Making a case for government-run long term care insurance: NIA

It’s not something we are ever prepared for. But many Canadians find out the cost of long-term care can range into the thousands per month when something happens to a loved partner or parent. It’s a cost that few expect or plan for.

Those are some of the reasons why the National Institute on Ageing (NIA) is calling for a national long-term care insurance plan, reports The Toronto Star.

NIA’s Dr. Samir Sinha calls such a program “a necessary `social contract’ that will especially help GenXers, the eldest of whom are marching towards 60, and the massive cohort of millennials, who will start turning 50 in the early 2030s,” the newspaper reports.

“More people are living paycheque to paycheque and so they aren’t really doing a great job saving for their retirement,” Sinha, who is also director of geriatrics at Sinai Health and University Health Network, tells The Star.

“And the biggest thing that can really threaten anyone’s retirement or how they live in retirement will be if they all of a sudden have long-term-care needs,” he adds.

Long-term care is defined by the NIA “not as the traditional nursing home depiction, but as a mix of supports or health care services from public or private care providers across a range of settings, including institutions, the community and individual homes.”

“Many will one day need extra help, with bathing or getting dressed; or from physiotherapists or occupational therapists. It’s not just the potential vulnerability of old age, many will be living with disabilities. Some coverage is provided currently by a patchwork of provincial systems across Canada, the paper said, but often expenses are paid by the individual, if they can afford it,” the article notes.

Often, the article reports, people think they can look after an elder family member on their own. This is harder than it may sound, states York University’s Pat Armstrong in the article.

“The assumption that care will be provided by family, especially women, often leads to an unhappy awakening, given that many caregivers are not qualified to provide the support needed,” the article notes.

“It takes medical training that many don’t have, whether it’s looking after a partner with dementia or a chronic disease,” the article continues.

“It’s especially the case now when you have people with catheters and kidney failure and all kinds of other equipment they go home with,” Armstrong tells The Star. “That requires an incredible amount of training and skill. And the recognition that those skills mean you have to pay for them.”

The article notes that Germany, Japan, the Netherlands, Taiwan and the US state of Washington all provide state-run long-term care insurance programs for citizens.

Without any state insurance program, we face some rather dizzying costs, the article reports.

“In nursing homes… co-payment fees cost more than $33,000 a year for a private room and $28,000 for a semi-private room. In-home services, the paper said, can range from $1,000 to $3,500 dollars per month while the cost of complex home care in Ontario can cost as much as $25,000 a month.”

It will be interesting to see if any levels of government in Canada explore this idea, particularly given the fact that the NIA predicts that one quarter of Canadians will be over 65 by 2030 and by 2048, the eldest GenXers will be in their 80s.

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The National Institute on Ageing is a relatively new university-based think tank focused on leading cross-disciplinary research, thought leadership, innovative solutions, policies, and products on ageing.

The NIA brings together thinking not only on the money side of retirement, but the health side as well.

So says the NIA’s Dr. Bonnie-Jeanne MacDonald, PhD and FSA (she is also resident scholar at Eckler Ltd.), who recently took the time to speak with Save with SPP. “A happy, healthy retirement is not just about money,” Dr. MacDonald notes, adding that NIA hopes to tap into university, government and other worldwide research to come up with “better ideas that will help Canadians as they age.”

One aspect that Dr. MacDonald has done much research about is the “decumulation” phase of retirement, the period when savings from the work years are used to finance life after work.

“Retirement planning used to focus on saving up until age 65,” she explains. You would then start spending and travelling, with “the old assumption (being) that you would begin to need less money as you aged, that you wouldn’t be spending as much by age 90.”

However, Dr. MacDonald notes, this type of thinking overlooked the possibility that retirees might eventually need to pay for age-related healthcare costs, including living in a nursing home.

In reality, many retirees in their 60s and even 70s “can still earn money, and can choose to downsize, or reduce spending. Their expenses are flexible,” Dr. MacDonald explains. “Once you are 80 to 85, there is less flexibility, expenses are increasingly less ‘voluntary’ (namely the costs arising from declining health) – so it is at this age when having a steady stream of income becomes much more necessary for financial security.”

What she calls “shifting socioeconomic customs” have driven changes in the way retirement money is spent and the effect it has on individuals and families.

“Society has shifted, women are now working more and are not able to provide elder care without accruing considerable personal expense,” notes Dr. MacDonald. Even still, the majority of caregivers are women. The NIA’s report on working caregivers, authored by Dr. Samir Sinha, a geriatrician and Dr. MacDonald’s colleague at the NIA,  shows that women are not only more likely to be working caregivers, but that they provide much more care to their elderly relatives than do men. What’s more, the typical age at which women provide care overlaps with peak career earning opportunities and with their own family building, which in turn causes a knock-on effect on their lifetime earnings and income potential. Financial independence in older age has significant ripple effects, beyond just the individual.

In the past, it used to be more likely that the family would look after elderly parents, helping to feed them, socialize them, prepare their taxes, transport them, and so on. And while 75 per cent of elder care is still done by the family, increasingly people are finding they have to or want to pay for their own care as they enter their late 80s and 90s. And while family caregivers play an important role in the lives of the elderly, people generally prize their independence. But independence also comes at a cost. “It costs a lot of money to replace (the care provided by family), it has become extremely expensive for nursing home care.,” says Dr. MacDonald.

While some retirees can afford to cover the costs of their own care, those who can’t must be assisted by the government, she explains. “The overall effect of this is that some older people aren’t decumulating their savings as expected. They are holding onto their money; they are concerned about the future,” she adds.

Dr. MacDonald is the author of a recent paper on this topic for the C.D. Howe Institute called “Headed for the Poorhouse: How to Ensure Seniors Don’t Run Out of Cash Before They Run Out of Time.” The paper suggests the creation of a government-sponsored LIFE (Living Income for the Elderly) program that would provide additional life income beginning at 85.

“LIFE would provide longevity insurance to Canadian seniors at their most vulnerable time of life… giving them choice, flexibility and income security at advanced ages,” she writes in the paper.

In an article for the Globe and Mail written last year, she suggests women – who live longer – consider not starting their CPP benefits until they are older. “Starting CPP benefits at the age of 70 instead of 65 will increase a person’s CPP by 42 per cent,” she notes in the article.

NIA is looking at other ways to boost income security for older retirees. One way, says Dr. MacDonald, would be to find ways “for people to stay in their own homes longer.” Another way would be to allow family members providing care to be paid. Currently rules generally allow paid caregiving by strangers, but not by someone’s daughter,” she notes.

We thank Dr. MacDonald for taking the time to talk with us.

Remember as well that before decumulation can occur there needs to be retirement savings. The Saskatchewan Pension Plan offers a flexible savings program for individuals.

Written by Martin Biefer

Martin Biefer is Senior Pension Writer at Avery & Kerr Communications in Nepean, Ontario. After a 35-year career as a reporter, editor and pension communicator, Martin is enjoying life as a freelance writer. He’s a mediocre golfer, hopeful darts player and beginner line dancer who enjoys classic rock and sports, especially football. He and his wife Laura live with their Sheltie, Duncan, and their cat, Toobins. You can follow him on Twitter – his handle is @AveryKerr22