Growing old isn’t fun. How often have you heard that? In Quebec, add insult to injury, literally, because we call it ‘l’age d’or’. The golden age. Really? What is golden about it? Oh, I guess they mean retirement, not having to work every day, reaping the benefits of your investments, company and government pensions.
But that is not everyone’s situation, because depending on the province, many only have their OAS (Old Age Security) and a government pension. No RRSPs much less TFSAs (Tax Free Savings Accounts) to add, and scarce returns, if any, on real estate investments, stock market, savings accounts, none of which took place during their life- time.
Here is the saddest part. All statistics are not available, but we can say that Canada leads in or has one of the highest majority of its citizens who die in hospitals, 61.5%. That compares to England at 51%, 31% for the Netherlands, and, unbelievably only 20% in the United States (perhaps because of the high cost of U.S. hospital stay). That is not our wish. 87% of us do not want to die in a hospital, but in our home. Sadly, only 20% of Canadians do die where they reside. Because such a large majority of us take our last breath in a hospital, we spend more on “end-of-life care and medication than other high-income countries.” What’s wrong?
For starters, we are not getting anywhere near full value for our investment in Health Care in Canada. Don’t blame our caring health workers. We should be reducing suffering, and improving quality of life through Palliative Care. The C.D. Howe Institute has released a most enlightening study. It states the reason for these high medical costs is an insufficient number of palliative care beds, where we could substantially reduce costs avoiding sending the patient to a hospital’s acute care unit, and most often die in the hospital.
Palliative does not necessarily mean it is for those whose death is imminent, but often includes curative intent, recovering from serious illness and requiring assistance in relieving suffering.
If that is missing in the chain of our public health system, the end-oflife costs in acute care are going to be exorbitant, and they are. Authors Kieran Quinn, Sarina Isenberg and James Downar, (palliative care administrators) point out that because we spend so much more on costly acute care in our hospitals, we are not getting a good bang for our buck, not even close. Solution? The authors say this. “A major avenue to cost saving is greater use of palliative care, rather than more costly acute care, in end-of- life treatment. Palliative care primarily focuses on improving comfort and quality of life, often avoiding hospital-based, invasive, costly and potentially inappropriate care”.
The C.D. Howe report also includes the fact Canada has even fewer hospice beds where patients receive end- of- life care. An increase would free costly hospital beds and provide patients with the appropriate end- of- life care.
Please excuse the bluntness of these statistics on such a sensitive topic, but the facts are these. It costs 36 thousand dollars to die in a hospital versus 16 thousand to die at home. But the cost is not the issue, at least not the intent of this column. It’s the patient’s comfort, and home life, that are important rather than “invasive, often inappropriate acute care” in a facility. All the more reason to want to stay at home.
“Dad, the Dutch have attitude” my daughter once told me, and they do. The latest example from the Netherlands is the realization that “the greatest potential for improving the lives of the elderly lies in technology built for the young”. The home of an 87-year-old Dutch near the city of Rotterdam has been transformed into a cyber house, by his sons and daughters.
Rather than have health workers watch over him in a long-term facility, Dolf Honée is at home ‘watched’ when he gets up, walks around, makes breakfast, turns the range on and off, shaves, perhaps stumbles, and leaves the house. A smart stove switches itself off if it detects a fire hazard, and smart pipes turn off a tap left running. When the doorbell rings, his smart watch tells him who has arrived.
A tech company called Sensara has an app that pings on the kids’ phones if anything goes wrong or seems out of place. What else can it do? “Sleep is monitored via a device in his ear, his fridge suggests what he might eat, and a pill dispenser can give him tailored medication,” says Mr. Honée. “They’re always watching me but I feel safe, and I’m where I want to be at my age. Home.”
That’s what I’m Thinking.
Robert Vairo
robert@newsfirst.ca
