First of all, no matter what you’ve been reading online, you will not live to be 200 years old.
This is a myth propagated by science fiction writers and investment firms that want you to commit for the long term.
Second, if you were born between 1946 and 1965, you will soon be part of what has been termed the Grey Tsunami, a pig-in-a-python population bulge that, as it rounds age 77 and heads for 80, poses an existential threat to our already strained health care system.
Baby boomers, at every turn of their fortuitous, privileged existence, have always defined — and defied — social trends.
From the tie-dyed ’60s to the “Greed is good” ’80s to the Freedom 55 ’00s, these legendary disrupters are about to redefine growing old in a way the Canadian Medical Association predicts will nearly double the cost of elder care by 2031, the year the eldest among them turn 85.
Whether it’s long-term care, home care, hospital care, or some yet-to-be-invented kind of care, they will squeeze the health care system like a distended pimple.
And without a fix to relieve pressure, it will bleed.
“As part of Gen X, I’m terrified that when I do require care in the coming years, there will be nothing left,” laments Margaret Schneider, a 49-year-old Wilfrid Laurier University kinesiology prof who experienced the frailty of the health care system firsthand when her parents entered long-term care during the pandemic.
“The fabric of our current health care system is tenuous and threadbare on its best of days. The upcoming surge of baby boomers, followed by the baby bust, has the potential to completely ravage this system beyond repair.”
Advocating for her parents in a system ill-equipped for change was, she says, “completely demoralizing.”
“I found myself caught in a tangled web of people who were trying to help, but with few resources to go around there was only so much they could do,” says Schneider, whose father passed away mid-pandemic.
“To get what you need, you must fight tooth and nail with absolutely everyone you encounter. Full stop. Even then, you receive far less than you need.”
If she sounds exhausted, it’s because she is.
“It shouldn’t be this hard to advocate and care for our loved ones. This is only going to get harder unless someone puts a stop to it.”
It’s a common sentiment, bolstered by the rise in hallway medicine, closure of emergency rooms, dramatically distended wait times, shortage of family doctors and the province’s controversial embrace of private medicine.
“The baby boomers are the biggest driver of aging in our population and will continue to be for some time,” says Martin Cooke, a University of Waterloo health sciences prof and demographer.
“But I don’t know if people are thinking about it.”
Most experts agree they should be.
But are things as bad as they seem? Is there away to avoid a looming boomer Armageddon?
“First of all, demographics do not explain (two-thirds) of everything,” says John Hirdes, a University of Waterloo prof at the School of Public Health, who disputes the notion put forward by Canadian demographer David Foot in his book, “Boom, Bust & Echo.”
“Policy explains a hell of a lot more than demography ever will.”
While no-one disputes the system needs to brace for the geriatric wave to come, there are things that matter more:
The seniors of today are nothing like seniors of the past
“Older people are healthier than they used to be,” points out Cooke, who says the rates of disability are changing.
“Being 60 now is not like being 60 40 years ago. The baby boomers are also the first cohort more likely to arrive in older ages having been divorced, and having smaller families themselves.
“That changes the systems of social support.”
In another departure from the past, Hirdes says that by the time people arrive in long-term care today, they have few other options.
“I remember long-term care homes in the 1980s and early ’90s had dedicated parking spots for the residents,” Hirdes says.
“You don’t see residents in nursing homes anymore who drive. People are much more severely impaired, but the relative increase in expenditures hasn’t matched that change in population intensity.”
Elderly people aren’t a drain on the health care system. They’re the reason it exists
“A lot of people don’t realize that care of the elderly is the future of health care,” says Hirdes.
“Older people aren’t the problem. They should be the primary focus of health care. In a perfect world, nobody would need to go into a hospital for an overnight stay if they were under 70, because we’d all be healthy enough to not need to go for heart surgery or stroke or other chronic diseases.”
If it’s a pipe dream, it’s one worth striving for.
“It’s very common for people to say the elderly represent, say, 15 per cent of the population but 35 per cent of health care expenditures,” says Hirdes, noting that population aging accounts for only “a couple of percentage points” in driving up health care costs.
“Well, dammit, I’d like them to represent 90 per cent of health care expenditures, because then the rest of us are healthy enough that we don’t need health care.”
“We use more expensive devices than we ever have in health care,” notes Hirdes. “If you or I have a heart attack today, there will be a lot more things that get done to us than in 1970.”
Health care professionals shouldn’t be taken for granted
“We’re losing large numbers of staff because they’re burned out,” says Hirdes.
“The behaviour of some people in the last year and a half of the pandemic has made life very stressful for them. They feel undervalued. I have friends who were attacked on the way to hospitals.
“We started off banging pots in celebration. And at the end of the pandemic, they were feeling like their security was under threat.”
Treating workers with respect, financially and otherwise, is key.
“I just don’t get how that math can possibly work, because you’re alienating people that have worked their butts off in very difficult circumstances over a less-than-inflation wage increase.”
The importance of user-friendly hospitals
“We need to think about designing hospitals in a way that reduces the bad things that happen to older people, like delirium, an acute confusional state caused by medication errors, stress, acute health conditions, noisy environments and so on,” says Hirdes.
“Falls, use of restraints that can trigger delirium, and getting pressure injuries like skin ulcers are all things that happen in hospitals that aren’t well designed.”
Regardless where it’s directed, it’s about the money, stupid
“The main thing we’re facing is not so much that population aging is happening,” says Hirdes. “It’s that our health system hasn’t been adjusted to keep up, because we’re not putting the money into it to match what the needs are.”
“At the start of the pandemic we were in a situation of thinking, ‘We have to fix long-term care! This was terrible! We’ll never let this happen again!’ And today, it’s, ‘Uh oh, gas has gone up another five cents!’ ”
Putting things off for another day is no longer an option
“Population aging shouldn’t be a surprise to anybody,” says Hirdes. “We’ve been talking about this since I was an undergrad student in the ’80s. It’s not a Grey Tsunami. It’s a Grey Glacier that everybody has seen coming forever.
“In the 1980s and early ’90s, if we made mistakes in terms of policy choices, there were lots of areas in the health system where we could gain economies and get that money back.”
Not so today, where “we’ve run out of wiggle room in terms of screwing up things when it comes to health policy.”
Health care numbers can be misleading
“If you look at it in terms of size of the population, every government in the future will say they’re spending more on health care than the previous government, because population sizes have gone up,” says Hirdes.
“Inflation also means they’re spending more. So you can never look at the raw dollar spent. You always have to look at the per-capita expenditures, adjusted for inflation.
Home care and long-term care operate in tandem and must be funded accordingly
“If you want the system where you can stay out of institutions to the latest point of your life, healthy and happy in the community for as long as possible, we need to fund home care at a higher level than we’re funding it today,” says Hirdes.
“None of us want to end up in a crappy long-term care home, so we have to provide funding to ensure they can provide the right resources to match your needs. And we need all of these systems to be checked so that they’re doing a good job.”