Chapter 5: Aging in Place of Choice

Canadians should be able to grow older in the place of their choice.  Most seniors express a strong preference for staying in their homes as they age. Sometimes supports are required to allow seniors to age in the place of their choice. Currently, the labour force is structured in such a way that family members and friends often have great difficulty balancing work and care for the frail elderly.  Although formal supports can supplement the support of family members, there are significant differences across the country in the formal supports to seniors.

This chapter outlines a series of issues and options proposed by witnesses before the Committee related to aging in place of choice. It presents options relating to housing, home support and home care, transitioning to integrated care, and needs of groups under federal jurisdiction.   

The Committee recognizes that there may be other as yet unidentified options for supporting aging in place of choice and welcomes discussion on those as well as the options outlined herewith.

5.1 Housing

Most seniors (93%) live in private homes, and have a strong preference for staying in their own homes. Factors which push seniors to move out of their homes include inappropriate design or size of the home, loss of a spouse or decline in health. Some may no longer be able to afford their homes or keep up with home maintenance.

The Committee has heard it is more efficient to plan and build housing and neighbourhoods that will continue to meet the needs of people as their health status changes. While building regulation is the responsibility of provincial and territorial governments, most provinces and territories adopt or adapt the model National Building Code and enforce its requirements. 

CMHC has two programs, the Residential Rehabilitation Assistance Program and the Home Adaptations for Seniors' Independence (HASI) program, to make sure that homes can be adapted to allow low-income seniors to live independently in homes that meets basic health and safety standards.

Furthermore, the Committee has heard that the lack of affordable housing poses particular challenges for single seniors, seniors in urban areas and Inuit seniors. Aboriginal organizations have stressed that the lack of quality, affordable housing is one of the greatest challenges to Inuit, Métis, and First Nations seniors.

The following options have been identified to address housing design, affordability and adaptability:

    50-            Increase publicity about CMHC home adaptation programs

The Committee has heard that some Canadians who are in need of funding for renovations may not know that these programs exist. 

    51-            Increase the stock of affordable housing across the country

    52-            Increase the availability of vouchers to allow low-income seniors to pay for adequate housing

    53-            Ensure that the standards for barrier-free design that are already contained in the National Building Code of Canada are consistently met by builders or enforced by inspectors

Options for Assisted Living and Supportive Housing

For seniors who need more assistance, supportive housing can provide support services such as meals, housekeeping and social and recreational activities.  The Committee has heard that the costs of supportive housing, difficulties accessing information on available choices, and the lack of regulation are issues which need to be addressed.

The cost of supportive housing is a barrier for some seniors.  Seniors who own their homes may feel that they can control their costs at home better than in supportive housing.  The Committee has heard that it is very difficult to access information on supportive housing options in other jurisdictions, posing a challenge for seniors who may want to move.

Supportive housing and assisted living are not heavily regulated across the country.  Witnesses have noted that some assisted living facilities are providing levels of care that go beyond basic supports, cautioning against assisted living facilities becoming entrenched as unregulated long-term care facilities. There is an assumption that supportive housing needs minimal regulation because consumers can exercise choice, thus placing upward pressure on service standards. This requires choice for consumers – a choice which does not exist in many parts of the country.

The following options have been identified concerning supportive housing:

    54-            Increase the stock of affordable supportive housing

Would initiatives to increase the supply of affordable supportive housing put upward pressure on all providers of supportive housing to ensure that minimal standards are met? Should the Canada Mortgage and Housing Corporation play a greater role in stimulating the development of supportive housing across the country? 

    55-            Increase the supply of affordable supportive housing for First Nations and Inuit seniors

    56-            Improve the regulation of supportive housing across the country

Should the federal government play a role in the communication of best practices in regulation?  Do different jurisdictions get together to so that they each do not need to “re-invent the wheel” in developing a regulatory framework for supportive housing?

    57-            Facilitate access to information about housing options across the country

Should a central information database be developed to share information on supportive housing options which exist throughout the country?  If so, what would be the best way to get this information to seniors? 

Options for Long-term Care

Although most seniors will not live in long-term care facilities, it is a necessary housing option in some instances. There is variation across the country in the level and type of care offered in long-term care facilities, co-payment arrangements, and how institutions are governed. The majority of these facilities (outside of Quebec) are privately owned, with the rest evenly distributed among non-profit organizations and governments.  The direct service role of the federal government for long-term care is elaborated in Section 5.4.

There is no portability for long-term care services between jurisdictions.  Witnesses have suggested that Canadians may not be aware that services such as long-term care are not provided in the publicly funded health care system.

The portability criteria under the Canada Health Act ensures that residents moving from one province or territory to another continue to be covered for insured health services by the "home" jurisdiction during any waiting period imposed by the new province or territory of residence. This portability criteria does not apply to the extended health care services under the Act, including long-term care.

The following options have been identified:

    58-            Encourage the provinces and territories to make reciprocal arrangements to eliminate the waiting period for residents from another province

As they move across the country, seniors may have to pay the full fee of the long-term care facility for a waiting period before being eligible for cost-sharing through their new province or territory of residence.  This is an insurmountable barrier for some seniors and their families.

    59-            Communicate information and best practices about adapting long-term-care facilities to address the needs of a multi-cultural society

Providing culturally sensitive services that meet the needs of immigrant seniors will become increasingly important to ensure that they find facilities that meet their needs.

5.2 Home Support and Home Care

Home care programs include professional services such as nursing, occupational therapy, and social work; personal care services to assist in the activities of daily living, such as bathing, toileting, transferring, and grooming; and home making and home support services such as cleaning, doing laundry and meal preparation.  Much of the home care and home support required by seniors is provided informally within the family. This raises the issue of how we support informal caregivers.

Studies on the cost-effectiveness of home care have demonstrated that home care services generally cost governments less than residential care services for people with the same levels of care need.  These studies have also found that the majority of the home care services required is for non-professional home support services. Approximately 32,000 individuals provide home support across Canada at this time, and that this number is likely to double in the next decade. Although these workers are part of the continuum of the workforce serving seniors, there are significant variations in qualifications and training requirements across the country. 

The Canada Health Act makes reference to home care under its definition of extended health care services. Since the 2004 First Ministers' Accord on Health Care Renewal, however, short-term home care has been recognized as a part of the acute care system.  Some have suggested that this focus on acute care home care has had the unintended negative consequence of reducing the availability of longer-term care.

The following options have been identified to improve access to home care:

    60-            Introduce a National Home Care Program

The patchwork quilt of home care services has resulted in a call for a national home care program with standards and with the provision of core services comparable from province to province. Would there be a danger that a national home care program would result in a reduction of services in jurisdictions which already have exceeded the scope of a standardized program? Given that different jurisdictions have different resources, is there a danger that a standardized program would put excess pressures on those jurisdictions which have less?  

    61-            Address the uneven qualifications and conditions of work of home care staff

The Committee heard that non-professional or paraprofessional workers provide most of the paid home care services in the country.  It has been suggested that the lack of a national human resource strategy and training standards for this sector has a significant impact on the quality of care from one region to another. Is there a role for the federal government in planning a human resource strategy aimed at home care workers?  Could the federal government fund the creation of a national training curriculum for home care workers?

    62-            Create a registered chronic care savings plan

Because home care is not entirely publicly funded, some witnesses have suggested that Canadians be urged to save so that they will eventually be able to afford the services to meet their needs. This could be done through the creation of a registered chronic care savings plan, similar to an RRSP.

Options for Supporting Informal Caregivers

The aging population is translating into an increased need for individuals to care for family members or friends.  Informal caregivers provide about 80% of all home care to seniors living in the community. The majority of family caregivers provide care because they see it as a family responsibility or they simply choose to do so. A significant number indicate they have taken on this role because there is no one else available or because there is a lack of home care services. 

Being a caregiver presents physical, mental, emotional, and financial challenges to caregivers, particularly for those who balance caregiving and paid employment.

The following options for providing support to informal caregivers have been proposed to the Committee:

    63-            Provide information to caregivers

Caregivers need information and education to care for themselves as well as those they are supporting. In Canada, there is no one-stop shopping for caregivers.

    64-            Create a National Respite Program

Currently, the availability of caregiver support depends on where individuals live, how much money they have and for whom they are caring. The creation of a national respite program would help caregivers get the physical and emotional rest they need to provide care.

    65-            Make Changes to the Compassionate Care Benefit

Compassionate care benefits under the Employment Insurance program are paid to persons who have to be away from work temporarily to provide care or support to a family member who is gravely ill.  Some eligible Canadians do not know about the program.  A number of improvements have been suggested to make the EI Compassionate Care Benefit more flexible, more widely available, and available over a longer period of time. This could include delivering the benefits outside the Employment Insurance program in order to extend eligibility for the Compassionate Care benefits to groups who cannot access Employment Insurance. Changes to the EI benefit might include: a broad public information campaign about the availability of the benefit; increases to the length of the benefit; and broader definitions for eligibility under the program.

    66-            Provide financial support to caregivers

A number of proposals have been put forth to reimburse caregivers for expenses or to provide financial recognition of their work.  The federal government could offer enhanced financial assistance to home care consumers through allowances, tax deductions and reimbursable tax credits to offset the costs of caregiving at home. It has been suggested that the federal government could convene an expert panel on the financial security of caregivers.

    67-            Introduce a Canada Pension Plan (CPP) drop-out provision for caregivers

Taking time off to care for ailing family members can result in reduced entitlements under the CPP.  The CPP currently allows people who have left the workforce temporarily to care for their children to drop these periods of little or no income from the calculation of CPP benefits. These CPP drop-out provisions could be extended to support informal caregivers who have left the workforce to care for ailing relatives.

5.3 Support for the Transition to Integrated Care

Allowing seniors to age in the place of their choice requires a myriad of services, including adequate and affordable housing options, long-term care, community support services and home care. Ensuring that the right care is delivered at the right time in the right setting requires a high level of integration and coordination of services.  The Committee has heard compelling evidence that the most pressing need is the integration of the various support options available to seniors. 

The integration of these services could alleviate the pressure seniors and their families currently face as they try to navigate the multitude of available services to meet ever-changing needs.  Integration and coordination creates greater efficiencies and allows governments to get better value for money. A move toward integrated care is happening in some jurisdictions across Canada, but there has been a lack of national leadership in this area.

The following options have been identified to address the need for integrated care:

    68-            Introduce a National Policy Initiative for Integrated Care

The federal government could help provincial governments address the costs of an aging population by helping them move toward models of integrated care.  Witnesses have suggested that the federal government work with the provinces, through the Social Union Framework Agreement, to develop a federal funding initiative which would provide financial support to the provinces to facilitate the move toward integrated models of care for the elderly.  The goals and conditions of the program could be designed to ensure:

·         A move toward one-stop-shopping for seniors and their families;

·         Improved portability of services between provinces; and

·         A greater emphasis on independent living.

    69-            Share of best practices related to integrated care

Integrated care is happening across the country with minimal opportunities to share experiences across jurisdictions.  This is even the case between government departments with Veterans Affairs offering one of the leading models of integrated care in the country in contrast to the care provided by the Government of Canada for First Nations people. How could the federal government facilitate information sharing in this area?

5.4 Groups under Federal Jurisdiction

The federal government delivers direct services to eligible veterans, First Nations on-reserve and Inuit in designated communities and federal inmates.

Veterans

The Veterans Independence Program (VIP) is a national home care program provided by Veterans Affairs Canada to help eligible veterans remain in their own homes or communities. Through this program, war service veterans who served during the First and Second World Wars and the Korean War may be eligible for a range of services, including grounds maintenance, housekeeping, personal care services, access to nutrition services, and health and support services.

The following options have been proposed by veterans’ organizations:

    70-            Create a needs-based 'Seniors Independence Program' for all Canadian seniors, modelled after the Veterans Independence Program (VIP)

    71-            Expand the Veterans Independence Program to all Canadian Forces veterans

Many Canadian Forces veterans, including peacekeepers, are not eligible for the Veterans Independence Program.

First Nations and Inuit

If services to veterans represent a model of supports to seniors, the same cannot be said of the services to First Nations and Inuit seniors. The housing needs in First Nations and Inuit communities are great.  Representatives of First Nations, Inuit and Métis peoples have made it clear that the primary need of seniors is access to adequate and affordable housing.

Although Health Canada’s First Nations and Inuit Home and Community Care Program serves seniors, persons with disabilities and persons suffering from chronic illness, and Indian and Northern Affairs Canada (INAC) operates an Assisted Living Program that provides non-medical social support services to First Nations people, there are significant support needs among First Nations and Inuit people.  The Committee has heard that a 20-year long moratorium has been in place in terms of the construction and operation of personal care homes. The Committee has also heard that inadequate medical and support services on reserves can exclude Aboriginal seniors from the benefits of living and/or dying at home with their family. 

Indian and Northern Affairs Canada and Health Canada are co-funding a multi-stakeholder initiative for developing a national policy program and program framework for continuing care, of which assisted living is an integral part. 

The following options have been proposed to the Committee:

    72-            Increase the stock of adequate and affordable housing for First Nations and Inuit

    73-            Provide First Nations and Inuit with the same package of services available to war service veterans in the VIP program

Federal Inmates

The Correctional Service of Canada (CSC) is responsible for the care and custody of offenders serving sentences of two years or more.  The needs of senior offenders are different from those of younger offenders. Although research indicates that programs designed specifically for senior offenders have positive outcomes, such support may not be currently available in federal institutions.

Options which have been proposed to the Committee include:

    74-            Implement the recommendations contained in the Correctional Service of Canada’s (CSC) Report on Elderly Offenders

In 2000, the CSC developed a strategy that would make it possible to better meet the specific needs of older offenders. The Committee has heard that implementation of this strategy has been stalled.

    75-            Amend the Corrections and Conditional Release Act by adding offenders who are elderly or who have serious health problems to the list of offender groups with special needs

The Elizabeth Fry Society suggested that conditional release arrangements could provide opportunities for individuals to go into senior homes, other age‑appropriate residences or palliative care facilities instead of trying to develop those within prisons themselves.

    76-            Amend the Corrections and Conditional Release Act to make terminally ill offenders serving life sentences or indeterminate sentences eligible for parole on compassionate grounds

The Committee has heard that Section 121 of the Corrections and Conditional Release Act allows parole by exception to be granted to an offender who is terminally ill, whose physical and mental health is likely to suffer serious damage if the offender continues to be held in confinement, or for whom continued confinement would constitute an excessive hardship that was not reasonably foreseeable at the time the offender was sentenced. These exceptions do not apply to an offender who is serving a life sentence imposed as a minimum punishment, commuted from a sentence of death or serving a penitentiary sentence for an indeterminate period. 

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Chapter 6: Regional Distribution of Health Costs Associated with Seniors

        The Committee has heard that labour force mobility has exacerbated the aging of the population in some jurisdictions, particularly Atlantic Canada.  Because the costs of providing health care to seniors is higher than for other age groups, per-capita health funding through the Canada Health Transfer may eventually result in a widening gap in the basket of services provincial and territorial governments will be able to provide to seniors as the population ages. This chapter will examine options for addressing this issue.

The Committee recognizes that there may be other as yet unidentified options for addressing the regional distribution of health costs associated with seniors and welcomes discussion on those as well as the options outlined herewith.

6.1 Seniors and Health Care Costs

It is well documented that as people age, their use of the health care system increases. The Canadian Institute for Health Information (CIHI) reports that while seniors today are generally healthier than those of previous generations, they remain more likely than younger people to have chronic conditions and to suffer from poor health, and consequently also require and use more health care services.

This fact has important implications for the cost of delivering public health care in Canada. Health care expenditures, most of which fall under the jurisdiction of provincial and territorial governments, are significantly higher on a per capita basis for seniors than for the population as a whole.

Indeed, for most of a person’s life, the cost of health care is relatively uniform. With the exception of the first year of a child’s life, the average per capita cost to provinces and territories of providing public health services varies little from childhood through to about age 50. At that point, however, CIHI data show that costs begin to rise exponentially. From $1,898 for Canadians aged 45-49, provincial and territorial expenditures on health services rise to $5,412 per person for those 20 years older. For Canadians aged 85 and over, the average cost of provincial/territorial government health care services was over $20,000.

For many, the combination of an aging population and the increased cost of providing health care services to the elderly signals an impending crisis for the public health care system. It is frequently argued that as the average Canadian grows older, the burden on public health care spending will increase dramatically. Indeed, provincial and territorial government expenditures on health care are already growing at a rapid rate, rising by an average of 6% per person since 1999. These rising costs are seen by some as an early warning that the health care system as it exists today will not be able to withstand the pressures of an aging population.

This viewpoint persists in spite of a large body of evidence to the contrary. Several studies have concluded that the effects of population aging on public health care expenditures are, in fact, minimal; an aging population does contribute to rising health care costs, but its effects are modest.

If demographic trends are not a major driver of health care costs in Canada, then why are those expenditures rising? The two major factors behind this increase are inflation and the expansion of health care services. This expansion includes innovations and developments such as the increased availability of drugs, technological advances, improved surgery techniques, and an increase in the capability, and use, of diagnostic imaging equipment.

Moreover, while medical innovations can result in more effective health care treatment, in many cases improvements also lead to increased use of the health care system. Less invasive techniques, better drugs, improved diagnostic capabilities, and faster recovery times all increase demand for medical treatment. At the same time, as Canadians are living longer and healthier lives, many are in a better position to benefit from certain types of medical treatment. This is particularly true of seniors.

Hospital utilization rates and other instances of health care service use by the elderly have risen dramatically in recent years. For instance, in the five-year period from 2000-2001 to 2005-2006, total angioplasties performed in Canada rose by 62%, knee replacements by 84%, hip replacements by 47% and cardiac surgeries by 33%.[5]

There is thus a critical distinction to be made between the effects of an aging population and rising consumption of health care services. While demographic change may not be a major driver of health care expenditures in and of itself, the amount and cost of health services demanded by seniors is increasing considerably. 

In other words, it is not the aging of the population that is driving up health care costs in Canada, but rather, the fact that demand for health care services by seniors is increasing. The rise in per capita consumption of health care services by seniors accounts for about two thirds of the change in national health care expenditures over the past thirty years. Indeed, in the late 1990s, the provincial and territorial governments identified growing demand for health services by seniors as the basis for their request for additional financial support from the federal government under the Social Union Framework Agreement.

6.2 Demographic Projections for Provinces and Territories

The issue of growing demand for public health care services by seniors is complicated by the fact that there are differences in the age structure of the population across the provinces and territories. A number of demographic and socioeconomic factors have contributed to the fact that seniors represent a higher proportion of the population in some provinces compared to others. Moreover, demographic projections indicate that these differences will, for the most part, widen over time.

Differences in Population Age and Structure by Province

That the Canadian population is aging is well established. From 1971 to 2006, the median age in Canada – the age at which half the population is younger and half is older – rose from 26.2 years to 38.8 years. In 1971, 7.9% of the Canadian population was over the age of 65. In 2006, that was true of 13.1% of the population.

However, the population is not aging at the same rate across Canada. There is a growing east-west divide, in which the populations of the five easternmost provinces are, in general, older and aging more quickly than the populations of the five westernmost provinces and the three territories. 

A similar trend is evident when considering the proportion of seniors in each province. Alberta is by far the youngest province in Canada and also has by far the lowest proportion of seniors. While seniors made up 13.1% of the total population in Canada, they accounted for only 10.4% of the population in Alberta.[6] Ontario is also home to a lower-than-average share of seniors, at 12.8%.

At the other end of the spectrum, Saskatchewan has the highest proportion of seniors at 14.9%, although, unlike all other provinces, this share is not growing; it has been relatively constant since the mid-1990s. Aside from Saskatchewan, the three Maritime Provinces have the largest proportion of seniors in their populations.

Differences in population age and the proportion of seniors across the provinces are the result of a combination of several factors. Perhaps the two most important of these are birth rates and inter-provincial migration trends.

High birth rates lower the median age of the population and also indirectly reduce the proportion of seniors in the total population. In Canada, birth rates are highest in the three Prairie Provinces, while the country’s lowest birth rates are found in Newfoundland and Labrador, Nova Scotia and New Brunswick.

More significant is the impact of inter-provincial migration across Canada. Each year, about 1% of the Canadian population moves to a new province or territory. In 2005-2006, for example, nearly 333,000 Canadians are estimated to have changed their province or territory of residence. Although a 1% annual rate of migration may not seem significant, when multiplied over decades it can result in large population shifts across the country.

The general trend of inter-provincial migration is of young Canadians moving from poorer provinces to those where economic opportunities are greater. Since the early 1970s, there has been a large net flow of inter-provincial migrants out of the Atlantic Provinces (except PEI), Quebec, Saskatchewan and Manitoba. Ontario, Alberta and BC have been the primary beneficiaries of these migration flows. Students and young working-age Canadians, those 20 to 39 years old, accounted for half of all migration in the past five years. Another quarter of inter-provincial migrants were under 20.

Demographic Projections through to 2031

Because of factors like inter-provincial migration and birth rates, differences in population age structure across the provinces and territories are expected to widen in the future. Statistics Canada has published data projecting provincial and territorial population, by age, through to 2031 under a range of growth and migration scenarios. According to figures under the conservative “medium growth, medium migration” scenario, seniors will represent a higher share of the overall population in all provinces in 2031 compared to 2006. However, the population of seniors is expected to grow faster in provinces where seniors are already more prevalent.

Nationally, seniors made up 13.1% of the population in 2006, a figure expected to rise to 23.4% by 2031. In Atlantic Canada and Quebec, however, the proportion of seniors is projected to be markedly higher in 2031, ranging from 25.3% of the total population in Quebec to 29.5% in Newfoundland and Labrador.

In the western provinces, demographic factors and migration patterns work in the opposite direction. Higher birth rates and/or an influx of migrants from other provinces are expected to slow the relative growth of the over-65 population. By 2031, the proportion of seniors in the western provinces is projected to range from a low of 21.4% in Alberta to a high of 24.9% in neighbouring Saskatchewan.

6.3 Consideration of Expenditure Needs in Federal Transfers

The average cost of delivering public health care services rises rapidly for Canadians over the age of 50. At the same time, migration trends and other factors are causing some provinces to age more rapidly than others. This combination represents a significant policy challenge for Canada.

Public health care is already the single largest area of expenditure for provincial and territorial governments. Nearly 40% of provincial/territorial program spending is on health care. The fact that the population is aging more rapidly in some provinces suggests that the cost of delivering health care services will also rise faster in those jurisdictions. Moreover, many of the provinces in which the proportion of seniors is rising fastest are also among the poorest in Canada.

The provinces and territories receive financial assistance from the federal government to help offset the cost of providing health care and other public services. According to data from the Department of Finance Canada, the federal government provided transfers to other levels of government totalling $43.5 billion in 2006-2007, equivalent to 19.6% of total federal budgetary expenditures. The vast majority of these funds (92.4%) are delivered through three major transfer programs – Equalization, the Canada Health Transfer (CHT) and the Canada Social Transfer (CST).

It has been suggested that the federal government consider adjusting its system of transfer payments to reflect differences in age-based expenditure needs across the provinces. The Committee has identified two broad ways in which this could be done. The first is by incorporating age-based expenditure needs into one or more of Canada’s existing major transfer payment programs. The second is by creating a separate and distinct transfer to address that specific policy challenge.

There are a number of options for amending the existing transfer payments. These options and the option for creating a new transfer payment are outlined below. The options outlined below are not intended to be exhaustive. The Committee is welcoming input on these and any other options which might be identified. 

Options for Incorporating Age-Based Expenditure Needs into Equalization

Equalization is a federal formula-based transfer program that helps to smooth out the differences in revenue-generating capacity across the provinces.  On the surface it is intuitively simple - equalization provides annual cash payments to those provincial governments that have a relatively weak ability to generate revenues using the tax bases at their disposal.  Equalization is governed by the principle that provinces should have access to sufficient revenues so as to be able to provide a reasonably comparable level of services at a reasonably comparable level of taxation.

Although the principle of equalization is simple, the program itself is complex. Through an established formula, equalization creates a Representative Tax System (RTS) which evaluates how much money each province could raise (on a per capita basis) if all provinces had the exact same tax rates. Each province’s per capita total under the RTS is then compared with the average for all ten provinces. If a province’s per capita total is below this standard, then, subject to some conditions, it qualifies for as much equalization as necessary to reach the standard.

Because equalization is formula-driven, the total cost of the program varies from year to year depending on the relative economic strength of the provinces. If the gap between rich and poor provinces falls, whether because of weakness in the former or strength in the latter, total payments fall. Conversely, if the gap between rich and poor provinces rises, again whether because of strength in the former or weakness in the latter, total payments rise.

However, equalization only addresses one half of the fiscal equation. It is silent on the issue of expenditure needs or the cost of delivering services. Once equalization entitlements are calculated, population size is the only direct determinant of the value of total payments.

There are three basic options for reforming equalization to account for differences in population age.

    77-            Reform the Existing Equalization Program

Perhaps the most straightforward way to incorporate age-based needs into the present equalization formula is to introduce a provision that adjusts per capita payments according to population age. For instance, for every resident over a certain pre-determined age, a province would receive a premium on its equalization payments. One example of such a program would be that provinces could receive 110% of their per capita equalization entitlement for every individual over the age of 65.

To incorporate such a reform would be easy to implement, but it comes with several drawbacks. Foremost among them is the fact that population age is already reflected in the equalization program as it exists today.

Equalization compensates provinces that, loosely speaking, have a below-average ability to generate own-source revenues. A province with a proportionately large share of seniors would, all else being equal, already have lower revenue-generating capacity. Seniors earn about 80% of the total income of the average Canadian, meaning that a government’s ability to raise income tax revenue is more limited in a province where seniors are more prevalent. A high percentage of retired seniors could also affect a province’s fiscal capacity in other revenue fields, like payroll taxes, for example. These factors are already reflected in the equalization program as it exists today.

Moreover, the intent of equalization is to ensure that all provinces have access to a reasonably comparable level of revenues with which to finance government services. Considering the multitude of factors that affect provincial government finances, it might be difficult to make the case that special allowances should be made for age-based needs, but not other factors.

    78-            Introduce an Age-Based Expenditure Needs Component to Equalization

A second option is to introduce an age-based fiscal need component to equalization. Under such a program, a measure would be made of the relative cost of delivering a broad series of provincial government services by age range. Provinces which had a higher-than-average expenditure burden owing to the age structure of their population would then be compensated for this difference via the equalization program.

Under such a program, a province’s total equalization payments would be a function of two considerations: its fiscal capacity relative to the other provinces; and the cost of providing services based on the age structure of its population relative to the other provinces. The positive and negative equalization entitlements that result from each would be added together to arrive at a final payment value.

A carefully-devised program which accurately calculated age-based expenditure needs would be an effective vehicle through which to compensate provinces where the cost burden associated with population age is higher. However, while creating such a mechanism is feasible, it would likely be quite contentious.

One problem is that it would be difficult for the federal government and the provinces to find agreement on how age-related costs are to be measured. Another is the fact that a balance must be struck between simplicity and comprehensiveness. Simple measures of age-based needs need not be costly or difficult to make, but that simplicity often comes at the expense of accuracy. By contrast, it may be possible to design a thorough measure of age-based needs, but the expense in data collection and calculation could be formidable.

Witnesses appearing before the Committee offered two other concerns with the idea of incorporating age-based needs into the equalization program. If the number of seniors – or some other measure of population age – warrants consideration in the equalization formula, then the same could be said for provincial infrastructure needs, the number of university students or even snow removal costs.

In addition, there is an important distinction to be made between expenditure needs and the cost of providing services. A province like Newfoundland and Labrador, which has a large proportion of seniors, may have greater expenditure needs because it must provide more health services and long-term care facilities to seniors, for example. At the same time, however, while there are relatively fewer seniors in Alberta, the cost of providing those same services is higher because of factors like higher wages and salaries and the price of real estate. The province in which the fiscal burden is greater is not immediately obvious.

    79-            Introduce a Comprehensive Fiscal Needs Component to Equalization

Another way to incorporate age-based expenditure needs into equalization is to create a comprehensive equalization program – one which not only equalizes provincial revenue generating capacity, but all provincial expenditure needs as well. To the extent that population age affects the cost of delivering health, education, social services, and other provincial government services, these additional costs would then be reflected in equalization entitlements.

For the purposes of equalization, expenditure needs can be measured in one of three ways: by estimating the cost of providing a standardized set of public services; by using observed historical spending patterns and average costs for various expenditure types; or by creating a Representative Expenditure System (RES), an approach analogous to the RTS on the revenue side. This third approach is the most thorough and best captures the spirit and intent of the equalization program.

While a comprehensive RES is intuitively desirable, it is also considerably more difficult to set up and may lack the transparency of a simpler approach. Indeed, creating an RES requires the following steps:

·         Determining which categories of expenditures will be included;

·         Determining, and differentiating, the influence of both cost and need on overall expenditures; and

·         Creating a national standard against which to measure provincial spending in each expenditure category.[7]

In each of these steps, the capacity for disagreement with, and between, the provinces is considerable. Another issue with regard to creating an RES mechanism is the relationship between cost and need. While some may argue that the need for medical services is higher in provinces like Nova Scotia where the population is older, it is also true that the cost of providing services could be greater in wealthier provinces where wages and property values are higher. Both cost and need considerations should be included in any equalization program which considers provincial spending levels. However, the interplay between cost and need could have unpredictable results. In other words, it is possible that a detailed analysis of provincial government costs and needs could result in a decrease in equalization payments to recipient provinces.

In spite of these drawbacks, there is an intuitive appeal to a comprehensive equalization program. For many, ensuring that all provinces are capable of providing a similar level of public services requires some consideration of the relative cost of delivering those services across the country.

A number of countries around the world operate equalization programs that already incorporate some measure of expenditure need. The most notable example is Australia, which operates a detailed transfer program that considers 18 categories of revenue and 41 categories of expenditure.

Options for Incorporating Age-Based Needs into the Canada Health Transfer

The CHT is an unconditional transfer from the federal government to the provinces and territories intended to help offset the cost of providing health care services. The CHT was created in 2004 when, in an effort to improve transparency and accountability, the former Canada Health and Social Transfer (CHST) was split in two, creating the CHT and the Canada Social Transfer.

The CHT is a two-part transfer. It consists of an annual cash payment and the nominal value (to each province) of a one-time transfer of tax room (in 1977) from the federal government to the provinces. The value of the tax room grows in line with the personal and corporate tax base, while the value of the cash component is determined in multi-year funding commitments.

The entire CHT is distributed on an equal-per-capita basis. However, the cash payment is the only actual transfer which takes place on an annual basis. The tax room vacated by the federal government over 30 years ago essentially acts as an offset to cash payments: since the total transfer is equal per capita, the higher the value of the tax points to a province, the less cash it receives. 

For example, in 2007-2008, the total value of the CHT transfer was about $1,054 per person. In Ontario, the tax point component of the transfer was worth $425, while it was worth $377 in Nova Scotia.[8] As a result, Nova Scotia received higher cash payments – $677 compared to $629 in Ontario.

This method of distributing the CHT has been a long-standing point of contention between the provinces. While many provinces support the current method of distribution, some, like Ontario, have argued that all provinces should receive the same cash payments because the tax point transfer is strictly notional and has long been considered provincial own-source revenue.

In Budget 2007, the federal government announced its intention to move towards equal-per-capita distribution of CHT cash. However, because the government is in the midst of a 10-year funding commitment on health care, this move is not scheduled to begin until 2014-2015.

The transition to equal per capita cash transfers will be controversial. In order for all provinces to receive the same cash payments per person, those that receive lower payments today – Alberta and Ontario – will have to be brought up to the level of the other provinces. This implies faster growth in CHT cash to the richer provinces, at least during the transition period. Poorer provinces interpret this transition as the federal government giving the most cash to those who need it the least. For the provinces that benefit, the increase in transfers simply rectifies a longstanding imbalance that has always favoured the poorer provinces. For its part, the federal government maintains that for poorer provinces, the recent changes to the equalization program – which have made that transfer more generous – should offset the slower growth in CHT cash transfers down the road.

The case for including age-based expenditure considerations into the CHT is perhaps stronger than the case for making related adjustments to the equalization program. Equalization is intended to help provinces afford to deliver a wide range of public services. By contrast, the CHT is targeted exclusively for provincial spending on health care service and, as described earlier, age is clearly a major determinant of public health care spending.

There are three broad options for how age-based needs could be incorporated into the CHT.

    80-            Weight Federal Health Contributions by Age

One option is to adjust the value of federal cash transfers to the provinces according to population age. This idea was proposed in 2002 by the Standing Senate Committee on Social Affairs, Science and Technology. In its report, The Health of Canadians – The Federal Role, Volume Six: Recommendations for Reform, that Committee recommended weighting federal health contributions to each province/territory by the proportion of its population over the age of 70.

There are some drawbacks to this option, however. For one, weighting federal health contributions by age is necessarily subjective. The federal government would have to make choices as to which age thresholds it would consider, as well as how heavily to weight them. In both cases, there are a multitude of possibilities, making agreement across the provinces and territories unlikely.

Another drawback is that this option does not address the issue of expenditure need versus cost. Age is but one determinant of public health care spending. Geography, population density, transportation costs, property values, wages and population health all factor in to the cost of delivering public health services. If a special adjustment is made for age but not any other factor, has the CHT been made fairer as a result?

    81-            Create a Measure of Age-Based Expenditure Need

To create an appropriate measure of age-based expenditure need requires a mechanism that isolates the impact of population age on health care costs. Not only is age one of many determinants of health care spending, but also the amount spent by provinces and territories on health care is a function of policy choice as much as it is of expenditure obligations.

One relatively simple way to isolate the effects of age on health care spending is to create a standard expenditure rate at each age range and then use this measure (and not actual provincial expenditures) as the basis for determining the effects of population age on total costs. This approach is not unlike the equalization formula. In equalization, provinces are compared not on their actual revenues, but on how much revenue each could generate if all had the same tax rates. In this case, provinces would be compared on how much their health care expenditures would be (by age range) if their cost structure was the same at all ages.

A 2002 Library of Parliament publication, Incorporating Age-Based Needs into Federal Health Transfers examined how such a program could be created. The process it outlines can be expressed through a series of questions (using Nova Scotia as an example):[9]

1)    Using the national average health care expenditure rates, what are provincial health care expenditures by age in Nova Scotia?

2)    If the population age structure of Nova Scotia was identical to the national average, what would provincial health expenditure requirements be, by age range?

3)    At each age range, what is the difference between 1) and 2)?

In essence, this option works to isolate the effect of a province’s age structure on heath care costs. If its age structure creates an additional cost burden, then, like the equalization program, that province would qualify for federal health transfers to compensate for the difference.

The most significant advantage to this option is that it incorporates age-based needs into health transfers in a policy-neutral way. The spending decisions of an individual province do not affect the amount of CHT transfers it would receive, except to the extent that one province affects the national average. This option also effectively isolates the impact of population age on provincial health care expenditures, independent of other considerations and does so in a relatively objective manner. Finally, by using national average health expenditures, it would not be necessary for the federal government to broach the contentious issue of finding an appropriate measure of age-based costs.

Although this funding option improves on some of the shortcomings of previous options, drawbacks remain. Because it mimics the equalization program, it could be subject to some of the same criticisms: complexity and a lack of transparency. Moreover, it does not address the fact that, once again, age is the only health-related cost factor to merit special compensation.

    82-            Introduce a Comprehensive Needs-Based Approach to Health Transfers

A final option is to include population age in a comprehensive measure of expenditure needs and cost pressures, one that takes into account all the major factors which affect provincial health care expenditures. This option is similar to the idea of creating a representative expenditure system for the equalization program, except that in this case, the representative expenditures would be limited to those in the area of health care spending.

As such, most of the advantages and disadvantages described in the equalization section apply here as well. The most significant advantage to creating a broad-based formula to estimate expenditure need in health care is that, if constructed carefully, it would reflect all the expenditure needs and cost pressures facing health care spending across the provinces and would distribute federal health transfers accordingly. Provided that there was widespread agreement from all stakeholders about how costs and needs were to be measured, such a transfer program would address the concerns of provinces with a rapidly-aging population, as well as those of provinces where the cost of delivering public health care is high for other reasons.

However, agreement would be difficult to achieve. Given that a host of indicators could be used to measure provincial and territorial health spending requirements, ranging from broad macro data like average life expectancy, to the incidence of specific ailments, to detailed information about waiting times for certain types of surgeries, provincial/territorial governments are unlikely to reach a consensus on what the best approach should be.

A related concern is data collection. Not all provinces and territories gather the same information on health care, or necessarily use the same methodology to do so. The costs associated with standardizing data and arriving at a comprehensive formula to measure health care expenditure needs may be too high to be worthwhile.

Moreover, even if agreement could be reached on a way to measure expenditure needs for public health care, there is no guarantee that the end result would be more funding for provinces with a higher proportion of seniors. When age is lumped together with other cost and need considerations, it is conceivable that provinces with older populations could receive less than an equal-per-capita share of federal health transfers because the effects of these other factors could outweigh the additional expenditure needs associated with a higher proportion of seniors.

    83-            Reform the Canada Social Transfer to Include Age-Related Costs

The Canada Social Transfer is, in essence, the smaller twin of the CHT. While the CHT is intended to support provincial and territorial expenditures in health care, the CST is a block transfer in support of provincial and territorial government spending on post-secondary education, social assistance, and social services, including early childhood development, early learning and child care.

Until recently, the structure of the CST was identical to the CHT – the total transfer entitlement was a combination of notional tax points and cash, the sum of which was distributed on an equal-per-capita basis.  However, it was announced in Budget 2007 that the federal government would move towards an equal-per-capita distribution of CHT and CST cash. While the change in the distribution of CHT funds is not expected to begin until 2014-2015, the CST became an equal-per-capita cash transfer in 2007-2008. The total value of cash payments that year was just under $9.5 billion. Beginning in 2009-2010, CST cash will grow by 3% per year through to 2013-2014.

In an effort to improve transparency, the federal government also announced in Budget 2007 that it will provide information on the distribution of cash transfers within the various components of the CST. It is important to note, however, that the CST remains an unconditional transfer. Provinces and territories are free to spend the transfer as they wish.

For the most part, the CST is not pertinent to the expenditure needs associated with a population that is aging unevenly across Canada. Many of the programs supported by the CST are intended for younger Canadians. About 40% of CST cash in 2008-2009 is intended for spending on post-secondary education and support for children. The remaining $6.2 billion is nominally earmarked to support provincial and territorial social services programs such as welfare. It is only to the extent that seniors qualify for these programs, or that senior-specific social programs exist in the provinces and territories, that the CST is relevant to the discussion at hand.

In fact, the notion that the distribution of CST transfers could adjusted to reflect differences in population structure weakens the case for adjusting CHT transfers in a similar manner. If it can be argued that Quebec and the Atlantic Provinces are entitled to a greater share of CHT funding because seniors are more common in those provinces, then it could be argued with equal justification that Alberta, Saskatchewan, Manitoba and the three territories should receive a greater share of CST funding because they have a higher-than-average proportion of the population under the age of 30.

While it is true that the CHT is a considerably larger transfer than the CST, the net effect of a redistribution of transfers according to age-based needs is less than clear. It is for this reason, in fact, that federal transfers to the provinces and territories tend to be distributed on an equal-per-capita basis. Given the host of factors that affect costs and spending needs – not to mention the policy choices of individual governments – the equal-per-capita distribution of transfers is, for many, the most equitable approach.

CST transfers are only faintly pertinent to the fact that provinces which are aging at different rates face diverging expenditure burdens. For this reason, it may not be appropriate to offer recommendations on adjusting the distribution of this particular transfer.

However, several organizations have suggested that the transparency of CST payments could be improved. Specifically, they recommend that the CST be split into two transfers – one explicitly in support of post-secondary education, and one for social programs and social assistance. Endorsing this view is an option for the Committee. For the most part, post-secondary education financing is not a relevant issue for seniors. By contrast, social assistance, welfare and poverty reduction are most certainly important issues affecting seniors. Splitting the CST in two would isolate the federal transfers that are most relevant to seniors and make it easier for seniors and other stakeholders to seek improvements in federal support in those areas.

    84-            Introduce a supplementary Program to Compensate Provinces for Uneven Aging

Instead of making changes to existing programs, it has been suggested that Canada introduce a new transfer program explicitly designed to address differences in population aging across the provinces. This idea was better received by witnesses, many of whom were opposed to making fundamental changes to Canada’s existing system of federal-provincial transfers.

A direct transfer in support of provinces with a faster rate of population aging has several advantages. For one, because such a transfer would be separate from Canada’s existing federal-provincial transfers, the role and purpose of each would be clear and transparent, preserving efficiency and accountability. Second, while public health care is perhaps the most important area where expenditure needs will vary across the provinces and territories, there are others as well. A transfer devoted to differences in population aging would allow for all age-related cost pressures to be reflected.

Finally, it was argued that it makes little sense to modify existing transfer programs for a temporary phenomenon. The Committee heard that the cost pressures associated with population aging will peak in the 2030s and then slowly fall back.

While there are ways in which existing transfers could be modified to reflect age-based expenditure needs, any such changes would likely be complex and controversial. The simplest and most straightforward way to help provinces with the costs associated with a population that is aging more rapidly might be to provide a separate and distinct transfer payment for that purpose.

---

List of Proposed Options

1-....... Provide tax credits for volunteerism

2-....... Ensure multi-year funding for volunteer activities

3-....... Invest in infrastructure for volunteer organizations

4-....... Initiate a skills matching program

5-....... Promote and recognize volunteerism throughout the life cycle

6-....... Expand educational tax credits

7-....... Support a life-long learning website

8-....... Carry out a life-long learning awareness campaign

9-....... Adapt New Horizons for Seniors for Aboriginals

10-.... Reduce isolation through better urban planning

11-.... Educate Canadians about the benefits of physical activity

12-.... Eliminate barriers which limit active living

13-.... Facilitate the sharing of knowledge and best practices

14-.... Launch a national strategy to combat ageist stigma and discrimination

15-.... Promote the development of alternatives to chronological age as indicators of competency

16-.... Promote research on competency

17-.... Launch an awareness campaign on the recent legislative changes that removed barriers to phased retirement

18-.... Restore the actuarial neutrality of Canada Pension Plan by increasing the incentive to delay uptake

19-.... Work with the provinces to  change the Canada Pension Plan  so that older workers who begin to collect CPP before age 65 continue to contribute to the CPP

20-.... Work with the provinces to  change the Canada Pension Plan so that individuals between the ages of 60 and 65 who want to apply for CPP and continue working no longer have to quit work or earn up to the maximum of CPP in the months prior to the application

21-.... Undertake both an awareness campaign against discrimination against older workers and more aggressive scrutiny of the treatment of older workers for compliance with existing legislation and regulations

22-.... Amend the Employment Insurance program to provide benefits to unemployed older workers, rather than forcing early reliance on CPP or other pensions that may penalize for early withdrawal

23-.... Explore options for other forms of income streams

24-.... Make OAS/GIS benefits non-taxable if they are the only source of income

25-.... Propose to provincial governments that survivor’s benefits under CPP be sustained at the same level after the death of the spouse

26-.... Modify GIS to keep seniors from dropping below low-income cut-off lines

27-.... Work with provincial governments to increase the income replacement rate for the CPP (currently 25% of income up to the average wage) and/or to increase the maximum pensionable earnings beyond the average wage

28-.... Analyze any changes with respect to retirement income to assess and correct for differing impacts on men and women

29-.... Undertake more aggressive campaigns to ensure that all eligible Canadians are receiving all retirement- and age-related benefits

30-.... Make retroactive repayments with interest to eligible recipients who did not apply for OAS at 65 or CPP at 70, or who were denied benefits due to administrative errors and make these payments cover the period between the ages specified and the age at which repayment is made

31-.... Harmonize the design and operations of Old Age Security and the Guaranteed Income Supplement and supports and services (largely provincial) so that modest increases in income do not result in a reduction of supports or services

32-.... Develop a federal/provincial/territorial accord to ensure that increases in OAS and/or GIS do not result in loss of eligibility for subsidies or services for seniors

33-.... Reconsider the design of CPP in light of increasing variations in labour force participation

34-.... Establish a national comprehensive publicly-insured or publicly-privately-insured prescription plan

35-.... Introduce public information campaigns about nutrition, targeted at seniors and the general population

36-.... Ensure that the dental care programs for First Nations and Inuit, veterans, and inmates in federal facilities cover the costs of dentures

37-.... Develop supports for caregivers and promote education to prevent burnout

38-.... Improve training for the continuum of human resource workers on seniors’ needs

39-.... Share best practices on the prevention of elder abuse

40-.... Sign the Hague Convention on the International Protection of Adults

41-.... Support capacity building projects for training in geriatrics and gerontology

42-.... Implement a funded national partnership on palliative care

43-.... Implement a public education program to inform Canadians about end-of-life services and the need for advance care planning

44-.... Increase training and education opportunities surrounding palliative and end-of-life care for health professionals and volunteers

45-.... Apply the gold standards in palliative home care to veterans, First Nations and Inuit, and federal inmates

46-.... Develop tools to facilitate the early diagnosis of mental health conditions

47-.... Remove the 3 percent cap on NIHB health services

48-.... Expand eligible expenses under the Non-Insured Health Benefits Program to include the cost of foot care

49-.... Ensure that senior inmates in correctional facilities receive necessary support aids in a timely fashion

50-.... Increase publicity about CMHC home adaptation programs

51-.... Increase the stock of affordable housing across the country

52-.... Increase the availability of vouchers to allow low-income seniors to pay for adequate housing

53-.... Ensure that the standards for barrier-free design that are already contained in the National Building Code of Canada are consistently met by builders or enforced by inspectors

54-.... Increase the stock of affordable supportive housing

55-.... Increase the supply of affordable supportive housing for First Nations and Inuit seniors

56-.... Improve the regulation of supportive housing across the country

57-.... Facilitate access to information about housing options across the country

58-.... Encourage the provinces and territories to make reciprocal arrangements to eliminate the waiting period for residents from another province

59-.... Communicate information and best practices about adapting long-term-care facilities to address the needs of a multi-cultural society

60-.... Introduce a National Home Care Program

61-.... Address the uneven qualifications and conditions of work of home care staff

62-.... Create a registered chronic care savings plan

63-.... Provide information to caregivers

64-.... Create a National Respite Program

65-.... Make Changes to the Compassionate Care Benefit

66-.... Provide financial support to caregivers

67-.... Introduce a Canada Pension Plan (CPP) drop-out provision for caregivers

68-.... Introduce a National Policy Initiative for Integrated Care

69-.... Share of best practices related to integrated care

70-.... Create a needs-based 'Seniors Independence Program' for all Canadian seniors, modelled after the Veterans Independence Program (VIP)

71-.... Expand the Veterans Independence Program to all Canadian Forces veterans

72-.... Increase the stock of adequate and affordable housing for First Nations and Inuit

73-.... Provide First Nations and Inuit with the same package of services available to war service veterans in the VIP program

74-.... Implement the recommendations contained in the Correctional Service of Canada’s (CSC) Report on Elderly Offenders

75-.... Amend the Corrections and Conditional Release Act by adding offenders who are elderly or who have serious health problems to the list of offender groups with special needs

76-.... Amend the Corrections and Conditional Release Act to make terminally ill offenders serving life sentences or indeterminate sentences eligible for parole on compassionate grounds

77-.... Reform the Existing Equalization Program

78-.... Introduce an Age-Based Expenditure Needs Component to Equalization

79-.... Introduce a Comprehensive Fiscal Needs Component to Equalization

80-.... Weight Federal Health Contributions by Age

81-.... Create a Measure of Age-Based Expenditure Need

82-.... Introduce a Comprehensive Needs-Based Approach to Health Transfers

83-.... Reform the Canada Social Transfer to Include Age-Related Costs

84-.... Introduce a supplementary Program to Compensate Provinces for Uneven Aging

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Witness List – Second Session Thirty-ninth Parliament

November 26, 2007

Human Resources and Social Development Canada

Shawn Tupper, Director General, Social Policy Development;

Dominique La Salle, Director General, Seniors and Pensions Policy Secretariat;

Roman Habtu, OAS Benefits Policy.

Department of Finance Canada

Frank Vermaeten, Director General, Assistant Deputy Minister’s Office;

Krista Campbell, Senior Chief, Federal-Provincial Relations Division;

Andrew Staples, Acting Chief, Federal-Provincial Relations Division.

December 3, 2007

Canadian Institute for Health Information

Jean-Marie Berthelot, Vice-President, Programs;

Christopher Kuchciak, Program Leads, NHEX/OECD.

Canadian Centre for Policy Alternatives

Marc Lee, Senior Economist.

As an individual

Robert Evans, Professor of Economics, University of British Columbia.

Joe Ruggeri, Professor of Economics, University of New Brunswick.

Public Health Agency of Canada

Margaret Gillis, Director, Division of Aging and Seniors/Office of Voluntary Sector.

December 10, 2007

Canada Mortgage and Housing Corporation

Luis Rodriguez, Senior Researcher;

Debra Darke, Director, Community Development. 

Canadian Healthcare Association

Sharon Sholzberg-Gray, President and Chief Executive Officer.

The Royal Canadian Legion

Pierre Allard, Director, Service Bureau;

David MacDonald, Consultant, Legion Housing Centre for Excellence.

As individuals

Marcus J. Hollander, President, Hollander Analytical Services Ltd.

Margaret Isabel Hall, Assistant Professor, Law Faculty, University of British Columbia.

January 28, 2008

Canadian Automobile Association

David M. Munroe, Chair of the Board CAA National;

Christopher White, Vice-President, Public Affairs.

Canadian Medical Association

Dr. Briane Scharfstein, Associate Secretary General, Professional Affairs.

Lakehead University

Dr. Michel Bédard, Canada Research Chair in Aging and Health.

The Rehabilitation Centre, Ottawa Hospital

Dr. Shawn Marshall, Associate Professor.

Canadian Centre for Elder Law Studies

Laura Watts, National Director.

Alzheimer Society of Nova Scotia

Jeanne Desveaux, President.

February 4, 2008

Correctional Service of Canada

Ross Toller, Assistant Commissioner, Correctional Operations and Programs;

Leslie MacLean, Assistant Commissioner, Health Services.

Office of the Correctional Investigator

Ed McIsaac, Executive Director;

Howard Sapers, Correctional Investigator.

Canadian Association of Elizabeth Fry

Kim Pate, Executive Director.

Insurance Bureau of Canada

Mark Yakabuski, President and Chief Executive Officer.

Federation of Medical Regulatory Authorities of Canada:

Fleur-Ange Lefebvre, Executive Director and Chief Executive Officer.

February 11, 2008

Statistics Canada

René Morissette, Assistant Director, Research Business and Labour Market Analysis Division;

Garnett Picot, Director General, Socio-Economic and Business Analysis;

Ted Wannell, Assistant Director, Labour and Household Analysis Division.

As individuals

John Myles, Canada Research Chair and Professor of Sociology, University of Toronto.

Derek Hum, Professor of Sociology, University of Manitoba.

Human Resources and Social Development Canada

Maxime Fougère, Assistant Director, Labour Market Research and Forecasting.

Informetrica Limited

Richard Shillington, Senior Associate.

Women Elders in Action

Alice West, Chair;

Elsie Dean, Researcher;

Jan Westlund, Coordinator.

 

 

Witness List – First Session Thirty-ninth Parliament

November 27, 2006

Statistics Canada

Pamela White, Director, Demography Division;

Laurent Martel, Analyst, Research and Analysis Section.

As an individual

Byron Spencer, Professor, Economics, McMaster University.

National Aboriginal Health Organization

Carole Lafontaine, Acting CEO;

Mark Buell, Manager, Policy Communication Unit.

National Advisory Council on Aging

Robert Dobie, Acting Chair;

Margaret Gillis, Director, Division of Aging and Seniors, Centre for Healthy Human Development, Public Health Agency of Canada.

As an individual

Douglas Durst, Professor, Faculty of Social Work, University of Regina.

December 4, 2006

Human Resources and Social Development Canada

Peter Hicks, Executive Director, Strategic Analysis, Audit and Evaluation;

John Connolly, Director, Partnerships Division, Community Development and Partnerships Directorate;

Marla Israel, Director, International Policy and Agreements, Seniors and Pensions Policy Secretariat.

Public Health Agency of Canada

Margaret Gillis, Director, Division of Aging and Seniors, Centre for Healthy Human Development.

Health Canada, First Nations and Inuit Health Branch

Leslie MacLean, Director General, Non-Insured Health Benefits;

Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate.
 

Indian and Northern Affairs Canada

Havelin Anand, Director General, Social Policy and Programs Branch.

Veterans Affairs Canada

Bryson Guptill, Director General, Program and Service Policy Division.

Canada Mortgage and Housing Corporation

Douglas Stewart, Vice President, Policy and Planning.

Treasury Board of Canada Secretariat

Dan Danagher, Executive Director, Labour Relations and Compensation Operations.

Public Service Human Resources Management Agency of Canada

Cecilia Muir, Director General, Public Service Renewal and Diversity.

December 11, 2006

Canadian Association for the Fifty-plus, CARP

Judy Cutler, Director of Government Relations;

Taylor Alexander, Consultant in Aging Policy and Continuing Care.

Royal Canadian Legion

Jack Frost, Dominion President;

Pierre Allard, Director, Service Bureau.

International Federation on Ageing

Jane Barratt, Secretary General.

Canadian Institutes of Health Research

Anne Martin-Matthews, Scientific Director, Institute of Aging.

Canadian Association on Gerontology

Sandra P. Hirst, President.

National Initiative for the Care of the Elderly

Lynn McDonald, Scientific Director.
 

February 12, 2007

Human Resources and Social Development Canada

Peter Hicks, Executive Director, Strategic Analysis, Audit and Evaluation.

February 19, 2007

As individuals

Victor Marshall, Professor of Sociology, Institute on Aging, University of North Carolina.

Susan Kirkland, Professor, Canadian Longitudinal Study on Aging, Dalhousie University.

Policy Research Initiative

Terrence Hunsley, Senior Project Director.

Statistics Canada

Geoff Rowe, Senior Advisor – Microsimulation.

March 19, 2007

As individuals

Jacques Légaré, Professor Emeritus of Demography, Université de Montréal.

Marchel Mérette, Associate Professor of Economics, University of Ottawa.

Neena L. Chappell, Canada Research Chair in Social Gerontology and Professor of Sociology, Centre on Aging, University of Victoria.

Gloria Gutman, Professor, Gerontology, Simon Fraser University, and Director, Dr. Tong Louie Living Laboratory.

March 26, 2007

Statistics Canada

Leroy Stone, Associate Director General, Unpaid Work Analysis;

Danielle Zietsma, Senior Economist, Labour Statistics Division.

Conference Board of Canada

Paul Darby, Deputy Chief Economist.

Certified General Accountants Association of Canada

Rock Lefebvre, Vice-President, Research and Standards.

 

As individuals

Derwyn Sangster, former Director, Business, Canadian Labour and Business Centre.

Brigid Hayes, former Director, Labour, Canadian Labour and Business Centre.

Monica Townson, Economic Consultant.

May 7, 2007

International Federation on Ageing

Jane Barratt, Secretary General.

Organisation for Economic Co-operation and Development

Monika Queisser, Expert on Demographic Ageing, Employment, Labour and Social Affairs Directorate.

Healthy Ageing Project

Karin Berensson, Project Manager;

Barbro Westerholm, MP (Sweden) and participant of the Healthy Ageing project.

Active Living Coalition for Older Adults

Dianne Austin, National Executive Director.

Creative Retirement Manitoba

Marjorie Wood, Executive Manager.

International Council on Active Aging

Colin Milner, Chief Executive Officer.

May 14, 2007

Assembly of First Nations

Elmer Courchene, Elder;

Richard Jock, Chief Executive Officer.

Métis National Council

Don Fiddler, Senior Policy Advisor.

Inuit Tapiriit Kanatami

Okalik, Eegeesiak, Director, Socio-Economic Development;

Jennifer Forsyth, Health Technical Advisor;

Maria Wilson, Project Coordinator.

Pauktuutit Inuit Women of Canada

Jennifer Dickson, Executive Director.

National Association of Native Friendship Centres

Peter Dinsdale, Executive Director;

Alfred Gay, Policy Analyst.

Aboriginal Seniors Resource Centre of Winnipeg

Thelma Meade, Executive Director.

May 28, 2007

Alzheimer Society of Canada

Dale Goldhawk, Chairman of the Board;

Scott Dudgeon, Chief Executive Officer.

Advocacy Centre for the Elderly

Judith A. Wahl. Executive Director.

Canadian Coalition for Senior’s Mental Health

Faith Malach, Executive Director.

Canadian Ethnocultural Council

Anna Chiappa, Executive Director.

Fédération des aînées et ainés francophones du Canada

Jean-Luc Racine, Executive Director.

Canadian Network for the Prevention of Elder Abuse

Alison Leaney, Chair of the Board;

Charmaine Spencer, Member of the Board.

June 4, 2007

The Honourable Marjory LeBreton, P.C., Leader of the Government in the Senate and Secretary of State (Seniors).

National Senior Council

Jean-Guy Soulière, Chair.

Human Resources and Social Development Canada

Susan Scotti, Senior Assistant Deputy Minister, Income Security and Social Development.

Conférence des Tables régionales de concertation des aînés du Québec

Jean-Guy Saint-Gelais, Secretary and former Chair.

 

June 11, 2007

As an individual

Janice M. Keefe, Canada Research Chair in Aging and Caregiving Policy and Director, Nova Scotia Centre on Aging, Mount Saint Vincent University.

Canadian Caregiver Coalition

Palmier Stevenson-Young, President.

Group of IX

Bernie LaRusic, Vice Chairperson.

As an individual

Judy Lynn Richards, Assistant Professor, Department of Sociology and Anthropology, University of Prince Edward Island.

June 18, 2007

Canadian Hospice Palliative Care

Sharon Baxter, Executive Director;

Dr. Lawrence Librach, Vice-President.

Pallium Project

Michael Aherne, Director, Initiative Development.

Canadian Home Care Association

Nadine Henningsen, Executive Director.