The aging of Canada’s population and the significant burden posed by complex conditions, such as Alzheimer’s disease, is leading to concern about the deficit in quality care to meet the needs of elderly patients. According to the Alzheimer Society of Canada, there are 103,000 new cases of Alzheimer’s disease and related dementias diagnosed each year. There are 750,000 people living with some form of dementia and that number is expected to double by 2030. The annual cost of treating people with dementia is $33 billion today but expected to climb to nearly $300 billion in two decades.
In December, Health Minister Rona Ambrose signed the G8 Dementia Summit Declaration committing Canada to help find a cure or therapy for dementia by 2025.
In the meantime, what needs to be put in place to care for the growing number of people with Alzheimer’s disease and dementia?
The Alzheimer Society of Canada’s 2010 report, Rising Tide: The Impact of Dementia on Canadian Society, advocates the implementation of the “integrated model of community care” that would coordinate health care for the elderly with services available to them in their communities. It also recommends “chronic disease prevention and management,” with active involvement from the patient alongside health care teams. Other possible reforms include increasing the number of health care professionals trained to deal with dementia, making the public more aware of the importance of prevention and early detection of dementia, educating caregivers, and involving the volunteer sector. In 2013, it called on the development of a dementia non-profit organization to be funded by the Public Health Agency of Canada.
Harvey Lazar elaborates on the problem of meeting the social needs of an aging population in Many Degrees of Policy Freedom: The Federal Government’s Role in Care for Seniors, a November 2011 report for the Institute for Research on Public Policy. He says that the federal government is currently providing pensions and income support, as well as transfer payments to the provinces to support seniors’ care. The provinces’ role is to manage the delivery of the health and social services.
In his report, Lazar assumes individuals should “plan their retirement with the expectation that they may need to pay for some care services, but planning for and financing catastrophic care costs is best done by pooling the risk at the societal level,” claiming that it is not “reasonable” for individuals to plan for unlikely “prolonged, complex care.” The problem with relying on private insurance, according to Lazar, is that there is a small market for insurers who will finance long-term care and that usually those affected are unable to afford it.
Thus, he recommends social insurance and government support as a way to finance the needs of seniors demanding increased care. Many of his recommendations focus on payments from the federal government to the elderly, as well as refundable tax credits for caregivers. In addition, he supports more grants to the provinces to be used for financing services for seniors.
The 2012 report Dementia: A Public Health Priority, by the World Health Organization and Alzheimer’s Disease International, lists some examples of public policy in other parts of the world towards dealing with Alzheimer’s and dementia patients. In 2000, Japan established long-term care insurance to meet the demands of its growing number of citizens in need of increased care. The insurance, financing 90 per cent of service charges, covers ambulatory and residential services such as home visits and intensive care homes. It is half financed by monthly premiums on the insured (people over 40 years old). The rest is covered by different levels of government.
Mexico has seven registered daycare centres for dementia patients run by non-profits, but that is hardly enough to meet the needs of a country with the population of 120 million. They are mostly paid for by donations and small charges on the clients. In Malaysia, alongside government assistance, dementia patients can access palliative home care and daycare centres managed by non-governmental organizations.
Perhaps measures to improve long-term care will be most important in mitigating the effects of Alzheimer’s disease and dementia. In an excerpt adapted from her book, The Alzheimer Conundrum: Entanglements of Dementia and Aging, published in Policy Options, Margaret Lock argues that there is too much emphasis on developing a drug or cure for a possible molecular cause of Alzheimer’s, even though “the reality is that there will be no silver bullet for Alzheimer disease – the heterogeneity of the condition that so many researchers surely recognize ensures that this will be so.” In other words, Alzheimer’s is a complex and differentiated disease, that like cancer, is not likely susceptible to one cure. Instead, Lock says the focus should be on determining why high-risk individuals do not develop dementia and what can be done to improve public health, support services, and living standards.
“Aging and dementia cannot be disentangled,” says Lock. “All we can strive for is to find ways to stave off or halt the progression of (Alzheimer’s disease), at whatever age it strikes.”
Over the past seven years, the federal government has spent nearly a billion dollars on brain disorder research, but if Ottawa is going to meet its G8 declaration requirements, it will almost certainly have to increase such funding. Right now with Alzheimer’s, the saying that an ounce of prevention is worth a pound of cure isn’t even a choice as neither is a reality at this point.
