The Alberta Association on Gerontology reviewed the recent publication, “Alberta for all Ages: Directions for the Future”. The amount of work and wide- ranging subject matter considered are impressive, and the document contains a number of very good recommendations. We are, on the whole pleased with the conclusions expressed. We do, however have some concerns regarding certain recommendations, which we wish to bring to your attention.
At the beginning of the document, mention is made that aging affects all of us, and it is intimated that we are all responsible to maintain our health to the best of our ability. However there is no recognition given to the serious problems that affect certain segments of the population such as the people ages 45 to 60 who have lost their jobs and have few employment prospects. Nowhere in the document is mention made of recommendations to take action against this type of ageism in our society.
There are other groups, such as those over age 55, who have become widowed, separated from their spouses or who are single, particularly single mothers, who have serious barriers to maintaining their health in our present society. For this group, jobs are scarce, wages are low and the possibilities of achieving healthy aging are small. We all know that there is a definite link between poverty and poor health. We, therefore, suggest that there should be a recommendation relating directly to the need for an equitable assistance program for those people over age 55 who do not qualify for the Widows Allowance because of marital status.
We agree that safe, affordable housing for low and middle income seniors is a critical objective and an absolute necessity if people are to have a healthy environment. However, the report makes no mention of how we are to achieve this goal of “responding to the need for affordable housing” for these income brackets. It is important that the portent of these recommendations be more specific so that the meaning of recommendations relating to housing is clearly understood, and the approach is one that is fair to everyone involved. For instance, what kinds of partnerships are to be encouraged, or with whom should partnerships be formed? In addition, some incentives in relation to taxes and subsidies are needed to encourage the building and operation of affordable accommodation, particularly housing targeting the very low income group. Developers have not shown an interest in building this type of housing, since without government subsidies, they cannot make their profit.
There should be greater emphasis placed on adaptation of housing to prevent falls. Falls often result in serious injury for older people, and most falls occur inside the home. It would be a step forward to see this fact recognized and plans developed to improve this situation. Japan has now included home adaptation costs in their public long term care system benefits.
The Broda Report emphasized the idea of “aging in place”, which we believe indicates that while we need sufficient options in housing to accommodate a very heterogeneous population, we also need to be looking at innovative ways of facilitating people to age in place in their homes.
Encouraging supportive communities is a worthwhile goal, but we do not see any recommendations recognizing the need to combat ageism in our communities. It is no doubt important to raise the awareness of the needs of the elderly and to encourage the community to be helpful to them. However, it is also important to encourage people to accept seniors as worthwhile and contributing members of society.
We were pleased to see recommendations relating to transportation, particularly in the rural areas. Transportation is crucial if one is going to encourage greater independence among older people. It is a major barrier to achieving community participation and independent living. While lack of transportation is a greater barrier in rural areas, inadequate transportation also exists in urban areas, where overburdened and underfunded volunteer transportation services struggle to provide the transportation services needed. It is not enough to just look at providing transportation to a frail senior. We must consider that they may, and frequently do, need someone to accompany them to appointments, and to assist them in carrying out the usual activities of daily living.
Independence and Family Responsibility
We were pleased that the report recognized the need for independence and self-maintenance. It is also important to recognize that what we generally regard as independent living includes an ability to make choices and decisions regarding our own future, and also means that all people, not just the older adults, live an interdependent lifestyle. We would like to see interdependence stressed along with independence.
We are also concerned that people should remember that while the family and the individual have responsibilities, the communities, along with the government, have responsibilities also. In this age when women, the traditional caregivers, are also working outside the home to help maintain their own household, we should be looking at innovative ways of providing support for families of very frail, older people who may need a fair amount of help.
We are concerned by Recommendation 6.2, page 62 which states that families should be encouraged to prepare for and share responsibility for caring for aging parents, spouses and other relatives. Such a statement is demeaning, particularly in view of the actual facts. Statistics show that 80% – 90% of all care is already provided by families. On page 61, in the introduction material relating to this topic, it is noted that “In 1996, about 2.1 million Canadians looked after older family members or friends with a long term health problem.” This is a high proportion of the Canadian population, and certainly an indication that at the present time, families are taking responsibilities for their older members, and making efforts, sometimes with great hardships, to see that their elderly relatives receive good and appropriate care.
While recommendations are made to assist families with home adaptation to enable them to keep their older relative in their home, and to expand home care to assist them, we would like to see a recommendation relating to financial pressures on families. There should be consideration of programs that would provide income tax relief and pension compensation for caregivers that stay at home to care for an older relative. Greater effort should be made to find innovative solutions to assist them and to help lessen these stresses, so that they can maintain their health and continue their roles as principal care providers.
Health and Wellness Programs
We were pleased to see references to health promotion and a suggestion that wellness programs should be encouraged. We would like to see the report go further and suggest that there should be more funds provided to promote healthy lifestyles. At present, it is difficult to get funding for health promotion and wellness types of programs although we are all agreeing that this is a route to improved health and thus, it can lead to a better quality of life as well as reduced health care costs.
Responsibilities of Government
Since this document is a product of the provincial government, we would expect to see more specific direction to government bodies. Most of the recommendations are appropriate and seem to have a sound basis, but they lack specificity. They are broad and general statements. Each principle and recommendation should be accompanied by a strategy, and suggested timelines and costs that might be involved in carrying out some of these projects.
The primary government departments that should be involved are not mentioned, and this makes it difficult to determine where the primary accountabilities are for implementation. Recommendations of this type should include the principles of “What – When – How – Who if we are to increase awareness among all of the factions involved – older persons, their families, the communities and government.
The value in a report such as this is determined by the steps taken to implement the recommendations. We again wish to acknowledge the work and effort involved in producing this document. Since this report did not provide direction to government bodies, we would now recommend a report with the implementation plan for each of the recommendations identified.