases, a new Organization for Economic Co-operation and Development report says.
The latest OECD report, released Wednesday, told its 34 member countries -which include Canada, the United States, the United Kingdom and Australia -to consider new policies that would fight high turnover for professional caregivers and help informal caregivers, such as family and friends.
Currently, only about two per cent of the world's total workforce is employed in the sector, but the number of family caregivers is shrinking while demand will soar in upcoming decades, the researchers warned.
They projected that by 2050, those who are at least 80 years old will make up 10 per cent of the global population -up from four per cent in 2010. In 1950, a meagre one per cent of the world was 80 years or older.
"The future of long-term care is more demand, more spending, more workers, and above all, higher expectations that the final few years of life must have as much meaning, purpose and personal well-being as possible," the 300-page report read.
"Facing up to this challenge requires a comprehensive vision of long-term care. Muddling through is not good enough," the OECD researchers wrote.
In Canada, one per cent of the workforce is in the long-term care sector, the organization said. There are about 20 long-term care employees per 100 people over the age of 80 in the country. There are 4.6 million seniors in Canada and seven per cent of them rely on long-term care facilities, according to CARP, the nation's seniors advocacy group.
The latest Statistics Canada figures show that 2.7 million people are looking after family members who are over the age of 65.
Government and private-market spending on long-term care is about 1.5 per cent of GDP on average across the OECD's members, but figures will double or even triple by 2050, the report noted.
Don't skimp on benefits you offer to longterm care workers because it could cast the profession in a negative light, the report advised nations.
"Unattractive work conditions lead more workers to quit, which, in turn, further increases work burden and stress on those who remain -a vicious spiral," the study read.
Helping informal caregivers -90 per cent of whom are women -is a "win-win situation," the researchers said, noting that most family members caring for their elderly loved ones face a high risk of poverty and mental-health problems.
© Copyright (c) The Edmonton Journal
Sarah Boesveld, Postmedia News: Wednesday, April 13, 2011
TORONTO — Health-care spending is expected to shoot upwards over the next 20 years, forcing Canadians to make big sacrifices to cure the ill effects of this "spending disease," according to a report released Wednesday by the C.D. Howe Institute.
The wider availability of higher quality health care has hiked the price tag of health care in recent decades, but productivity and economic performance hasn't kept pace with the elevated expenditures, write the authors of Chronic health care: Spending Disease, a Macro Diagnosis and Prognosis.
None of their suggestions for addressing the problem — reducing provincial public services, hiking taxes, boosting individual spending and watching our system erode into disarray for want of a two-tiered health-care model — are much appealing either, former Bank of Canada governor David Dodge and co-author Richard Dion admit in their paper.
The pair set out to discover the extent to which health-care spending will absorb a larger chunk of personal income than Canadians have experienced under two scenarios: a 'baseline' approach that looks at how Canadians have contributed in the past, and an "optimistic" one that assumes a lot of improvements in the efficiency and effectiveness and a boost in economic performance takes place in the next 20 years.
Their results were dire, signalling a greater commitment to health-care spending would be necessary to maintain the status quo or even hope to improve the system by 2031, when seniors are expected to make up between 23 and 25 per cent of the total population, according to Statistics Canada.
"Even if we in Canada are incredibly successful in improving the productivity, efficiency and effectiveness of the health-care system — our optimistic case — we face difficult but necessary choices as to how we finance the rising costs of health care and manage the rising share of additional income devoted to it," the authors write.
In its share of the GDP, total health-care spending will rise from 12 per cent in 2009 to 18.7 per cent in 2031, said Dion, a senior business adviser at Canadian law firm Bennett Jones LLP.
This thanks to an aging population, an expansion in the scope and quality of medical services and, to a lesser extent, the rise in the relative price in health care services, he said.
"On a status quo basis, we project a total of health-care spending to rise faster than the income of Canadians and fiscal capacity of government in the last 20 years."
As Canadians make more money, they're also going to expect more and better health care services, especially as their needs become more pronounced, he said.
And if the health-care system keeps doing what it's doing, spending is expected to rise 6.4 per cent annually from 2012 to 2031.
Two per cent of that comes from growth in annual personal income, 2.1 per cent is from general inflation, one per cent is from the aging population, one per cent from expansion and scope of health-care services and the last 0.2 per cent will come from a general rising relative price of health-care services, Dion said.
"You see the fiscal squeeze that is implied by that," he said. There are two ways to alleviate the fiscal squeeze, he added: Boost effectiveness and efficiency or boost productivity in the economy. Either or both of these combined will help stimulate health-care spending, giving it a growth effect.
But even that is not enough, he said.
The four actions Dion and Dodge say will be "necessary" to manage Canada's "spending disease" are:
- Sharply reduce public services other than health care, especially those supplied by the provincial government.
- Increase taxes to finance the public share of health-care spending.
- Draw more cash from individuals for health care services that are currently insured by provinces through co-payment or by delisting services that are currently financed publicly.
- Put up with a major degradation of publicly insured health care standards. Canadians would have to face longer lines, poorer quality services and opt for a privately funded system, such as the two-tiered ones that are in place in the United Kingdom and elsewhere in Europe.
Two-tiered health care may be controversial in Canada, said Dion. "But it's something that one can debate over the next 20 years.
"There are some difficult choices ahead and the more information and discussion there is, the better choices Canadians can make," he said.
© Copyright (c) Postmedia News
Case in point is the last Benefits Canada Survey of Capital Accumulation Plan Members released in November. Some frightening statistics painted a grim picture of employee participation, which should act as a wake up call to plan sponsors. The survey showed that only 7% of those surveyed used employer-provided information to make investment decisions. Also, member contributions had declined from 7.3% in 2007 to 4.9% in 2010 and finally, only 21% of those surveyed recalled reading or hearing anything in the media about pension reform.
Tack onto those statistics the demographic facts of Canada’s aging workforce and plan sponsors are left with a number of arduous tasks. They must work harder to communicate effectively and prepare their DC pension plan members for the inevitable transition to retirement.
The right choice
For a large plan sponsor like Hudson’s Bay Company (HBC) with about 40,000 DC plan members—28,000 of whom are active—the sheer amount of investment choice and the types of funds offered can often overwhelm employees with their retirement decisions. This year the retailer is moving to a target-date platform on top of the a la carte menu of investment choice it already offers. And while it is not a target date fund per se, it is a platform that allows for a reduction in equity investments over time.
“This year what we’re doing is helping plan members invest for their future and we are going with a target date approach,” says Michelle Chusan, senior manager, retirement programs and communications with HBC. She adds that although enrollment in the pension plan has always been mandatory for members and is a condition of employment, the new platform will allow members to be less intimidated about making the right investment choices and concentrate more on their retirement end-goals.
And this is a point industry experts agree with. Jean-Daniel Cote, a partner with Mercer, says plan sponsors need to be thinking about transition to retirement and that up until now, too much focus has been on the accumulation phase of retirement assets. “As we get closer to baby boomers starting to retire, of course, there’s going to be an increase in interest towards finding solutions and helping plan members [with their] transition,” he notes.
Marylin Lurz, pension consultant with Lynmar & Associates reiterates the point. “Employers have had a huge focus on the accumulation phase. They really have not spent a lot of time thinking about retirement and the de-accumulation phase and how best to assist plan members with that transition,” she stresses.
Only 7% of employees use employer-provided information to make investment decisions. Member contributions have declined from 7.3% in 2007 to 4.9% in 2010.
Even a plan sponsor like electronics retailer Best Buy, which operates with an extremely young workforce who often look at retail as a transition point to the next career, is beginning to consider the tools needed to help plan for and move into retirement. The plan sponsor rolled out a DC plan three years ago to show employees that Best Buy need not be a transitional employer. And, says Kelly Cardwell, director, rewards and HRIS, with Best Buy, target date funds will likely play a role in their investment line-up as well. “[Pensions] are a major concern for us…one of the things we’ve been looking at are the investment choices we offer employees and [we] are looking at target date funds,” she says.
Communication and balance
Most plan sponsors of medium and large-scale DC plans likely have several communication tools either they, or with the help of their provider, supply to plan members. Best Buy’s Cardwell says a big push this year will be around communication. And because of its young workforce it is looking at unique and different ways such as social media to assist plan members. Lunch and learns and a focus on total reward statements, which emphasize the retirement plan, are all part of a broader communication strategy.
John McAteer, manager, savings and benefits plans Canada, with Direct Energy says his company helps members with transition issues by meeting regularly with its DC provider to analyze tools, promote material through internal communication and address issues of web traffic and how online tools are being used. Coupled with that are the target date funds and six outside funds it offers to employees in order to enhance their investment selection.
HBC works closely with field HR representatives to stay aware of upcoming retirements and work with their recordkeeper to get that member their retirement income options and ultimately ease the move from full-time work to retirement.
Lynmar & Associates’ Lurz says, however, that the balance within communications has been lacking. “Employers are not taking as proactive a role as they should be in driving what’s put in front of their members,” she adds. In other words, while communication is being offered and even some financial planning is a part of that, sponsors are not insisting on a variety of communications with regard to managing longevity risk and the need for members to protect themselves once they retire.
Tools (online calculators, booklets, in-person sessions, etc.), communications and balanced communications are all important parts of the retirement arsenal. And while Cote says providers are making good progress in helping with the penetration of these tools, they are only successful if they are being used. He says putting retirement projections at the beginning of statements, personalizing messages to members and custom emails all help bring up the “take up rate” and engagement by members.
When all is said and done, both plan sponsors and members have a responsibility to communicate with one another about goals, needs and what retirement should look like on an individual level. Without that two-way communication, the messages may be falling on deaf ears.
Joel Kranc is a freelance writer in Toronto.