Proceedings of the Special Senate Committee on Aging
Issue 1 - Evidence, November 27, 2006
OTTAWA, Monday, November 27, 2006
The Special Senate Committee on Aging met this day at 12:33 p.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chairman) in the chair.
[English]
The Chairman: Honourable senators, welcome to this meeting of the Special Senate Committee on Aging. This committee will examine the implications of an aging society in Canada.
We have organized a series of panels to help us gain an overview of the key issues confronting Canadians with regard to an aging population. These initial meetings have been organized around two central issues: to determine the priorities related to Canada's aging population and to help the government respond to the challenge of an aging society.
To help the committee better understand these issues, we have with us today Pamela White from Statistics Canada. She is accompanied by Laurent Martel. They will provide us with a statistical profile of Canada's demographics. We also have with us Dr. Byron Spencer from McMaster University. Dr. Spencer's work is on the macro-social and macroeconomic impact of an aging population. He directed a major research program on the social and economic dimensions of an aging population.
I welcome all of you to the Senate of Canada and to our committee. We will begin with Ms. White, and then we will move on to Mr. Spencer.
Pamela White, Director, Demography Division, Statistics Canada: Thank you for inviting Statistics Canada to appear before you today. My presentation will focus on the demographic challenges that confront Canada in the 21st century, in particular that of the aging of the population.
Between 1996 and 2006, Canada's rate of population growth slowed. Nonetheless, it remains significantly higher than Japan or Western Europe. Natural growth rate has long been considered the principle contributing factor to population growth. Since the early 1990s, this has not been the case for Canada. International migration is now the main source of population increase. Since 2000, over two thirds of population growth has been due to international migration.
Looking forward into the 21st century, Canada's rate of natural increase is projected to become negative between 2025 and 2030, if the country's level of fertility remains at its current low level of 1.5 children per woman. A level of 2.1 children is required to ensure population replacement, a level that has not been experienced in Canada since 1971. While the fertility rate of Aboriginal Canadians is considerably higher compared to non-Aboriginals, they account for only 3 per cent of the total population and contribute about 7 per cent of the overall natural demographic population increase.
The increasing importance of immigration to Canada's population growth is a significant factor that will have a major impact on the country's demographic composition, due to the characteristics and behaviours of the immigrant population. Increasingly, immigrants come from Asia and the Middle East and tend to settle in three large metropolitan areas: Toronto, Vancouver and Montreal, effecting rapid change in the ethnocultural composition of these cities. It is projected that by 2017, one Canadian in five will be a visible minority and that visible minorities will comprise over 50 per cent of the population of Toronto and Vancouver.
Aging of the population is mainly a result of declining fertility, but it is also due to a drop in mortality, as Canadians on average are living longer. While immigration contributes to population growth, its impact on aging is marginal. An increasing number of Canadians are reaching age 65 and once this age is attained, they live longer. This is considerable progress. The life expectancy of Canadian men is 77.4 years; for women, it is 82.3. These figures are among the highest in the world, behind only Japan and a few western and northern European countries.
Canadians are not only living longer but they also are living longer in good health. However, as their number of years of good health has increased at the same pace as their life expectancy, the burden that ill health represents over the life cycle has remained about the same over the past 10 years.
In 2002, more than 1.7 million adults aged 45 to 64 provided informal care to almost 2.3 million seniors with long- term disabilities or physical limitations. Roughly equal numbers of men and women aged 45 to 65 are involved in informal caregiving. Women are more likely to be high intensity caregivers, while men work longer hours at paid employment. Yet most of these caregivers are also in the labour force, with 70 per cent being employed. Just under half of these employed caregivers were women. One third of male caregivers spent one hour or less per week providing care compared with less than a quarter of women. Women are more likely to spend four or more hours per week.
As the baby boom generation reaches the traditional age of retirement and the potential for labour shortages increases, pressure to keep older workers in the labour force may mount. In addition, boomers are better educated and many may wish to continue working. However, they may also face conflicting demands on their time as older relatives and friends require care.
The proportion of persons age 65 or over was 8 per cent in 1971. It is 13 per cent today. When the first cohort of baby boomers reaches the age of 65 or over in 2011, another significant change will occur as the proportion of elderly among the total Canadian population will begin to increase more rapidly.
It is projected that by 2031, about one in four Canadians will be 65 years of age or over.
Canada's population is aging fast. Regardless of the projection scenario, by 2015 seniors aged 65 or over will become more numerous than children aged less than 15. This situation would be unprecedented in Canada.
The proportion of oldest seniors, those 80 years or over, would also increase sharply. By 2056, an estimated 1 out of 10 Canadians will be 80 years or over, compared with about 1 in 30 today.
Other countries already have a high proportion of elderly. In 2001, 16 per cent of the population of the U.K. and France was 65 years or older, a proportion that Canada will not reach until 2015. Equally, 18 per cent of the population of Japan and Italy in 2001 was age 60 or over, a proportion that Canada is not expected to attain until 2020.
The retirement of the baby boom generation is expected to have important consequences for Canadian society, including the labour market. The exact nature of these changes is difficult to foresee as there are important differences between the workers of today and those of tomorrow, who will have, on average, higher levels of education and labour force participation, particularly for women. In demographic terms, the working age population, that is the population aged 15 to 64, will decline steadily in the 2010s and 2020s. Currently, the working age population represents 70 per cent of the total population. By the beginning of the 2030s, it will decline to 62 per cent and then level off at about 60 per cent.
These trends are at the national level. However, aging of the population does not occur evenly across Canada. In 2006, the median age of Canadians was 38.8 years. With few exceptions, the older population in Canada is found east of Ontario, with the population resident west of Quebec and in the territories being younger. While differences are generated mainly by different fertility levels, migration also plays a role.
In the Atlantic region, outmigration of young adults is accelerating an aging process already fuelled by a persistent lower fertility. In 2006, all four Atlantic provinces had a population older than the national median. Except for Prince Edward Island, their median age was over 40 years.
Quebec, with a median age of 40.4 years, was the only province outside the Atlantic region to post a median age higher than 40. This median age was mainly due to a fertility that has been steadily lower than the rest of the country over the first 25 years following the baby boom. However, the recent increase in fertility, if maintained, could slow the province's aging process.
Ontario has a median age of 38.2 years, which is close to the national average. On the other hand, Manitoba and Saskatchewan have relatively younger populations as their median ages are 37.3 and 37.7 years respectively. A strong Aboriginal presence has helped both provinces maintain higher fertility rates. This has offset important losses of young people due to interprovincial migration, and at the same time slowing the aging process.
Due to a persistent higher fertility and the steady, strong inflow of young Canadians from other parts of the country, Alberta had the youngest population among provinces, with a median age of 35.5 years. Between 2001 and 2006, Alberta's median age went up by only 0.8 years, the smallest increase among the provinces.
In British Columbia, the median age was 39.8 years, making it the only Western province with a median age above the national level. This was the result of decades of lower fertility that offset the effect of strong migratory inflows.
The population was also younger in the three territories. The lowest median ages in the country were in Nunavut, 23.2 years, and in the Northwest Territories, 30.9 years, caused by their fertility rates, which are Canada's highest.
The Yukon, with a median age of 38 years, just below the national level, was an exception in the North. This is because it has fertility rates lower than the other two territories.
Overall, the median age of those living in Canada's metropolitan centres is lower, 37.7 years, compared to those living elsewhere, 40.7 years. The exceptions to this trend are Trois-Rivières, Saguenay and Victoria, where the median age ranges between 42 and 43 years. Close behind are St. Catharines-Niagara and Quebec, where the median age is 41.3 years and 40.8 years respectively.
In summary, since 2000, immigration accounts for two thirds of total population growth and will eventually account for all growth if fertility remains low. While immigration mitigates slower natural population growth, it has little impact on population aging.
Currently, seniors make up 13 per cent of the population. As baby boomers join the ranks of the age 65-plus population in 2011, there will be a rapid increase in the proportion of seniors in the Canadian population. By 2031, close to one in four will be over age 65. The old and the very old will become the fastest growing age groups.
In 2002, over one million employed people aged 45 to 64 provided informal care to seniors with long-term conditions and disabilities. Two thirds of women and nearly half of men who combined more than 40 hours of employment with four or more hours of caregiving per week experienced substantial job-related consequences such as reduction in hours, reduction in income or change in work patterns. However, caregiver burden seems to be associated more strongly with the intensity of caregiving than with the intensity of employment.
Atlantic Canada and Quebec will experience a more rapid aging of the population compared with Ontario, the Western provinces and the territories. While most large urban centres have a younger population, there are exceptions, such as Trois-Rivières, Saguenay, Victoria, St. Catharines-Niagara and Quebec.
Thank you for your interest in this topic and I would be pleased to answer any questions on the demographic issues that I have presented today.
Byron Spencer, Professor, Economics, McMaster University, as an individual: I am pleased to be here today and to have an opportunity to speak to you. I was told that I would have seven minutes, and in my seven minutes I thought I would try to give you seven messages.
The title I have given to these remarks is ``On the Challenge of Population Aging: A Canadian Perspective. I emphasize the Canadian perspective because the message would be different if I were speaking in certain other countries, as will be clear as we move along.
The first point I would make, and the message I would leave with you, is that, complementary to what was just said, population aging is inevitable. Contrary to popular views, it is not reversible. It cannot be reversed; population aging is inevitable.
Let me demonstrate that in the following way. Here is a projection of what the population is likely to do under standard projection that we have made close to the standard projection of Statistics Canada. You can see the population continuing to grow but increasingly slowly.
However, the other side shows what will happen to the proportion in old age, defined as 65 and older. I am cautious about defining 65 and older as old age but nonetheless it is a standard definition. If we start from the current situation in 2006, we see that the proportion that was just mentioned is about 13 per cent and that proportion will almost double under this projection in the next three decades or so. Substantial aging of the population is defined in that way.
What could offset that? The obvious answer usually is immigration. Even if we doubled immigration — and here is the same projection but immigration doubled instead of maintained at its current level — there is a big impact on the size of the population. Notice, however, what happens to the proportion 65 and older. It still increases up to about 22 per cent of total instead of 24 per cent or 25 per cent. The story is, that it is still a big increase in the per cent of old.
The other possible answer is that we could go back to a situation of much higher fertility. Higher fertility, which is this blue dash line here, represents about a 50-per- cent increase in fertility — from where it is now at about 1.5 up to the replacement rate of about 2.1. With that, the per cent aged 65 and older would decrease somewhat, but the big story is still substantial aging. Population aging from that perspective is inevitable.
Another way of ameliorating the extent of population aging is to redefine what we mean by ``old.'' That suggestion probably has a lot of appeal — and not just in this room, I would hope. I will tell you why I think that is important. The per cent for ``old'' would increase to about 20 per cent, other things being equal, if the definition of ``old'' were to increase in keeping with projected increases in life expectancy.
To redefine old in that way is a reasonable thing to do. The U.S., as you are probably aware, has redefined the age of eligibility for full benefits under its social security system to increase up to age 67 over a period of some years. That change is under way; it is happening bit by bit. As it does, in effect, they are redefining ``old.'' In Sweden, the age of eligibility for socially provided pension benefits is also indexed to increases in longevity, so it is increasing. In this sense, Sweden is redefining what is meant by old.
My first point was that population aging is inevitable. I hope I have persuaded you of that. The second point is that in consequence of population aging, the rates of population growth and labour force growth will both decline, and they will decline a lot. This point was already mentioned but let me show you here.
If we go back to the 1950s, when the baby boom was in process — members of the baby boom were very young — the rate of growth since then has been basically falling. It continues to fall to recent numbers, and the projection is that the rate of growth will continue to fall. The rate of growth remains positive in the projection here, but it continues to fall. As has already been mentioned, much of that growth is attributable to immigration. If immigration were to stop, the population growth would soon cease.
Labour force growth goes to zero much sooner than population growth. That is a result of the age distribution of the population. However, again, 20 years later than the peak in population growth, we see the peak in labour force growth and a rapid reduction in that rate of population growth. If immigration were to end more or less now, labour force growth would cease more or less now. The rate of labour force growth is that closely aligned to the rate of immigration.
The next diagram emphasizes how important our comparative situation in Canada is, relative to other places. The diagram was assembled by the Office of the Chief Actuary. As compared to the year 2000, we see Canada's working- age population — defined here as ages 20 to 64, the blue line — grows slightly. The line is basically flat after about 2020, as compared to the U.S, which continues to grow, although at a slow rate. The reason is that the U.S. has noticeably higher fertility than Canada, and that leads to a somewhat higher rate of growth of the working age population.
However, as compared to Canada, you will notice that most other countries in the Organisation for Economic Co- operation and Development, OECD — the exception being the U.S — have declines in the working-age population as we look ahead. The declines are projected declines — and substantial declines if we consider Italy, Spain or Japan. In the case of Italy, the projection is it will be down to about 45 per cent of the current working-age population by mid- century. In France, it is down to about 90 per cent of its working-age population, Japan is down to about 50 per cent of its working-age population and so on. These huge declines are projected; and barring a major reversal of fertility, they will happen. There is no other outcome that will occur. By international standards, and that is why I said the Canadian perspective matters, Canada has a much lesser concern with population aging than most already prosperous countries.
The projected decline in the rate of growth of the population and the labour force gives rise to concerns about standards of living in the future. My answer to those concerns is, contrary to widely held, popular views — not so much informed views — that it is unlikely to be a big concern. The slower population growth is not likely to lead to a reduction in the standard of living.
My fourth point tries to explain why that would be. The answer is that our standard of living in the future depends importantly, even predominantly, on the rate of productivity growth. To the extent that we can have positive impact on the rate of productivity growth, through all sorts of things that are mostly unrelated to population aging, we can ensure rising standards of living in the future rather than be concerned with lower standards of living in the future.
My fifth point is that government programs will remain manageable, at least in response to population aging. This, again, is not the popular view. The popular view is that increases in health care costs, which everybody thinks are obviously attributable to population aging, will break the bank — in particular, break government budgets — and things will be unmanageable. I think this view simply is not true. It is not true of public pension programs and income security programs, and it is not true of health care programs. There are concerns about private programs as they relate to pensions, and I will come back to those concerns briefly at the end, but the sustainability of government programs is not really in doubt.
Let me try to illustrate why I say that is so important here. A recent study has estimated that in the last three decades, health care expenditures in OECD countries have grown collectively at twice the rate of GDP. Obviously, that situation is unsustainable. They cannot grow at the rate of twice GDP for too long without absorbing more than all of GDP; and we cannot spend everything on health care, as much as we might be tempted.
In the same study, it is further estimated that if you isolate the component of those increases in health care expenditures that are attributable to the aging of the population, the increase is 11 per cent. The rest, 89 per cent, is attributable to other factors, in particular to increasing the amount that is spent on people in each age-sex group. That is not the result of aging; it is the result of spending more — increasing the benefit levels in the case of health care or increasing benefit levels in another sense in the case of pensions and so on. If you isolate only the effects of population aging, the increase in expenditures implied for government programs is entirely sustainable.
I was quoting a recent and important OECD study. However, I want to emphasize that the result is entirely consistent with our own findings, and the findings of many others for Canada as they relate to the health care system and to other things.
Some problems should concern us, though, problems associated with population aging. One of these problems has already been identified, and that is the uneven rates of population aging across the country.
The chart on population growth plots the projected rate of population growth over the first half of this century. It is organized from the East Coast to the West Coast. East of Quebec, the population growth is projected to be negative. In the case of Newfoundland and Labrador, it is projected to decrease by about 30 per cent if current trends continue over this half century. For Quebec, there is a projected increase. Looking west, all provinces are projected to increase, in Ontario by 50 per cent. I do not mean this as a forecast, but it is a projection of what would happen with current trends if they were to continue. The overall picture here is reduced rates of growth of the population and, similarly, of the labour force.
We can see that the labour force of Newfoundland will decrease by well over 40 per cent and that at the same time the labour force of Ontario will increase by about 40 per cent. The unevenness across the country is a matter of considerable importance. The proportion in this so-called ``seniors' group,'' 65 years and over, also varies unevenly across the country. That is one big concern, importantly, because of divided jurisdictions and jurisdictional responsibilities for health care expenditures. As we know, health care is already absorbing large fractions of provincial budgets; so the unevenness of this group matters a great deal.
As well, I draw your attention to the seventh point on the older group. One great success story in our income security program in Canada during the last number of decades has been the reduction in poverty as typically measured among older people in the population. This chart shows two measures of the prevalence of low-income rates. These measures are variously defined but they are often used as poverty measures, although it is not a term that Statistics Canada wants to attribute to them.
The first measure is the low-income cut-off and the second is the low-income measure. I will be happy to tell you more about what they are if anyone wants to know. They both indicate that about 20 per cent of the population over 65 was below these cut-offs, in poverty, in shorthand, in about 1980. If we take the measure based on the low-income measure, LIM, we see that it is down to about 2.5 per cent to 3 per cent by the end of this period, which stops in 1995; and that number is the current one as well. The number is low suggesting that poverty is almost vanished by these measures among the older age group. However, pockets of poverty remain among the older age groups and, indeed, among others. This next diagram illustrates a bit of that.
This diagram is based on the so-called low-income cut-off measures, LICO. In this chart we have females in one- person households that show the poverty rates among those older women, 65 and above, are about 20 per cent. Even if women are in two-person households, but are the primary earner in those households, the poverty rates are much higher than for male-headed two-person households. However, the other group here of some concern, single-person male households, has high poverty rates. Other pockets are out there but I draw your attention to those two.
The Chairman: Thank you, Dr. Spencer. You have given us much food for thought, as did Ms. White.
Senator Murray: I have one question but first, to clear the air, Ms. White, is there anything in Dr. Spencer's presentation in terms of the projections and other statistics that he has given us to which you would take exception or that you would dispute?
Ms. White: No: Mr. Spencer has presented, by and large, the measures of the Organisation for Economic Co- operation and Development. While his projections are probably based on the ones that we have provided most recently, I do not have a dispute with what he has presented.
Senator Murray: Dr. Spencer, would you take exception to any of the material that Ms. White has presented to us?
Mr. Spencer: Her remarks were unexceptionable.
Senator Murray: Ms. White, I am interested in immigration. You tell us that two thirds of population growth, and ultimately all population growth, will be accounted for by immigration. Would you talk for a minute about immigrants? One of the categories is reunification of families. Correct me if I am wrong but I understood that a good many of those immigrants are older people being reunited with younger family members in Canada. In any case, what do we know about the ages of immigrants coming to Canada? Do you track fertility rates among immigrants?
Ms. White: Those questions are good in terms of the impact on the demography of Canada. Immigrants tend to be middle-aged. We encourage those individuals who can adapt in the economy, so the average age is probably around 30 years, I would imagine. The average age of an immigrant is in the 30s. Immigrants, like native-born people, age so they contribute as well to the aging of the population.
In terms of fertility of immigrants, recent work that we have done on the fertility of both visible minorities and of immigrants has shown the following: The fertility levels of visible minorities have been dropping and levels for both groups are under replacement levels. In terms of their contribution to fertility, immigrant fertility rates have dropped from just under 2.1 per cent to about 1.8 per cent. The levels of both groups are not increasing the fertility level of Canadians, if you will.
Senator Murray: Are you talking about immigrants generally or visible minorities?
Ms. White: Visible minorities and immigrants, yes.
Senator Murray: Do you know what proportion of immigrants are under 30 years of age? How many people come to Canada with young families?
Ms. White: I do not have that number off the top of my head but I can provide it to the committee later.
Senator Murray: I hesitate to ask the question of a neutral body like Statistics Canada. Obviously, we need, and are looking for, immigrants who have skills and can contribute immediately to the economy but, given what you have told us about the average age of immigrants and the challenge of population growth, does that suggest to you perhaps not a change in policy but a different emphasis in our immigration policy?
Ms. White: I cannot comment on the immigration policy. However, I can provide you with a more detailed breakdown of the age range of immigrants over the past number of years. That breakdown might provide background information for the committee.
Senator Murray: Should we bring more babies to Canada, perhaps?
The Chairman: Dr. Spencer has spoken to some interesting statistics. I invite him to comment on Senator Murray's question.
Mr. Spencer: On the screen before the committee is the age distribution of immigrants, historically from 1991 to 2002. Consistent with what was said, we see that a bit over 40 per cent of male immigrants and a bit over 40 per cent of female immigrants are aged 25 to 30 years. They come to Canada with young dependents so one quarter of all immigrants are under the age of 15 years, most of whom have parents aged 25 to 39 years, one would think, although some might be a little over 40 years of age. A small proportion of immigrants are over the age of 65, but almost 20 per cent are over the age of 40.
Senator Murray: Twenty-five per cent are under the age of what?
Mr. Spencer: They are under the age of 15. They come with their parents. Their parents are typically in the age group of 25 to 39 years, although some of them might a bit older.
Senator Murray: Ms. White's testimony is that immigrant contribution to fertility is no greater than those of native- born Canadians. Is that accurate?
Ms. White: The rate is a little higher, but it is not above replacement level. For visible minorities, it is at about 1.8. It is the same with immigrants in general. Not all visible minorities, of course, are immigrants.
Laurent Martel, Analyst, Research and Analysis Section, Demography Division, Statistics Canada: We have conducted studies indicating that recent immigrants have higher fertility rates than Canadians. However, fairly rapidly after their entrance to Canada, their fertility rates drop and tend to match that of Canadians. They adapt in every way to the average fertility rate of Canadians.
The immigrant fertility rate is higher, but only shortly after arriving in Canada. After a while, between five and ten years, their fertility rate is consistent with that of Canadians.
The Chairman: It sounds to me like a new form of birth control.
[Translation]
Senator Chaput: I would like to hear from you about a new definition of seniors, that could include people who are 75 years old instead of 65.
I would also like you to talk about baby boomers. I have read that these people will benefit from better health because they are much more careful about what they eat and because they are much more physically active.
Recently, I have read that baby boomers will not necessarily be interested in quitting their jobs when they reach the age of 65. Some of them mention that they would like to be able to continue working, one of the reasons being that they are not necessarily ready financially, but also because they want to remain active on the labour market.
I would like to hear from Ms. White and from Dr. Spencer on this issue.
Ms. White: First, regarding the definition of the age of seniors, we have used the age that is normally recognized by demographers, that is 65 and over. I will leave it up to Mr. Spencer to express his opinion on the sociological aspect, on the definition of a senior.
Regarding baby boomers, it would be difficult to predict the tendency to continue working among this age group. Some baby boomers are worried about their capacity to have a well-subsidized retirement. They do not know whether they will be able to continue enjoying a financially comfortable life without working.
As far as better health is concerned, I am not an expert in the health of baby boomers. Perhaps Mr. Martel could make a few comments about health and aging.
Mr. Martel: I would like to add a few comments to Ms. White's answer concerning the age of retirement or even the definition of a senior. Obviously, the age of 65 is the legal retirement age in Canada. In Europe, the threshold of 60 years old is widely used. There are some variations, even in the definition of old age, between different countries.
There is indeed a need to reconsider this definition. The increase in life expectancy among Canadians has had a profound impact on the very idea of mortality in Canada. I was told once that it was chancellor Bismarck who chose the age of 65 as the age of retirement, realizing that there were few people who got to live that old and that consequently, it would not cost too much to sustain all these retired people.
In 1971, in Canada, 8 per cent of the population was 65 and over. We are trying to maintain this percentage. Today, 8 per cent of people at the top of the age pyramid, made up of people who are in their last period of life, are 81 years old. This gives you an idea of the incredible progress that has been made as far as mortality is concerned. So it might indeed be advisable to reconsider this age threshold.
As far as the health of baby boomers is concerned, we know that cohorts who reach old age will be different from those who already are at that stage. Each cohort arrives at the age of 65 with their own behaviors, their own values and experiences, including in the area of education. We know full well that future seniors will be better educated than present day seniors. They went to school for a longer time and we know that there is a link between education and health. So we might think that because they are better educated, they are also more aware of what is good for their health; perhaps they are more active in sports because they know how important physical activity is for their health. So we might think that indeed in the future, seniors will be in better health than today's seniors.
[English]
Mr. Spencer: There are a number of interesting aspects to this discussion.
On the matter of the definition of a senior citizen or what we account for as old age, I observe that in 1951 — which is now 55 years ago — the definition of old age was 65 years of age for legal purposes. That was the age at which one was eligible for particular benefits prescribed by law. Yet, life expectancy has increased over that period of time, in 50 years. It has increased by about 10 or 12 years.
It is obvious to everyone who was around in 1951 that a 65-year-old at that time is not the same as a 65-year-old in 2006. They are different people. They are, on average, much healthier nowadays and certainly have many more years of good health ahead of them.
I think it makes sense to change the definition — what we deem to be, for legal purposes and for age of eligibility for full benefits under social security and so on — in a systematic way as life expectancy increases, assuming life expectancy continues to increase as we may reasonably expect.
On the matter of the baby boomers wanting to retire later, I observe two things. One is that the labour force participation rates for women have been increasing steadily, including women among older working age groups. The big thing though is on the side of men, whose participation rates decreased over a period of about three decades, and by the mid- 1990s, the participation rates for males 55 to 64 were about 60 per cent, which is remarkable. The rates had been about 90 per cent two or three decades before that, so big decreases in labour force participation among that age group of men.
Recently, in the last decade, there has been a sharp upturn in those rates for reasons that are not fully understood, but some of explanation might have to do with this better health that we talked about. A lot of it has to do with the fact that jobs are available for them. If they are displaced from their employment, they can go to something else because there has been generally good labour market activity in this period.
Also, their income security has been challenged a bit over this period, and so they are more anxious to remain in the labour force. Adding to that, I will come back a point that I alluded to, namely, a serious and legitimate concern about the situation with private pension plans.
This issue is not a population aging one as such, but less than a third of Canadians have coverage at all under private pension plans. That is to say, less than a third of Canadians who are not employed in the public service have private pension plan coverage. Of course, they all have Old Age Security and Canada Pension Plan if they are working, and so on, but two thirds of people do not have private pension coverage.
That concern is a serious one among those who have some coverage. Many will not realize the coverage because they change jobs and the coverage does not go with them and so on. That concern is a serious one among people who are in low-income groups. These people rarely have any significant amount of private pension coverage.
Senator Keon: Mr. Spencer, you said something that interests me very much, which is that, fundamentally, the health care expenditure is growing at twice the rate of GDP. Correct me if I misquoted you. Is it correct that aging accounts for only 11 per cent of that?
I do not feel as comfortable with this number as you suggested, for the following reason, and I would like you to comment on it: We currently have a split of about 70 per cent and 30 per cent when it comes to the payer for health care in Canada. I think the 70 per cent will be sustained, but the 30 per cent is a worrisome part to me. About half the 30 per cent is paid out of the pocket and the other is covered by some kind of insurance.
The aging people are clamouring for security in this 30 per cent sector; in other words, the sector does not cover post-hospital care, custodial care, all their palliative care, care when they get to the homes and their homes are not sufficient and so forth. As far as I know, they are anxious to see a change in this area. I think when the change comes in this area, whether it comes through the single payer, the government, or the private sector, which I think requires revolutionary changes in the insurance industry in Canada, I think the change will blow that 11 per cent much higher.
I would like to hear your comments on that.
Mr. Spencer: First, let me be clear what the 11 per cent is. The study referred to the growth of health care expenditures over three decades in OECD countries collectively. The statement is that health care expenditures were growing in those countries, over that three-decade period, at twice the rate of GDP. That growth is clearly unsustainable; it cannot continue.
If you look at the age profile of expenditures at the beginning of those three decades, and you project ahead, suppose that we maintain the same level of expenditures for all those individuals in each age-sex group as they age over those three decades, how much would the expenditures increase? The answer is 11 per cent. In fact, they increased enormously more than that, but the reason for the increase is not because of population aging, and that was the point I tried to emphasize. There are lots of good things on which to spend money and one of them is better health, but population aging is not the only reason those expenditures will increase so much.
I will put the statement a little differently. A quip I like from a well-known health economist is that good health is only a state of incomplete diagnosis. We can always find more ways to spend money on health care. It does not mean that it is related to the aging of the population or to anything of that sort.
Senator Keon: You are basing your projections on the health status quo. You are looking through a retrospective scope and saying we are only spending 11 per cent and that is all we need to spend. My hypothesis is that the status quo cannot hold the line and that seniors will demand a tremendous change in the status quo as it relates to the things I mentioned.
Now, come back and give me comfort again that it will only cost us 11 per cent.
Mr. Spencer: I will look ahead rather than back. If we were to consider the expenditures now on, let us say, people aged 70 to 74 years old, 75 to 79 years old and, indeed, every other age group in the population, and we were to take the current level of expenditures and project those expenditures ahead, yes, we would find increases in expenditures on health care. The reason is that we will have people moving, on average, into age groups that are older, and hence have higher requirements for health care services.
Yes, there is an increase in expenditure in health. However, the increase that results from that aging of the population is of a modest order. It is not anything like doubling the expenditure on health care services. It is modest. That is true as we project into the future, not just historically.
Does that answer your question, senator?
Senator Keon: Yes, I deeply appreciate the answer. I am afraid I do not totally agree with you. You are the expert. I am talking from the point of view of perception.
Mr. Spencer: You emphasize something important and that is, there is a lot of pressure to increase the expenditures per capita. I want to emphasize that increase is not associated with the aging of the population; that increase is associated with the possibility of perhaps providing better services, but not necessarily better services. A lot of health care expenditures are demonstrably wasted.
Senator Mercer: I continue to learn but I also continue to be a little frightened at some of the statistics that I have heard.
Ms. White, there was a vague reference by both of you to other countries. Are there other countries with similar percentages in terms of population demographics and growth that we, as a committee, should study for a comparative study?
Ms. White: You may want to look at Australia for its similarity to us. If you want to look at the stock of immigrants in the population, immigrants make up about 18 to 19 per cent of our population; in Australia it is about 24 per cent. In terms of the shape of the population or the distribution of youth through to seniors, Australia has a similar distribution.
Clearly, if you look to the U.S, two-thirds of our growth in Canada is due to immigration, whereas in the U.S. it is due to fertility. The U.S. population is younger compared to ours.
We often make references to the U.S. However, population dynamics are different. Our rate of growth has been tracking similar to the U.S., a little under, from one year to the next. It will be a little over the U.S. and a little under the U.S. in terms of our actual population growth. It is projected that because they have a higher natural increase that the U.S. will grow at a faster rate than we will.
Senator Mercer: Do we know why two-thirds of the growth is because of fertility? We know our growth is two-thirds by immigration.
Ms. White: In the U.S., their fertility rate is close to replacement at two children per woman, where ours is 1.5. That rate is really the difference.
Senator Mercer: Is there an obvious reason for that?
Ms. White: Three factors probably contribute to higher fertility in the U.S. One is that the number of women under the age of 20 who have children is considerably higher than in Canada. That is not necessarily a fertility pattern that we would wish to emulate, because fertility amongst people under the age of 20 means that perhaps they are limiting their education and labour force participation.
The other two have to do with when women have children in the U.S., and when they have that second and third child. They tend to have their first child in their early 20s and follow up with that second and third child through their 20s and early 30s. Canadians are delaying childbirth until the late 20s and early 30s, and not necessarily having that second or third child, obviously.
Clearly, there are some differences amongst the populations in terms of Hispanic populations and Black Americans having more children. Also, when people have children within that society that contributes to the higher fertility rate.
Senator Mercer: You have both talked about redefining what a senior is or where old age begins, although I do not like the term. I remember when the age for receiving government benefits was higher. In fact, as Professor Spencer alluded to, I remember our grandmother living with us and she received it when she was much older than people today.
The problem that we all have is wrestling with this rapidly growing population; healthier in some ways but not in others, and all expecting certain programs. If we move the line and say they are no longer a senior at wherever that line is, but now at a higher level because they are healthier and there are more jobs, et cetera, I have difficulty with a group of people who have planned their life that at age 65 or whatever age they will retire, and that these benefits will be available.
One dilemma of the committee, and probably the biggest dilemma of government, is that as we plan for the future, how do we fulfil people's expectations at the same time as filling the needs, recognizing the financial constraints that go along with filling those needs, and all of that being affected by demographics?
Mr. Spencer: I would comment on one aspect of it. You are right to identify concern about people planning for their retirement. We do not want to make such changes, and especially big changes, without a good deal of notice.
For example, in the U.S., when the legislation was changed such that the age of eligibility for full social security benefits started to increase, it was 10 to 15 years before the age of eligible actually started. Once it started, the age at which they could receive benefits went up by one month for every year of time. It was phased in from age 65, being eligible for full benefits up to age 67, over a period of approximately 20 years.
The lead time and the announcement of these things as taking effect at some future date are important, for the reasons you identified.
Senator Cordy: I am wondering about demographics. Many of them were not surprising when you talked about out- migration from Atlantic Canada, which is where I am from. We all know many young people graduating from university or community college and heading to Alberta. Alberta has a younger population due to the fact that many young Atlantic Canadians are living there.
Within Nova Scotia itself — I will speak of Nova Scotia, my province, but I think it is the same in each province — we have the demographics of the rural versus urban. While the population of Nova Scotia has fallen slightly, it has remained fairly steady, down a little bit. However the population of Halifax has grown substantially and the population of the rural areas has fallen dramatically. Neither of you mentioned urban versus rural population in your reports. Have you done any studies on the number of seniors who live in rural areas? It seems to me that young people are leaving the rural areas and moving to the urban areas, but is that a fact or not? I do not know the statistics.
Ms. White: I alluded to it somewhat when I talked about median age, where urban areas have a lower median age compared to non-urban areas.
Rural areas tend to be older demographically, except for areas that are affected by Aboriginal populations. When you talk about the northern part of Ontario, Quebec and the Prairie provinces, populations as a median age are actually younger sub-provincially. Within a province such as Nova Scotia, outside of places such as Halifax, Dartmouth or Truro, the population demographic would be older.
Senator Cordy: How do you define a rural area? Since amalgamation Halifax regional municipality takes up a large geographical area, some of which is rural. How do you determine the definition you use for rural?
Ms. White: That question is a very pertinent. We look at zones of metropolitan influence in terms of commuting distance to an urban area. When I mention Halifax or Dartmouth, I am talking about that census metropolitan area, that area into which 50 per cent of the population travels at any given time during the workday. In a smaller province, there is less geographical area or spaces between urban nodes. We are talking here about less influence from the economic centre point of the city.
Senator Cordy: With regard to changing demographics and aging populations, we have had many discussions in terms of health care, but there are so many other issues: housing, transportation, palliative care, home care, drug coverage and all those kinds of things. Do we have sufficient data to make long-term policy changes for seniors? Do we have enough information or do we have gaps?
Ms. White: We must rely on the surveys that we have in terms of collection of information. In terms of the data gaps and each specific of those elements, I am probably not the best person to answer that, since my area is more demographics, as opposed to health or the economic situation of seniors.
There are officials in Statistics Canada who could address those specific issues. They could give you the nuances in terms of the ability to look at pharmacare or housing affordability.
Mr. Spencer: The rural-urban move is strong. It is not especially related to population aging, but it exaggerates the effects associated with population aging in the departing areas, the smaller communities and rural areas. Indeed, it is a huge thing. It can revolutionize the characteristics of the population. In many smaller areas in the Atlantic region we are left with very old populations indeed. The median age can be 60, and even older in some of the small areas.
There are huge problems not only with health delivery, but also with education, because we end up with very small groups in school. The economies of scale that go with the provision of any service become serious. While that issue was not mentioned in my presentation, I agree that it is a serious concern.
On the matter of data gaps, yes, we have important data gaps, but the gap depends on precisely what question you want to address. Often once you define the question carefully and look to see what data is available to answer it, the data gaps are not as serious as we thought they were. The data gaps are question-specific.
Senator Johnson: Dr. Spencer, is it preferable that boomers work past 60 or 65, given that the statistics show that many of them have inadequate pensions? The boomers are the population that has had probably the best standard of living in the history of man. I know many people who have lived wonderful lives but they have not done a lot in terms of their future. It is as though we thought this standard of living would go on forever and everything would be fine until we perished at age 100.
You had a conference recently about an uncertain future, private pensions and insecurity in old age. Maybe these issues tie in together. You can probably tell me from your conference what would be best economically, given that people are healthy and can continue to work.
Mr. Spencer: As you realize, I come at this issue as an economist. From an economics point of view, my perspective on these things is that we would like to give people, at least from a public policy point of view, a choice of whether to continue working or to retire when they see themselves able to do so.
I emphasize that we do not want public policies that will induce people to retire earlier than they would otherwise have done. As well, we do not want people, because of public policies, to save less for retirement than they would if it were not for that public policy.
I will give you an example of what I have in mind. People receive the guaranteed income supplement, GIS, if their incomes are sufficiently low. If they are a low-income earner when they are working, they have little incentive to save for their old age because, if they do, they will not get the guaranteed income supplement. That is an example of bad policy.
Senator Johnson: It is at cross purposes.
Mr. Spencer: Another example that concerns me has to do with the incentives under the Canada Pension Plan. We can elect to receive retirement benefits under the Canada Pension Plan as young as age 60, or we can defer them to age 70, the normal age being defined as 65. If we take the benefits younger than age 65, we receive a reduced benefit, and the reduction is roughly in keeping with life expectancy on average.
If we opt to take them at an older age, we receive an increased benefit, but it does not increase as much as the loss in life expectancy after age 65. From a policy point of view, there is clearly some incentive built into the Canada Pension Plan not to defer benefits until after age 65 but rather to take them then.
Many incentives have been built into the private pension system that induce people to retire at particular ages where it makes no sense from a socio-economic point of view but clearly makes a great deal of sense from an individual's perspective. Why would teachers keep working if they have achieved the rule of 85, or whatever is required, have reached age 55, and if they continue working they might receive $10 more a month than if they retire? It is not a matter of sensible policy, and it is certainly not a matter of sensible policy to induce teachers to quit at a younger age and then find that we have a shortage of classroom teachers. There are many examples of this sort of thing of which I am sure you are aware.
I think it important to identify areas where public policy provides perverse incentives.
The Chairman: We might want to look at this area. For example, the Alberta teachers' pension fund allows teachers not only to retire early but also, although they cannot collect their Canada Pension, the pension fund allows them to collect the full benefit and then collect a smaller amount for a couple of years after they are 60 to even it all out. As a result, there is a built-in incentive for teachers to retire as soon as they achieve 30 years, without necessarily being age 60, let alone 65. It is an issue.
Dr. Spencer, do you know how the OECD defines ``health''? Like Dr. Keon, I have some problems with this 11 per cent. My concern comes not with the publicly funded health care system. My concern is with those things that are not covered by the public health system, as I know Senator Keon's is. My particular interest, obviously, has to do with palliative care. I know that by the year 2020 we will have a higher percentage of deaths every year. If we continue to provide palliative care for a maximum of 25 per cent of what we do now, that will increase to providing palliative care for about 14 per cent, because of the increasing death rates we will experience. That is why I am interested in the definition of health.
Mr. Spencer: The definition of health expenditures in the OECD study was public expenditures. It was not concerned about private expenditures. However, it did include, for example, the portion of public expenditures on palliative care. Studies I have been associated with in Canada are mostly concerned with the public expenditure component. However, projecting the impact of continuing the existing public plans into the future and providing the same level of real expenditures and real service for people at each age-sex, to the extent that palliative care needs remain roughly the same, on average, for those aged 70, 74 and 79 years and so on, that would already be taken into account in the projections. The projections show clearly, and many people have reached the same conclusion, that health care expenditures would not increase as rapidly as GDP, for example, in consequence of population aging. That might be overstating it. It would not be a lot more than GDP, and it would be offset by other reductions in government budgets.
The Chairman: I do not think that we could have asked for a better group of individuals to start our discussion of Canada as an aging society, so I want to thank Ms. White, Mr. Martel and Dr. Spencer for their presentations this afternoon.
Honourable senators, you have before you a budget for the balance of this fiscal year, for $25,100. If you look at the detailed expenditures, for example, the meals, part of the reason for that, senators, is that I moved the meeting back a half hour because three of us have another committee at four o'clock, and I wanted to make sure that we were finished by 3:30 so that three of us would have breathing room for at least half an hour. There are hospitality expenses and conference fees in case there is an aging conference of some kind that comes up between now and March 31, but I have not identified one. Consultant fees are $10,000, and I want to be clear that I am recommending we hire Michelle McDonald as our consultant to this committee. The reason for that is she has been deeply engaged with me on the preparation of this study and, as a result, has done considerable research in the field. She has gone to several conferences on my behalf. She was also with me when I went to the Madrid Conference on Ageing, and prepared my remarks for the Federal-Provincial-Territorial Meeting of Ministers responsible for Seniors. I want to be clear as to who I included there so there were no surprises.
I think everything else is perfectly straightforward. Are there any objections? Could I have a motion then?
Senator Keon: I so move.
The Chairman: It is moved that this committee concur in the following budget application for the purpose of its special study on aging, and that the chair submit the said budget to the Standing Committee on Internal Economy, Budgets and Administration for approval; professional and other services, $15,600; transportion and communication, $9,000; all other expenditures $500, for a total of $25,100. All those in favour?
Hon. Senators: Agreed.
The Chairman: The motion is carried.
Honourable senators, we are fortunate this afternoon to have Carole Lafontaine, who is the Acting CEO of the National Aboriginal Health Organization. With Ms. Lafontaine is Mark Buell, Manager of Policy/Communications Unit. We also have Robert Dobie, Acting Chair, and Margaret Gillis, Director, from the National Advisory Council on Aging. As an individual, we have Douglas Durst, Professor, Faculty of Social Work at the University of Regina.
Carole Lafontaine, Acting Chief Executive Officer, National Aboriginal Health Organization: I am a member of the Metis Nation of Ontario, and accompanying me is Mark Buell, Manager of Policy and Communications Unit at NAHO.
NAHO appreciates the opportunity to appear before this newly formed Senate committee on aging to provide you with a general overview of some key characteristics of the current health status of Aboriginal seniors. For additional details, you can refer to the deck that was provided in the kit that we presented to the committee. We will also provide Aboriginal population projections that carry important implications for future policy and program development.
NAHO fosters an understanding of health that incorporates the mental, physical, emotional and spiritual components of the self. We view the social determinants of health as crucial to understanding health status. Socio- economic indicators add to the complex interaction of the broad social determinants that impact Aboriginal health status.
Inuit, Metis, and First Nations communities continue to face critical housing shortages, high rates of unemployment, lack of access to basic health services, and low levels of education attainment, all of which affect both life expectancy and quality of life in senior years.
Current life expectancy for Aboriginal men is 68.9 years versus 77.2 years for Canadian men, almost an eight-year difference. The current life expectancy of Aboriginal women is 76.3 years versus 82.1 years for Canadian women, almost a six-year difference.
Over 1 million people in Canada identify as Aboriginal, representing 3.3 per cent of the overall population: 62 per cent are First Nations, 30 per cent are Metis and 5 per cent are Inuit.
It is important to note that a pan-Aboriginal approach is not effective, since First Nations, Inuit and Metis have contextually specific realities that are influenced by such determinants as language, geography, and culture.
For example, geography determines access to services such as health care, food and nutrition, recreation and housing. As an example, Inuit in Rankin Inlet have unique needs compared to Metis in Edmonton.
Policy construction and program delivery must be informed by specific data that captures the need according to First Nations, Inuit and Metis realities.
The following are examples. Because many Inuit seniors are unilingual, they have special difficulties in acquiring and understanding health and service information, which is generally in English.
Regarding housing, Inuit seniors are especially affected, as they must live either within their children's multi- generation crowded homes or have other family members move into their small subsidized residences. Inuit seniors in Northern Canada live within a fragile infrastructure which impacts on housing, and the high cost of living threatens their already minimal income.
Currently, minimal population health or surveillance data is available about Metis seniors. Based upon available census data, we know the health status of Metis is poorer than that of the non-Aboriginal population. For example, one in five Metis report arthritis or rheumatism, in comparison to one in ten in the non-Aboriginal population.
Statistics Canada advises that Metis population growth in recent years is affected more by non-demographic factors such as growing pride in Metis identity, various court decisions, government policy changes, and possible improvements in census coverage than by demographic factors of fertility and mortality.
The mental, physical, spiritual and emotional health of First Nations seniors is impacted directly by various levels of trauma experienced in residential schools; many of the First Nations seniors are residential school survivors.
First Nations seniors report suffering from a variety of concurrent, long-term health conditions such as arthritis, rheumatism, high blood pressure, asthma and heart disease. Additionally, type 2 diabetes is also a cause of significant concern in elderly First Nations people.
Initiatives aimed at improving the health of the Aboriginal population requires the consideration of the key demographic characteristics and trends over time. Healthier First Nations, Inuit and Metis people translates into fewer burdens on the health care system.
Current statistical data projects that by 2026 the percentage of Aboriginal seniors will triple. While we must strive for optimal conditions for the general senior population in Canada, the vulnerable health of Aboriginal seniors requires specific attention, with interventions that are culturally appropriate.
When observing the current Aboriginal population distribution by age, it is evident that the number of Aboriginal people who will live to be seniors will grow over time. Projections into the future require immediate attention and long- term investment in the health of individuals throughout their lifespan, and investments in community infrastructure to meet those demands in the next 10 to 25 years.
Aboriginal communities, their organizations, researchers and policy architects have the responsibility to collaborate on developing initiatives and meaningful options for healthy aging indicators and targets. These options must be responsive to geography, culture, gender and income.
The board of directors and staff at NAHO would like to thank you for this opportunity to contribute to the work of the Special Senate Committee on Aging. If NAHO can be of future assistance to the committee and their mandate, please do not hesitate to contact us.
Robert Dobie, Acting Chair, National Advisory Council on Aging: The National Advisory Council on Aging, NACA, is pleased to present this brief. NACA's mandate is to advise the Minister of Health on all matters relating to aging of the Canadian population and the quality of life of seniors.
For more than 25 years, NACA has endeavoured to bring the issue of population aging to the attention of the federal government and to the people of Canada. The council develops recommendations that are grounded in the most recent research, and that are balanced, credible and mindful of seniors' input.
Recently, NACA released its 2006 report card on seniors in Canada, of which you have been given a copy. The report card looks at how well Canadian seniors are doing in five key areas: health status, health care system, economic situation, living conditions and participation in society. The overall grade of the five questions under study was a B, which means that improvements are still needed. However, improvements have been made over the last number of years.
Although demographic aging will have profound consequences for our society, the changes will take place over several decades. Still, the great diversity of seniors suggests that considerable flexibility will be needed to adapt to population aging.
If we look at the older aging population and the newer aging population — for instance, the baby boomers that will become part of our membership soon — you will understand that these people are not a monolithic group of people. Seniors are not a monolithic group of poor, frail, sick or dependent persons. The age 65-plus group presents considerable diversity in terms of life experiences, economic status, health status and resources for independent living.
An increasing number of Canadians now live longer and in better physical and mental health, but the increased incidences of diseases such as diabetes and higher rates of obesity could change that picture. A male aged 65 today has a life expectancy of almost 18 more years; a female aged 65 today has a life expectancy of 21 more years, an incredible increase in averages over the last number of years.
Seniors generally continue to view their health in positive terms. In 2005, in our report, 74 per cent of seniors assessed their health as good, very good or excellent. On the other side of the coin, Aboriginal seniors, living off-reserve especially, were more likely to view their health status as fair or poor compared to Canadian seniors as a whole.
The major risk factors for poor health are low income, especially for many unattached older women, low education and literacy and social isolation. We presented a brief to the Status of Women committee a few weeks ago in which we state that, as a group, older single women are very fragile in our community.
Because the number of seniors is increasing, particularly in the 85-plus group, the prevalence of various diseases will increase in Canada, posing a number of challenges for health care. In 2005, 91 per cent of seniors reported having at least one chronic health condition. The most common problems are heart disease, arthritis, diabetes and dementia.
Also, did you know that every hour in Canada, an older person dies as a result of a fall? Close to 1 million seniors will experience at least one fall per year, and that fall causes 84 per cent of injury-related hospital admissions of seniors in Canada. An incredible amount of money — $1 billion annually in direct health care costs — is a result of falls. It is important to note that evidence has shown that the causes and impacts of falls can be reduced.
Last month, I co-hosted a meeting with my provincial and territorial colleagues, in which we reaffirmed what seniors have been saying for many years, which is that health care and health are the most important issues. My colleagues and I released a statement indicating that we would work together to keep seniors' health issues at the forefront. We also emphasized the importance of recognizing the contribution of seniors to Canada's social fabric. This is why my presentation today is focused strongly on health issues.
NACA's recent analysis shows while there is room for improvement, the health care system serves the majority of seniors well, whether measured by access or quality of care. However, problems can develop quickly with seniors, and waiting times often aggravate benign conditions and increase the risk of hospitalization. This situation contributes to loss of autonomy, increased suffering and higher health costs.
Innovative ways of delivering health care, such as the extramural hospital model in New Brunswick, can contribute greatly to improved seniors' health. If you have not done so before, I strongly recommend inviting someone from New Brunswick. It is a worthwhile project to consider.
In addition, the health needs and metabolisms of seniors are different from younger adults. Sadly, training and education in geriatrics is lacking in Canada. In the year 2000, there were 144 geriatricians in Canada, although 481 were needed. By 2005, there were 191; an estimated 538 were needed.
I cannot overstress that an effective health system must place as much emphasis on health promotion as it does on health care. The causes of some serious conditions associated with aging will elude us, as will their prevention and treatment methods. However, many ill effects of chronic conditions associated with aging are avoidable.
Health promotion, including for the very old, can produce beneficial results. The prevention of falls, as well as changes in lifestyle, particularly with respect to physical activity and nutrition, must be given priority in promotion and prevention programs for the aging population.
Another emerging issue is emergency planning and preparedness. Natural and human-made disasters are occurring more frequently than ever. Recently, several high-profile disasters such as 9/11, the 2003 European heat wave, severe acute respiratory syndrome, SARS, tsunamis and hurricanes have opened many eyes and minds to similar potential threats. Here in Canada, we had the Manitoba floods, the flooding of the Saguenay a few years before and the famous ice storms in Quebec.
It is alarming that only last week, a report by the Ontario Medical Association and its pandemic plan indicated that those 85 years and over would not be considered a priority when it comes to treatment. This report is clearly a Charter issue. It is ageism at its worst.
Being a senior does not necessarily imply vulnerability. Seniors have a wealth of experience that often translates into valuable coping strategies for the entire community. NACA is pleased to note that Canada is taking a leadership role in ensuring that the needs of seniors are met during disasters.
Besides improving quality of life, disease prevention and health promotion not only makes good sense; it makes economic sense, in many cases. Unfortunately, federal resources invested in these areas have been woefully inadequate. Home care and home support services help people to maintain their independence, which is something seniors prize highly. Limited access to hospital and home care forces seniors to rely to a greater extent on families who assume 80 per cent of seniors' home care needs and pay for necessary services out of their own pockets.
Home care can be less costly, about one third the cost of institutional care, and can be more appropriate and more socially acceptable than institutional care. Real progress must be made toward the development of a national system of home care that is covered under the public health insurance system.
Canada's 2 million informal caregivers, many of whom are seniors themselves, also need support. The added responsibility of informal caregiving can lead to physical and mental exhaustion and have a detrimental effect on the health of caregivers. Lack of formal supports can lead to burn-out, causing caregivers to withdraw from caregiving. This withdrawal, in turn, can lead to higher rates of institutionalization for seniors. In any case, future generations of seniors cannot count on large families to provide personal care and will likely be more reliant on public services.
While virtually all seniors are covered by some type of prescription drug insurance, either public or private, the extent of this coverage varies significantly from province to province, leaving many seniors vulnerable to financial hardship. In its special report to the Romanow Commission on the Future of Health Care in Canada, NACA recommended that a national comprehensive publicly-insured or publicly-privately-insured prescription plan be established.
Approximately 7 per cent of all seniors and as many as 40 per cent of the very old, presently reside in long-term care facilities due to health problems. While future generations of seniors might be less prone to living in long-term care facilities, the sharp increase among very old seniors in years to come will place considerable pressure on long-term care systems. Increasingly, these facilities are called on to care for seniors who are older and sicker than they were in the past. The organization and funding of health care, as well as the hiring, training, and remuneration of health personnel, must adjust to this new reality.
There is also a need to develop alternatives to institutionalization such as supportive housing and assisted living. Supportive housing and assisted living can serve as an intermediate solution for seniors who require more care than is possible to provide at home, but less than that provided in extended care facilities. The lack of investment in social housing is another issue that must be considered. Many seniors cannot afford upscale private ``adult lifestyle'' or retirement homes. Seniors' housing developments should not focus on ``the gold in the grey'' only. Planning for an aging society calls for an inter-sectoral approach that combines health care, social services and housing. There are a number of good examples in Canada of integrating housing within a continuum of care for seniors.
Improvement in seniors' incomes between 1980 and today is one of Canada's true public policy success stories. In 1980, 21 per cent of seniors were ``poor,'' but this figure is below 7 per cent today. This success is largely the result of the maturation of Canada's public pension system but, the OECD pointed out that a large public system matures only once. It is becoming clear that inequalities in retirement income will increase in the future. Right now, the economic well-being of some seniors continues to be at risk. In a 2005 paper called Aging in Poverty in Canada, NACA highlights causes and possible solutions to the plight of low-income seniors. Certain groups, among them older women, unattached seniors and immigrant seniors are at particular risk.
Most seniors enjoy good living conditions and many are mortgage-free. They generally have good access to transportation and feel free from the threat of crime. However, it remains important to increase funding for affordable housing units and for public transit in both rural and urban areas because housing and transportation are key to seniors' autonomy and social participation — two ingredients that benefit Canadian society as a whole. To overlook seniors is to overlook one of Canada's most precious natural resources.
In conclusion, although Canadian seniors enjoy relatively good health and quality of life, we must not become complacent in addressing seniors' and aging issues. There are a number of bad news items when we look at specific areas. I noted the increased chronic disease and obesity, the urgent need for health promotion strategies for seniors, the lack of geriatricians in our health care system, continued low-income for certain categories of seniors and the need for more affordable housing options. It is my hope that we can work together to address these issues.
Douglas Durst, Professor, Faculty of Social Work, University of Regina, as an individual: I am honoured to be here today. I was sitting in the gallery listening to the previous speakers and I became fidgety because I took exception to some of the things said. I want to review them with you. I am a teacher in the Faculty of Social Work, so I come from a social research perspective. My research in the area of both Aboriginal persons and immigrants, shows that immigration and visible minorities in our aging population has been overlooked. There has been little research and little discussion about it.
First, I heard it said in the previous session that immigration does not have much impact on aging but, in fact, our immigrants are here and they are aging. There are two groups of immigrants in Canada: those who settled here when young, in the 1980s during high years of immigration, and this group is now aging; and those who were brought to Canada with family reunification. That aging population is significant.
You would be surprised to learn that the highest percentage of immigrants over the age of 75 in any city in Canada is in the city of Regina. Almost 50 per cent of the over-75 population in the city of Regina, Saskatchewan, is foreign- born, being mostly Ukrainian and German. That group has an impact in that it creates a culture around aging in Regina that includes some and excludes others. That is one point I would like to make.
The other point is on the way in which the statisticians aggregated the data and lumped groups together. They used 65 and up as the group of seniors. That age of 65 years was determined by Otto von Bismarck some 100 years ago as an age to which people naturally live, so that is the year we set for retirement.
Most of the literature talks about three groups. The first group is those from 65 to 75 years — the young old — who are healthy, fit and reasonably affluent. They want to travel and do things and are still in a creative and productive period of their lives. The second group is those from 75 to 85 years of age — the middle old — who are slowing down and are more interested in tending to their gardens and spending time with grandchildren. They have some money and resources but are beginning to watch how they spend and they are less interested in travel and making major purchases. The third group is those 85 years of age and over into their 90s — the frail old — who have special social and physical needs. Some of those you are familiar with.
The statisticians aggregate the data by not thinking about those populations and the great differences. The difference between a 65-year-old and a 90-year-old is 25 years.
There is a difference between someone who is 25 and someone who is 50. Why put those two people together in the same category? Their needs are different, and we need to think differently about those groups.
When I looked around this afternoon at today's meeting, I did not see many visible minorities. In fact, you are the first person to arrive that is of a visible minority. That is an interesting dynamic, because when you walk the streets of Ottawa, Toronto, and even the streets of Regina, there are vast visible minorities in our population.
There is little comparative research in mainstream society and ethnic groups, or between the ethnic groups. There is the danger of applying models and aggregating data from different groups as a form of reductionism, which invites generalizations and assumptions that may be false or misleading. For example, the role of the family as an emotional, social support may look different between groups and within the categories.
I have presented a table here and a brief paper. I was not sure whether to focus my discussion on Aboriginal persons or whether to focus it on immigrants, but I will share information collected on the immigrant population.
Almost 19 per cent of the immigrant population in Canada is over 65, and this number is much higher than the national average of 12.2 per cent. When I say ``immigrants,'' I am talking foreign born. Almost 31 per cent of the immigrants from Europe are over 65. European immigrants are an aging population. The senior population from eastern Asia, mostly Hong Kong, China and Taiwan, is 13 per cent of total immigrants of this region. The number of immigrants from East Asia, China, Hong Kong and Taiwan, is higher than, or close to, the national average. Caribbean immigrants are also older than other immigrant groups and are closer to the national average, at around 11 per cent or 12 per cent. The assumption that immigrants are young is not supported. Canada has the larger number of immigrants from diverse backgrounds, and the senior population in fact mirrors the Canadian mosaic. By percentage, the youngest group of immigrant seniors is from Central American and South America, at 6.7 per cent, and Africa and Southeast Asia, Thailand, Lao and Vietnam are still fairly young, at around 8 per cent. However, since many Southeast Asians came to Canada as refugees during the American war in Vietnam, their senior population is expected to grow. Those people came here in the 1970s and 1980s as young adults, and now they approach senior population at age 65.
Of the total senior population, 28 per cent are immigrants. Of all the seniors in Canada, persons over 65, 28.4 per cent are immigrants. That number is up from 16.9 per cent in 1981. In the past 25 years, there has been a dramatic change in the senior population among immigrants. Of all seniors, 19.4 per cent, close to 20 per cent, are from Europe. However, immigrant patterns from Asia show that 5.4 per cent, or 1 in 20 seniors in Canada, are Asian. Overall, 7.2 per cent of Canada's senior population are a visible minority. That increase in the past ten years is significant.
What does that mean? As this population comes through the system, they will have different needs and different expectations. They will put different pressures on our health care system, our social systems, our financial institutions and so on.
Adrienne Clarkson turned 65 during the last year or so of her term. She grew up in Canada, and her needs and expectations are different. At the universities, expanded in Canada in the 1970s, they hired a lot of faculty from diverse populations. They are all reaching retirement age, and they have different expectations and ideas. They will be good at demanding services. The population of seniors that is a small group is not so small when you put the two groups together: the 40 to 65 age group is a large group, and in 10 or 15 years, they will all be in the senior category. In the senior category, if they aged here, they will have an idea of what is available and there will be demand for their own services. Whether we want parallel services such as Chinese nursing homes or integrated services will depend upon the region of Canada and the needs of the particular group.
For families who have emigrated to Canada and brought over their senior parents to care for their children, the parents are taken care of by their family, but when they enter the health care system they have been in their families for a long time. They enter the health care system late, they are unhealthy and they have extensive health care needs. Reaching that population of family reunification immigrants and making sure they get adequate support and care while they are still in their family, is one method whereby we can make sure they have a high standard of life, high quality of life, and, in fact, will have less demand on the services later.
You also talked earlier about the rural-urban split, and that is significant. It has regional variances in Canada. In Saskatchewan, if you travel to the rural places, you will be struck by the age of the farmers still working those fields. They need protection, and they need certain kinds of services. The rural-urban split is important as well.
I also took exception to Dr. Spencer's comment about the GIS being a bad idea. He implied that poor people have some kind of choice about saving money. They do not have a choice. They spend their money to care for their families and children, and they do not have the option of saving for some kind of private pension.
Dr. Spencer also criticized the 85 rule, and I am sorry he is not here to defend himself or respond to my comments. The 85 rule gives people a choice, and gives people freedom to make choices. It is a negotiated agreement between the workers and their employer. After 30 or 35 years, it gives people such as teachers and police officers, who are in a stressful job, the option of retiring with dignity and with a reasonable pension. To me, providing this option is a good thing and not necessarily a negative thing that we should discourage.
Those are most of the key points that I want to present to the committee
Senator Johnson: Ms. Lafontaine, you talked about your senior population. Do you have information about on- reserve or off-reserve, and do you have those kinds of services in place in either jurisdiction in the city or on the reserve?
Mark Buell, Manager, Policy/Communications Unit, National Aboriginal Health Organization: The Aboriginal population, as I am sure everyone is aware, is becoming increasingly urban. Something like more than 50 per cent of the Aboriginal population in Canada now resides in cities. There is a huge difference in the services that can be accessed in an urban centre, services that everyone can access, compared to what is available in a rural or remote community where there may be nothing.
Senator Johnson: Do you have any examples of anything being done in rural areas in terms of either assisted living or long-term care?
Mr. Buell: A lot of the time people have to travel out of remote communities to urban sectors to access long-term care.
Senator Johnson: I am from Winnipeg. Do you have any information on Winnipeg in terms of this population? Are Aboriginal people accessing what is available in the city now? Would that be generally fair to say?
Ms. Lafontaine: That is generally what they do. They are brought into the main urban centres to access their requirement, to meet their needs.
As far as statistics go, we would need to do some research for you and get some further information.
Senator Johnson: That would be helpful; otherwise we cannot know where this population is, in the system. I have no idea, and I have been on the Standing Senate Committee on Aboriginal Peoples for 12 years; that is something we have not looked at.
Mr. Buell: I would like to highlight that lack as a key problem. There is a serious lack of good data on Aboriginal people; where they are, what they access and what they are unable to access. Winnipeg is a great example; 10 per cent of the population is Aboriginal but we do not know where they are, what they do, what they access and what they cannot access.
Senator Johnson: I know what is happening in a number of other areas, but this one I am not familiar with.
Mr. Durst: I would like to speak to this and our research in Regina. More seniors tend to stay on the reserve in the population. They tend to be in housing that is overcrowded, substandard and with poor water. At a certain age, almost all of them have diabetes, type 2.
Senator Johnson: Are they usually with their families?
Mr. Durst: They are with their families, and as disabilities increase they are further socially isolated there. Then when they come to Regina they are in poor health and poor physical condition, and have a great demand on services. There does not seem to be a strong infrastructure for supports for home care and supporting the family in caring for them.
The other statistic we found in our study is that there is a preference to be cared for by their family. When told we can provide really good care for them but it is not in their family, their preference was to be with their family and to be cared for by them.
If these Aboriginals in poor health move from the reserve into the city, they receive the formalized medical services and those sorts of things if they are in hospital, but then they return home and there is a reoccurrence of the same kinds of issues and problems. Those that live in the city fare slightly better in terms of their overall health. These statistics that I have looked at have come out of the federal government. They fare a little better in the city. However, they are not accessing the many other services. Seniors living in Regina are isolated and are not getting out into the community. Regina has a host of programs and services for seniors: recreational programs and those sorts of things. These Aboriginal people do not access those services. We found that they do not feel comfortable going to white-dominated agencies. They feel when they go there they are chastised for not taking care of their diabetes. There is an implication that the health care professionals suggest they are non-compliant, and then they tend not to go, which makes the problem worse. They are isolated. We need more research on that population, on both groups.
They become caught in the jurisdictional issue between the federal, provincial and band governments in accessing programs and services: receiving support aides such as wheelchairs, crutches and all sorts of things that could help them. They become caught in that system and are kicked around between the band, federal and provincial governments.
Mr. Dobie: We have done a certain amount of research on that issue. When the elders go to urban areas they may receive good medical treatment. However, that is where it stops. The urban areas are unable to provide the social aspect. The question of meals is a big problem. That was pointed out by the representatives of the Aboriginal people that we have met; the question of meals and cultural differences. It is enough to make them sick again. Inasmuch as the health care is there, the social aspect is not, and they are forced to go back to their communities. It may be a better health situation for a short period of time, but we are not able to provide them with those services.
Senator Johnson: In terms of women, Mr. Dobie, and this of course applies to all your populations that you are talking about here: immigrants, Aboriginals and Canadians in general. You said that the older single woman is the most compromised and vulnerable person in this area of the seniors, which is right. I know that.
Mr. Dobie: Based on economics, most older single women have not been in the workforce for a long period of time. Consequently, pensions are low. Number two, there may have been marital problems, and 20, 30 or 40 years ago it was not de rigueur to pursue your rights. Even though legislation has been presented it is almost impossible to think that an 85-year-old woman would go after her ex-husband for what she is entitled to, and would rather be quiet and live within her means. That is a serious problem. Fortunately, over the years that problem may be eliminated, but right now that is a problem.
Senator Johnson: I have experience in one community in Manitoba where we have been aggressive on the front with our elderly population, and we have assisted living beside the long-term-care home. This community-based model has worked well for us in Gimli, Manitoba, and we have been doing this for, I do not know, 100 years. In terms of the long- term care, should we add assisted living for the aging population and not go directly into long-term care at age 60 but having this interim period of assisted living? Would there be an argument for more monies to be spent in a community- based model, if people want to stay in their communities, families, on reserve and in towns? It is appropriate in the rural areas. Would this be a direction we could go in?
Mr. Dobie: It is the flavour of the month in aging societies; providing assisted living to the aging population. First, quality of life is much better. This morning I listened to the news in Quebec: 14 people in another hospital with C. difficile. If you can keep people out of hospitals, then keep them out of hospitals. I operate a non-profit seniors' home and I dread having a 92-year-old go to hospital for ``tests'' because I fear never seeing him or her again because of the long period of time they may be there.
Keep them at home and in their setting as long as possible, but that approach must be accompanied with assisted living and budgets: much cheaper, a third of the price, and quality of life is so much better.
Ms. Lafontaine: I agree that having seniors living at home with their family is beneficial. In reality on reserves, you do not have the support. You do not have the doctors, nurses or support system to give that care at home. The ability to provide nutritious meals and so on sometimes is not doable. Yes, it is beneficial.
Senator Johnson: We are talking about assisted living, which is not necessarily staying at home, but in a facility that accommodates people with these needs.
Ms. Lafontaine: Definitely.
The Chairman: The reality is that the services for many of our Aboriginal peoples are simply not available on the reserve. I am thinking of dialysis, which more and more type 2 diabetics among our Aboriginal population unfortunately end up receiving. We now have portable dialysis units, but they are not located in Aboriginal communities. Many are in our cities, but any time we attempt to get them into an Aboriginal community there are roadblocks to their existence. Quality of water is one of them.
Senator Cordy: We know when we look at seniors that we must cross many boundaries. One of you spoke earlier about crossing between federal and provincial jurisdictions, but even within specific levels of government we deal with different departments; housing, health, transportation and those kinds of things. Are there models in Canada that work well where silos have been broken down, areas where a minister is responsible for seniors? Does that make a difference, or is it only something to make people feel better?
Mr. Dobie: Few provinces have a minister dedicated to seniors. Quebec has one dedicated to families, youth and seniors. New Brunswick's new government has named a minister for seniors, and our person in the field has already met that person twice, although she has not been in place long. That minister has access to the other ministers, as you mentioned. Things are much better that way. Other governments need to look at that.
Considering that seniors are almost 30 per cent of the population, they are an important aspect, and politically they are a strong lobby. For governments to listen to this portion of the population, what better way than having a minister involved and dedicated strictly to seniors? This approach needs to become practice soon. In the previous federal government, as in the current one, there were two or three ministers. It seems that everyone wants a piece of the pie, but there is no cohesiveness. A ministry strictly for seniors will be good for the senior population.
Mr. Durst: I cannot speak very well to this question because it is outside my field. However, Regina is a city of 200,000 and then there is the surrounding area. The provincial government has a strong history of trying to provide quality health care and integrated service. The city of Regina has what is called a System Wide Admission and Discharge, SWAD, group. It is a team of inter-professionals of the health care field, social work and government. Even housing people can be involved. When someone enters the system, that team coordinates its level of service and access to various health care and related social programs.
That group has done well at, for example, eliminating waiting times for homes by integrating waiting lists. It integrates planning if they move from a personal care home to some other form of assisted living or to other sorts of services. It follows the client through the system.
We can do that in Regina because it is a small city, the professionals know one another, and they can function that way. That model could be looked at from that end of things.
It is surprising and interesting in the small city of Regina that when we enter the system of personal care homes, nursing homes and the health care system, the entire system — the floor cleaners, cooks, nursing aides, nurses, occupational therapist, doctors and medical specialists — is multicultural. There is a diverse cultural group throughout the entire system from all around the world. The clients in Regina are almost all white, either Ukrainian or German. We are starting to see that population shift.
When the question was asked of what country you think about seeing, the answer was Australia. I like that, because I do not think you would see that in countries such as France and Germany. You may see it in the U.K., but Australia would have a similar kind of multicultural service industry with people who are honestly trying to address culturally sensitive issues.
I have high regard for the professionals in the province of Saskatchewan.
Senator Cordy: Ms. Lafontaine, how much research information and data do we have on Aboriginal seniors?
Ms. Lafontaine: The only data resource that we have presently is the First Nations Regional Longitudinal Health Survey, RHS.
Mr. Buell: There is some data in the regional health survey. The 2001 Aboriginal People's Survey also has some information. There is a serious lack of information on First Nations, Inuit and Metis health across the board, especially with regard to older Aboriginal people. The focus is on the younger generation, because there are so many young Aboriginal people.
That is not to say there is nothing out there. Research exists, but it is minimal.
Senator Mercer: Several of you made reference to housing. I want to narrow that. Where do you see the most need in housing where governments should be involved one way or another, most likely as a provider of funding? There are self-contained senior citizen apartment buildings and there are various other levels of housing with minimum-, mid- or full-level support, right up to nursing homes and palliative care centres.
Where is the need the greatest?
Mr. Dobie: The last big plan for social housing of the Canada Mortgage and Housing Corporation ended in 1990. From about 1980 to 1990 CMHC had projects building seniors' homes, mostly managed by municipalities at that time. These homes are starting to be old now. They are 25 years old, and in some cases they have not been taken care of. When there is no money from the government for that type of housing, we suffer the effects.
We have this subsidized housing from Canada Mortgage and Housing Corporation from a number of years ago. To keep people in those homes now rather than institutionalize them, we need to add the health and assisted-living components. Those components should be added with Health Canada or the departments of health in each province along with the housing agencies. Virtually no money has been spent in social and low-cost housing for almost 20 years.
Mr. Durst: We have seen many examples of various non-profit organizations, NGOs, religious groups and cultural groups applying for and building various facilities. Some of the facilities are intergenerational with a variety of health care needs, and they have been successful.
The other area is personal care homes, which have been more of a private market field. They can be costly. In my province, people are caught because they do not have enough money for personal care homes, which are in the private system, and they are not eligible for extended nursing care facilities, so they are caught and often isolated. They need help but, because they cannot approach services in the private market, they are left out. If they become very sick or have an injury, they enter the hospital, which increases costs. Money spent to support that population in the middle would go a long way.
Senator Mercer: While personal care homes are costly, the major factor I see is the lack of control of the level and quality of service. It varies from place to place. It can vary from one city block to the next, depending on who the manager or the private owner is of these facilities. Some of them, even in this day and age, are scary compared to where we should be.
Mr. Dobie, the National Advisory Council on Aging put out its 2006 report card. I gather that the previous report card was issued in 2001. There must have been some improvements in that time.
Mr. Dobie: Definitely.
Senator Mercer: Can you give us a couple of examples of improvements?
Mr. Dobie: The income level of seniors is much more favourable now than it was five or six years ago. Health care has also improved, although the demand on the system in increasing. Consequently, there must be further improvement there.
One thing that has not been adequately addressed is the waiting time for seniors. For a younger person to wait six months for an intervention can be acceptable, if I may use that term, but for a senior to wait six months is life or death. That difference must be addressed. Some improvements have been made in health care, but improvements must be done at the economic level, too.
Seniors have become caregivers themselves. It is not uncommon for a retired teacher like me to go into another field and be a caregiver for seniors. That is why we look at it from the point of view that seniors themselves will become important assets to the community rather than be looked at as the little old man with the cane. Seniors will be an incredible asset. There are ways to train these people and give them professional help so that they become good caregivers. That is one aspect that is still lacking. It is not much money, but it is money well spent. For every dollar we spend there, we will save thousands.
Senator Mercer: I come from the voluntary sector. I have worked with tens of thousands of volunteers over the years. Someone made vague reference to the support and the importance of volunteers in working with seniors. Would anyone like to elaborate on that? I think that one thing we are missing, and the current government has cut back on, is funding in the voluntary sector.
Mr. Dobie: One of the biggest basins of volunteers is young seniors. Mr. Durst talked about teachers and policemen. We have more educators who are involved in volunteerism. They do not volunteer with youth — they have had enough with their kids for 35 years. They volunteer with seniors. I think that is something that should be encouraged. This group of people is itching to do something useful. If they are recognized, I think society will be better off for it.
Mr. Durst: Studies and good research have come out of Imagine Canada, the former centre on philanthropy, on this topic and on the major impact and social impact of volunteer seniors of that healthy age group — that is, age 65 to 75 and sometimes beyond. Their contribution to the community on all levels is extremely significant. I did not mean to pass that up. In some areas, some individuals are almost exploited and become burnt out because they are always called upon. Helping them to make good choices on what to volunteer for and what to become involved in can go along way toward healthy meaningful progress.
Mr. Buell: I want to highlight a difference between formal volunteering and informal volunteering. In Aboriginal communities, informal support is given by the cooperative nature of many communities, and is fundamental to allowing seniors to stay in those communities. There are things such as food sharing. Especially in remote Inuit communities, where food prices may be so high, a lot of hunters will share their food with the seniors in the community, making the lives of those seniors that much easier. It would be interesting if there were a way to recognize that.
The Chairman: Before I turn to Senator Keon, I notice that several of you made reference to training volunteers. In my experience, one of the first things the volunteer needs to learn is to take care of the volunteer.
Senator Keon: Mr. Durst, when you came in, you challenged the previous witnesses who fundamentally left the message that immigration increases the population but it does not increase the aging population. In my opinion, you looked at the whole subject from a different direction. You talked about immigrants and said they are aging also, but I suspect the statistics from the previous group and your statistics are correct; it is just a different approach and perception.
Does the time really matter, for example, when the German population of Regina to which you referred are seniors? They have been Canadians for a long time. Are they any different than the rest of Canadians? I must be careful of that. There are huge differences across the population, but are they any different than the general mix?
Mr. Durst: I think that question is good. What I took exception to before was the suggestion that because immigrants and immigration does not change the demographics of aging, we do not need to look at it. That is what I challenged. Maybe I challenge it because that is the heart of a lot of the research I am doing, and my interests. Maybe I have a vested interest. I think it does make a difference. If you go to extended care at Parkside in Regina, at this time of year they are putting up the Christmas lights, and so on. Thursday is perogy, sausage and sauerkraut night. That menu really fits at that centre. However, if the demographics change, someone may have lived on rice and that sort of diet all their life, they do not celebrate Christmas in that way, and they may be of a different faith or background. They may be used to having a large group of family in the room whereas for the other culture group it is one or two people and quiet during visiting hours. One group may want to sing, and have a whole group around the bed and burn incense, and so on. A whole host of associated things is tagged on.
I think of a Lao woman that I know. She was brought over in family reunification. The family worked hard to keep her at home. They received almost no supports, and finally they could not look after her anymore and she came into this nursing home. She is Lao and does not speak English. She has had her family diet all her life and here she will celebrate sauerkraut and perogy night. I just returned from Vietnam and for five weeks I have been on an Asian diet. I look at some of the food that I have been eating and you adjust to it, but this lady died within three weeks. Her family brought in pots of sticky rice and fish, et cetera. The staff tried to be sensitive and care and they did everything possible to accommodate, but still the institutional structure moves in that Christmas season to turkey and dressing diet, music and all of rest of it. Culture is much more than diet and dress. I do not want to give that kind of an impression.
The staff in this place are all multicultural and they are itching to do some of this. I think the needs will be different. Some of the illnesses and disabilities will be different.
The other thing I found in working with different cultures is that attitudes about receiving and accepting help, dependency, self sufficiency, and so on, are different, as is wanting and asking for help from professionals versus waiting until your granddaughter comes so she can do it for you. There are a lot of cultural things.
With our population clearly aging and our Asian population increasing, I think these changes will have major impacts right away in places such as Vancouver and Toronto; the major cities. I see it in Regina.
Senator Keon: In keeping with that subject, let me shift to you, Mr. Dobie. I would like all four of you to comment on this. I hope I am not being difficult.
At what age would you define a Canadian citizen becoming a senior, Mr. Dobie?
Mr. Dobie: We refer to it as aging, so therefore it is a continuum. The age that is usually considered is 65. I found out that age 65 was an arbitrary figure that came out of Germany during the war. The government had to give out a certain amount of money. They said, this is the amount of money: you tell me at what age I should give this money. The age chosen happened to be 65.
That choice was probably okay in the 1940s, 1950s or 1960s. A lot of people refused to retire at age 65, and rightly so. However, for demographic, economic and pension purposes, we use a figure of 65. It could be challenged easily.
Senator Keon: Ms. Lafontaine, what would be your guess?
Ms. Lafontaine: Our definition would be the same. It would be defined as age 65, due to the pension. As far as our cultural beliefs, an elder can be as young as 15, due to the cultural differences. As far as a government definition of a senior, it would be age 65.
Mr. Buell: Across the different nations within Canada, every community would define an elder as a different thing. Keep in mind that there is a big difference between an elder and a senior in an Aboriginal context.
Senator Keon: I would think it is something totally different, is it not? An elder is a leader, a statesman, and the definition of wisdom, to my way of thinking. I do not know anything about it.
Mr. Buell: Absolutely.
Mr. Dobie: For demographics too, it is nice to say age 65 today, but if you use demographic studies, you have to use ages that are before that so that you can get ready.
I made mention that the baby boomer, as a large influx of our population, will be seniors soon. It is a special grouping of people: usually economically more favoured, a little more spoiled and a little more demanding. You know what that will do to the health care system. The debate has been going on for years about a two-tier health system. The person who can afford it, which is more apt to be the baby boomer, will be more demanding of that. I do not dare get into that debate.
Population shifts, interests and priorities will obviously change. However, if I were in business or politics, I would say: Okay, this group of 50 to 65 — whatever it is — is a large group and therefore I need to start looking at that group soon.
Senator Keon: Mr. Durst, before you respond, I suspect it was the financial planners that contributed to Freedom 55. I made the cover of a seniors magazine the week after I turned 55. I did not consider it a compliment.
Mr. Durst: Some research has come out of the U.S. on Aboriginal aging. A couple of authors have suggested, when thinking about Aboriginal First Nations seniors and aging, to think about 55 as being equivalent to 65. They said, we ought to look at providing services and programs for a younger chronologically aged group for seniors due to the health and social conditions, diabetes, and so on. That is important. That is where we need to be conscious and sensitive to not aggregating large data and not making assumptions about different groups.
The Chairman: I think it is fair to say that the first definition of aging at 65 came from Chancellor Otto von Bismarck. He became Chancellor of Germany shortly after 1870 with the unification of Germany. That is the old history teacher in me. He was only in his 40s at the time and the lifespan of the average German was less than 65. When he introduced a social policy to cover those over 65, he did it for a small group of people.
[Translation]
Senator Chaput: I want to make sure that I have understood correctly. Demographic data on the aging of the Canadian population from Statistics Canada are aggregate data, obtained by province and territory.
If we had a different breakdown of these data, either by identifying more specific client groups such as Natives, Inuit people, Metis or immigrants, we would probably have a more realistic picture of the conditions of an aging population in Canada.
If that was the case, we might draw conclusions that would help developing politics that would be more focused on the needs of this aging population in Canada. I am putting the question to whoever might want to answer it. Would there be a difference if data were collected in a more directed and specific way?
Mr. Dobie: Obviously, different communities have different needs. The only group that you have overlooked are aging single women and we have been able to identify this group of people. So I would say that when we identify target groups, we have to make adjustments.
Representatives of First Nations have stated that the problem is rather acute among some people who are younger than 65. That is the reason why we have to make adjustments.
Senator Chaput: Mr. Durst mentioned that one out of 20 senior person is from Asia. That is what I understood during his presentation. I believe that this person also has different needs when getting old. If we took into consideration these different needs, would that affect decisions that are made at the policy level?
[English]
I am not sure if my question is clear.
Mr. Durst: It is an interesting question. Some needs are the same and some are different.
My mother was of Irish background and she was a fighter. She wanted to stay in her own home all her life. She had a concept associated with independence and she refused a lot of help. It was difficult for my brothers and me to support her because she wanted to be independent. She talked about being a burden and did not want to be a burden on her sons. She wanted to die in her own home, and she did.
Someone from a different cultural background may not have that same understanding of independence and self- sufficiency, and may be comfortable being surrounded by family members. In fact, that may change over time as well.
When we think about policies and certain kinds of programs, we need to, first, appreciate that we may have different understandings or appreciations of what their needs are. Second, we do not necessarily assume that if we provide the program, they will access it.
This is where the good example of the Aboriginal and First Nations seniors in our cities comes in. They are there and they would love to have the services, but they are somehow falling through the cracks and not getting those services, especially our Aboriginal seniors in the cities. They are lost in the system.
In Regina, about 11 per cent or 12 per cent of the population is Aboriginal, either Metis or First Nation. Yet, if you go to the various programs, 12 per cent of the clients are not Aboriginal. Where are they and why are they not accessing the services?
That is where we think about the different needs and different perceptions about isolation, independence, self- sufficiency and those sorts of things.
Senator Murray: Ms. Lafontaine, we can get these statistics, but if you have them at hand, you can put them on the record now. Life expectancy for Aboriginal women, you told us in your statement, is 76.3 years versus 82.1 years for non-Aboriginal women; for Aboriginal men, it is 68.9 years versus 77.2 years for non-Aboriginal men.
Do you know what the life expectancy was 10 or 20 years ago? In particular, do you know whether the gap has narrowed at all between Aboriginal and non-Aboriginal Canadians?
Mr. Buell: I do not have the statistics but they exist. The gap is narrowing, absolutely. Over the past four or five decades, the gap has narrowed greatly, in fact.
Senator Murray: What about over the last one or two decades?
Mr. Buell: It has continued to narrow. I do not have the statistics in front of me.
Senator Murray: It must have been one heck of a gap a few years ago. This gap is substantial — 76 versus 82, in one case and 68 versus 77 in the other case.
Ms. Lafontaine: The National Aboriginal Health Organization is one component, and we do not represent all people. However, what we bring to the table is identifying some of the research and findings we have in hand. The committee needs to consider bringing the Assembly of First Nations, the Metis National Council and Inuit Tapirisat to the table to discuss the populations specificly, because they would have further information to enhance this brief presentation that we did here today.
Senator Murray: Apart from the National Aboriginal Health Organization, are there other organizations attempting to speak for Aboriginal seniors specifically?
Ms. Lafontaine: They would be represented by the First Nations — the Assembly of First Nations, Metis National Council and Inuit Tapirisat.
Senator Murray: Professor Durst, I will not pursue the matter that Senator Keon raised, but I was interested in what you tried to tell us about the Germans and Ukrainians. The statistic was that 50 per cent of those over age 75 in Regina are foreign-born. I do not know what the absolute numbers would be. Do you have a ballpark?
Mr. Durst: Absolute numbers of over age 75?
Senator Murray: Yes; there is a population of 200,000 in Regina in total.
Mr. Durst: I forget. I would like to make one comment about the life expectancy among Aboriginal people. In the last numbers I looked at, a decade or so ago, there was a difference of 10 or 11 years between Aboriginal and non- Aboriginal groups. It has decreased closer to 6 or 6.5 years. However, what was interesting is that the numbers have improved for men at a faster rate than for women. This number is life expectancy, so that incorporates accidents, disease, early death and all those sorts of things. That number was interesting. Those numbers would be available from Statistics Canada and from the Department of Indian and Northern Affairs.
Senator Murray: The gap, according to Ms. Lafontaine, is narrower for women than it is for men.
Mr. Durst: But it has improved faster for men. It still has not caught up. The men have not caught the women, but the women have seen less benefit than the men in terms of improved health care, safety and so on.
Senator Murray: In terms of life expectancy, the reason that you suggest for that slower improvement on the part of women is that the availability or quality of health care for women is not as good as it is for men.
Mr. Durst: Or safety as well — violence against women, disease or medical attention. I do not think anyone really knows. It is a curious twist in the numbers that I saw.
Senator Murray: I agree with what you said about the GIS. I do not see how there is, or could be, any serious disincentive to save for those who receive the GIS, unless some genius in the government decides sometime to start imputing income, including the value of a person's house or something like that.
I agree with you also about the 85 formula that has been negotiated as part of collective bargaining. However, one issue that I think we will face, knowing what we know about the aging of the population, is whether there are professions or lines of work where we might think about providing incentives for people to stay on longer. I wish we had more time with the macro economist. What do you say from your perspective?
Mr. Durst: It is just a thought. To me, mandatory retirement is being swept away across the country in one province after another. It has a lot of implications in terms of employer-employee relations and collective bargaining. I think we will see some changes when employers hire people, with more term positions.
I know in the university they are already talking about those changes, and issues about tenure and all kinds of performance indicators. Then there is the rights argument, of people having that right to choose. I think it will change things a lot.
Senator Murray: If we need more teachers and cannot find them, would we provide incentives for teachers, or nurses, for example — there is a shortage of nurses, partly because of bad policy guesses that were made a few years ago? Should we provide incentives for them to work longer?
Mr. Dobie: Presently, we have a disincentive to bringing people back into the workforce, with the cap in their pension at $58,000. If a teacher, for instance, receives a pension of $45,000 or $50,000, as soon as the teacher finds another type of employment, then receives $58,000 or $60,000, the teacher works for absolutely nothing. There is a disincentive now with the caps.
Even if we do not look at salary, we need ways of acknowledging contribution, through certain types of fiscal receipts or something of that nature, to make it attractive for a person to give their talents back to society. Right now for a person to go back into the workforce, the person might as well volunteer on an ad hoc basis because that is what they are doing.
I think that area needs to be looked at.
The Chairman: I am delighted with the level of testimony we heard this afternoon. I appreciate your coming.
Honourable senators, I will recommend our research people do a demographic comparison between Aboriginals and non-Aboriginals on a decade basis. I think you may find some of that material in the status report on Aboriginals, in terms of the Aboriginal commission. I think we need to take a careful look at that.
Again, let me thank all of you. It has been a good day to begin our study, and that was mainly due to the presentations that you made before us this afternoon.
The committee adjourned.