Advocacy

Seniors’ sensory health requires expanded prioritization. Further investment and coverage to increase treatment options and reduce wait times are urgently needed. Investment is also specifically required in the area of sensory restorative health.

Recommendation #14: Eyesight

• Increase funding and patient choice for cataract, glaucoma, diabetic retinopathy, macular degeneration, and other eye-related healthcare needs.

Recommendation #15: Hearing

• Invest in hearing health and provide hearing device grants or subsidies.

Recommendation #16: Oral

• Provide affordable and accessible dental care for all seniors, including hygiene and restorative work.

Recommendation #17: Touch

• Prioritize research, funding, and treatment options around tremors, post-stroke sensory loss, spasticity, and arthritis.

Recommendation #18: Feet

• Include foot care health in provincial healthcare coverage and provide podiatry services. Include foot care as part of covered care at home, including in retirement and long-term care homes.

With the profound increase of dementia and cognitive impairment in our aging population, systemic and individual supports must be embedded not just within the Canadian healthcare system, but also within communities and families.

Recommendation #19: Capacity Assessments

• Make mental capacity assessments timely, equitable and affordable. Integrate mental capacity assessments into health and social services to cover the cost of medically needed capacity assessments.

Recommendation #20: Dementia-Friendly Systems

• Increase focus and prioritization of the development of dementia-friendly healthcare, communities, and systems supports. Prioritize timely diagnosis, response and treatment of dementia.

Recommendation #21: Dementia Education

• Invest in education and resources to support front-line healthcare workers learning about and managing dementia.

Recommendation #22: Destigmatize Dementia

• Create a public awareness campaign to destigmatize dementia. Stigma is one of the most profound barriers to early detection and treatment, as well as economic security and social inclusion of those living with dementia. Work with persons living with dementia, families, caregivers, communities and medical professionals to ensure both a multi-pronged and targeted approach to the campaign.
• In that campaign, underscore that discrimination based on a dementia diagnosis is a violation of human rights and contrary to the UN Convention on the Rights of Persons with Disabilities, to which Canada is signatory.

Recommendation #23: Adult Day Programs

• Invest in more day and social programs for persons living with dementia, including for non-Alzheimer’s forms of cognitive impairment and early-onset dementia.

Recommendation #24: Innovation to Support Diagnosing and Living with Dementia

• Prioritize investment and innovation in technology and digital supports to aid persons living with dementia in living full, engaged, and vibrant lives.

Recommendation #25: Implementation of National Dementia Strategy

• Implement the newly adopted National Dementia Strategy and ensure adequate investment to operationalize the strategy. Encourage research and innovation in the search for a cure and for effective treatments.

Mental health issues and substance abuse are on the rise in the seniors’ population. These seem to be increasing in the era of COVID-19, particularly with social isolation and loneliness. Yet, stigma and lack of care options for seniors remain barriers to treatment and well-being.

Recommendation #26: Psychogeriatrics

• Invest in sector capacity building specifically for psychogeriatrics. Increase grants, placements, and medical fellowships to increase the number of psychogeriatricians in Canada. Allocate more funding towards allied healthcare professionals to develop expertise in geriatric mental health and addictions.

Recommendation #27: Screening

• Regularize screening for depression and anxiety for older adults, particularly in isolated, long-term, or congregate care settings.

Recommendation #28: Grief Supports

• Develop community-based grief programs and supports.

Recommendation #29: Research

• Invest in academic and community-based research to better understand how older adults’ mental health and addictions present, and differ from, that of younger people.

Recommendation #30: Education and Destigmatization

• Develop and implement more educational programs for Canadian seniors about mental health to reduce the associated stigma.

Canada urgently needs to develop sector capacity in geriatric health and social care to meet the needs of the rapidly aging population.

Recommendation #31: Rotations and Training

• Work with the regulatory health colleges and educational institutions to require geriatric rotations and/or training modules for all physicians and healthcare professionals.

Recommendation #32: Rural Capacity

• Increase the number of general practitioners and nurses in non-urban centers with a specialty in geriatrics.

Recommendation #33: Financial Incentives to Create Sector Capacity

• Create financial incentives through educational grants to support an increase in students studying geriatric health and social care generally, then practicing in Indigenous, rural, and remote communities specifically.

Seniors need dedicated time and resources from their healthcare providers for rehabilitation and recovery, as well as the required accessibility devices to regain and maintain well-being.

Recommendation #34: Coverage

• Change the criteria to determine the coverage of rehabilitation, physiatry, occupational therapy, and other allied rehab care supports a medical needs basis, rather than the current time-limited provisions. Coverage should be determined by the treating healthcare provider and not expire after a fixed number of weeks.

Recommendation #35: Billing

• Work with the healthcare colleges and associations to find a new funding model for healthcare visits, such as annual salaries or block-billing for geriatric health visits. Geriatric assessments cannot be done in five-minute intervals.
• Provide necessary top-up or gap coverage for necessary assistive devices to ensure mobility, accessibility, and inclusion. Wheelchairs, motorized mobility devices, walkers, grab bars, canes, toilet risers, commodes, lifts, bathing supports, and hospital beds are critically important for well-being and aging in place.

Recommendation #36: Acute Care

• Integrate more physiotherapy, physiatry, occupational, and rehabilitation health supports into primary healthcare settings, including hospitals, urgent and/or acute care centers, rehabilitation facilities, complex and/or extended care units.

Canadians have unequal access to needed surgical interventions and diagnostic imaging. They too often face health deterioration because of significant wait times. This can be particularly true in rural, remote, Northern and Indigenous communities.

Recommendation #37: Prioritize Investment into Key Areas

• Prioritize heart and bypass surgeries, orthopedic repair including knee and hip replacements, cancer care, CT and MRI scans.

Recommendation #38: CIHI Benchmarking

• Establish benchmarking for wait times by the Canadian Institute for Health Information (CIHI) for bypass surgery, CT and MRI scans, and cancer surgery, none of which are currently measured.

Recommendation #39: Non-Urban Diagnostic Imaging

• Develop surgical and diagnostic imaging capacity to better serve rural and remote, Northern, and Indigenous communities.

COVID-19 has highlighted the need for modernization of practice regulations in regard to inter-jurisdictional practices. Canadian health and social care providers need increased ease and mobility to practice across Canadian jurisdictional borders, particularly as the use of distance e-health treatments is on the increase during COVID-19. This is especially evident when a healthcare provider is licensed within one Canadian jurisdiction, but the patient may be in another part of the country for a limited period of time.

Recommendation #40: Update Rules

• Work with professional colleges and self-regulatory organizations to modernize rules of practice to further allow for interprovincial mobility, virtual cross-jurisdictional visits increased access, and non-location-based treatment (i.e., Zoom appointments).

Recommendation #41: Modernization

• Modernize criteria and guidelines for telehealth medicine across jurisdictions, particularly in light of COVID-19.

Canada needs to invest in innovation focused on the digital provision of health and social supports, particularly in the time of COVID-19. Advances are required in research, innovation, education, and knowledge mobilization on aging.

Recommendation #42: Sustain Canada’s 3 Networks of Centres of Excellence in Aging

• Support Canada’s three networks of Centres of Excellence in the field of aging beyond the end of the 2023 planned phase-out of the NCE program.
  • AGE-WELL www.agewell-nce.ca,
  • Canadian Frailty Network www.cfn-nce.ca
  • NICE Network National Initiative for the Care of the Elderly www.nicenet.ca

Recommendation #43: Technology

• Invest in age-friendly technology, startups, incubators, and commercialization of research to produce products and services in the health and consumer markets that are accessible, scalable, fast-to-market, and build capacity in Canada’s AgeTech sector.

Hospice, palliative, and end-of-life care (HPE) are not adequately accessible or culturally appropriate for the large majority of Canadian seniors. This is particularly true for seniors with dementia and seniors who live in long-term, congregate, or hospital care settings.

Despite having a mortality rate of 4.3 times higher than seniors without dementia, HPE is rarely offered or provided to seniors with dementia. They are less likely to be referred to palliative care teams, are prescribed fewer palliative care medications, and are infrequently referred to, or are in fact, denied access to hospice care

Recommendation #44: Dementia

• Work with stakeholders such as Alzheimer’s Societies and healthcare providers to integrate HPE care into dementia supports.

Recommendation #45: Dying at Home

• Expand HPE care into home settings. The government and stakeholders in the sector should work with home care providers and families to increase education and training for HPE at home.

Recommendation #46: Advance Care Planning

• Integrate legal education on substitute and supported decision-making, rights, and Powers of Attorney/Representation Agreements (or local provincial equivalent) into health and social care training as a required component of licensing. Support healthcare training to support conversations about the importance and benefits associated with advance care planning.

Recommendation #47: Medical Assistance in Dying (MAiD)

• Ensure equitable and accessible access to appropriate medical assistance in dying (MAiD). Develop resources to support the education of patients and healthcare professionals about disability rights and supports, HPE care and MAiD. As MAiD qualifications develop and modernize, ensure expanded access and knowledge tools are made available to individuals, caregivers, and healthcare professionals.

As our population ages at an unprecedented rate, we are moving into uncharted territory with regards to health care provision, policy, and resource planning. We need to ensure that an age-focused lens is applied to all medical, social, health, infrastructure, and support programs moving forward.

Recommendation #48: Identify Inequities

• Identify age-based health inequities and barriers to health access through increased research, data collection, and knowledge mobilization.

Recommendation #49: Sector Building on Aging

• Invest and prioritize in sector-building on aging, including creating educational incentives to enter needed fields required to support an aging population; integrating professional and employee development for health and social care workers in geriatrics; and designating a specific investment envelope for innovation and technology to promote age-inclusivity.

Recommendation #50: Pharmacy Integration in Care

• Support pharmacy integration, polypharmacy controls, and deprescribing programs to reduce the adverse effects of medications and to support the tracking of prescriptions. Work with pharmacist colleges and associations to cover all qualified scope of practices and areas of care, particularly to support healthcare in rural, remote, Northern, and Indigenous communities.

Recommendation #51: Digital

• Work with the private sector and AGE-WELL, CFN and NICE to develop digital and technological health and wellness transformation opportunities for an aging population. Embed requirements of knowledge mobilization to allow for easy-to-understand uptake of best evidence.

Older adults in Canada currently are significantly under-vaccinated, leading to poor health outcomes and the spread of infectious diseases. However, the Canadian review, approval, and purchasing system for vaccines are ineffective and leads to considerable health inequities. This system needs to be improved along with vaccine education and uptake before a COVID-19 vaccine is ready. This is as true for existing diseases with available vaccines as it is for COVID-19. A focus on fixing the system now and keeping our seniors’ population vaccinated is imperative to improve health resilience and reduce the load on critical and emergency care.

Recommendation #52: Fully Cover Best-In-Class Seniors’ Vaccines

• Fully cover all seniors in Canada for the three modern, best-in-class vaccines most beneficial to their well-being: high dose flu, pneumonia, and shingles, as currently, only 3% of all seniors are up-to-date on their adult vaccinations.

Recommendation #53: Federal Approval Reform

• Replace the current volunteer National Advisory Committee on Immunization (NACI) with a permanent arms-length federal body, to speed up and streamline approval processes and prioritize vaccine modernization.

Recommendation #54: Purchasing Reform

• Centralize vaccine purchasing under a federal mandate for distribution to the provinces and territories, consolidating purchasing power and supply chain management. Ensure that all Canadians have the vaccines they need, regardless of location.

Recommendation #55: Education

• Work with partners to create needed educational materials for seniors and healthcare providers to educate about the importance of older adult vaccinations, increase knowledge of vaccine coverage, address vaccine hesitancy, and encourage vaccination uptake.

Recommendation #56: Barrier-free Distribution and Uptake

• Adult vaccinations must be available with as few barriers as possible to ensure effective distribution and uptake. Pharmacists must be able to distribute all adult vaccines. In the time of COVID-19, all innovative distribution measures must be considered including at-home vaccinations, drive-thru vaccination sites, and other outdoor physically-distanced sites.

Seniors are the most vulnerable population to COVID-19 infection and death. As a result, they have been tragically and disproportionately affected by the virus. The loss of life due to COVID-19 has been shameful.

It is critically important for seniors to stay as healthy as possible in order to improve their chances of not succumbing to COVID-19. To that end, they must be prioritized to get all the other recommended vaccines in order to avoid pre-existing weakened states resulting from influenza, shingles, or pneumonia.

Recommendation #57: Seniors Covered and Prioritized for COVID-19 Vaccine

• Fully cover the cost of a COVID-19 vaccine for all seniors. Prioritize seniors, as the most high-risk group, for the COVID-19 vaccine.

Recommendation #58: Designate Immunocompromised Status to Seniors 60+

• During the COVID-19 pandemic, include all people 60 and older as “designated immunocompromised” due to their high-risk status for infection. Being designated as immunocompromised will provide seniors with immediately increased coverage for certain vaccines such as the most effective pneumonia vaccines.

Recommendation #59: Prioritize Caregivers

• During the COVID-19 pandemic, designate all paid or unpaid caregivers of older adults in the high-risk category and prioritize their adult vaccinations including a COVID-19 vaccine. Start with paid and unpaid caregivers of older adults living in congregate or long-term care.

Overwhelmingly, older adults do not know: a) how important adult vaccines are, b) when or how to get them, c) how much they cost, or d) what is covered. Part of the reason why is that Canada does not have an Adult Vaccine Schedule. This is a key contributing factor to the very low adult vaccination uptake.

Record-keeping of adult vaccinations is very poor, and most seniors do not know the correct schedules for their vaccinations, which version of a vaccine they may have received, and if or when they received it.

Recommendation #60: Adult Vaccination Schedule

• ​Create an easy-to-understand national campaign with a clear schedule for all adult vaccinations similar to existing schedules for children and youth.

Recommendation #61: Adult Vaccination Registry

• Create a modern, integrated, and digitalized adult vaccination registry. This is especially critical in the time of COVID-19.

Recommendation #62: Vaccines in Long-Term Care Homes

• Institute vaccine requirements for long-term care and congregate care seniors’ settings, similar to children and youth school programs.

Currently, infection control in long-term care and congregate care settings is very difficult to manage, leading to a significant spread of infection, illness, and tragic loss of life. This needs to improve immediately.

Recommendation #63: National Standards

• Create pan-Canadian long-term care and congregate care infection control quality assurance standards. Prioritize vaccines in long-term care and congregate care settings. Incorporate the Vaccination National Standards into National Long-Term Care Quality Standards.

Recommendation #64: COVID-19 Infection Control Standards

• Establish pandemic infection and testing protocols specific to COVID-19 in long-term care and congregate care settings (i.e., don’t use flu testing protocols for COVID-19). Upgrade infection protocols in long-term care and congregate care, including designating these settings as priorities for PPE, testing, screening, and visitor education. Require regular, unannounced on-site inspection for upgraded infection control.

Recommendation #65: Home Care Infection Control

• Providers of care at home should also be prioritized for PPE, testing, screening, and education.

Seniors are disproportionately harmed by climate change and natural disasters such as heatwaves, floods, drought, fires, snow, and windstorms. While working to remedy this crisis, Canada must also ensure an appropriate, actionable plan to support vulnerable seniors during climate change events and natural disasters.

Recommendation #66: Pan-Canadian Seniors’ Disaster Plan

• With the support of the Public Health Agency of Canada, create a pan-Canadian disaster plan for seniors, including for those in long-term care and congregate care settings, community settings, Indigenous, Northern, rural and remote communities.

Recommendation #67: Community Response

• Create easy-to-understand implementation guidelines for community response to support seniors during climate change and natural disasters. Include information and resources that can be accessed during a disaster that is not dependent on electricity. Work with key stakeholders and agencies to implement these programs. Create a neighborhood seniors’ “check-in” system to ensure older adults are safe, and when they are in need, to connect them with emergency or social services.

Recommendation #68: Heat

• Establish maximum temperatures for long-term care homes and congregate care settings. Require air conditioning in all existing and newly built common and residents’ rooms, and retrofit existing care facilities for effective cooling.

Recommendation #69: Snow and Debris Clean Up

• Work with municipalities and community-based organizations to organize snow removal and post-storm debris clean up. Prioritize municipal clean-up crews to vulnerable seniors.

Family caregivers need greater support, assistance, and relief in order to continue to provide the almost 75% of all seniors’ care in Canada. This is especially true as the population ages and more care will need to be provided by relatively fewer people.

Recommendation #70: Essential Caregiver Program

• Ask Federal, Provincial and Territorial governments to work with stakeholders to define, develop, and implement national standards for an Essential Caregiver Program for Seniors. This Essential Caregiver Program can be scaled up from the Ontario Caregiver Organizations’ pilot program, which defines essential caregiving, establishes training standards, and supports a caregiver ID program.

Recommendation #71: Change the Caregiver Tax Credit to a Refundable Tax Credit

• Amend the federal Canada Caregiver Tax Credit to become a refundable tax credit from its current earned tax credit requirement. Many caregivers are not in the paid workforce, because they are at home providing needed care. This particularly negatively impacts women who disproportionately provide the bulk of unpaid care in Canada.

Recommendation #72: Community Adult Care Hubs and Increased Respite Care Services

• Create Community Adult Care Hubs which bring together respite supports, adult day programs, and childcare to support people of all abilities and build intergenerational and inclusive communities. Respite supports should include affordable options for hourly, daily, weekly, and monthly respite care, including overnight care.

Recipe for long-term care

• National Quality Standards
• National Regulator
• Federal and Provincial Funding Increases
• Staffing Reform
• Infrastructure Funding and Upgrades
• Emotion-Focused Care Models
• Infection Controls and Vaccines

Canada has no National Quality Standards or national licensing standards for long-term care, which has led to substandard conditions in many homes across the country. National Quality Standards are needed to ensure that seniors get the dignified care they need and deserve, regardless of the ownership of the long-term care home or the postal code where they live.

Recommendation #73: F/P/T Working Group with Long-term Care Stakeholders

• Establish a Federal/Provincial/Territorial Long-term Care Working Group, which includes both seniors and caregiver organizations, to study and make recommendations for the positive transformation of long-term care in Canada.

Recommendation #74: Fund a Feasibility Study of Adopting and Adapting the Australian Long-term Care Regulator Model for Canada

• In contrast to Canada’s performance during COVID-19, Australia has experienced relatively few deaths of seniors in long-term care. Fund a feasibility study focussing on how Canada might adopt and adapt the Australian model of Long-Term Care regulation. This Australian model includes a national arms-length regulator that oversees licensing, quality standards, and has the ability to suspend licenses and issue fines. This model works in a federated nation and can be created in such a way where it would not offend the division of powers.

Recommendation #75: Federal Funding of Long-term Care

• Designate specific federal fund transfers to the provinces and territories for long-term care, attached to the new National Quality Standards and requirements. Federal funding should flow to the provinces and territories to support long-term care homes premised on them implementing the National Quality Standards.
• Federal funding is allotted to long-term care under a separate agreement similar to the Canada Health Act.

Long-term care staffing issues have reached a crisis state. Pre-COVID-19 staffing shortages in long-term care were well-documented and a consistently pressing concern. Since COVID-19, staffing shortages have reached the breaking point. Staff in long-term care are often underpaid, may have to work several jobs with unpaid travel time, and often have to work in difficult and unsafe conditions.

In Ontario, 80% of nursing home administrators reported having difficulty scheduling shifts, which can impact their ability to meet regulatory requirements. They reported that of the positions to be filled, personal support worker positions were the most difficult to fill.

Recommendation #76: Staffing Ratios

• Establish staffing ratios and increase staffing numbers. Include both staff-to-resident ratios as well as establishing healthcare staffing ratios of doctors, registered nurses, licensed practical nurses, rehabilitation care providers, social workers, and personal support workers. Stop downloading healthcare to personal support workers in long-term care.

Recommendation #77: Living Wages, Benefits and Pensions

• Increase pay for staff, particularly personal support workers, to ensure living wages are achieved, including pensions and benefits. Encourage full-time work at one long-term care location. This will improve employee engagement, create stable staffing and care relationships while decreasing the potential of cross-home infection spread.

Recommendation #78: Pay Staff by Work Performed, Not Location

• The financial compensation of home and long-term care staff is half of what hospital staff receives, with the same qualifications. Financially compensate health and social care staff for the work they perform, not the place where they perform their work responsibilities. Pay equity should be established among long-term care, home care and hospital care settings.

Recommendation #79: National Strategy for the Health & Human Resources (HHR) Sector

• Care provision requirements for the aging population will increase. In order to adequately meet these requirements, as well as meet long-term care residence staffing needs while avoiding retrieving staff from other care sectors such as home care, Canada urgently requires a national strategy for the health and human resources necessary for current and future needs. Provinces and territories must work collaboratively with the federal government, on a F/P/T basis, to create and implement this strategy with key stakeholders in the sector.

Recommendation #80: Immigration Priority for the Aged Care Sector

• Establish home care and long-term care worker immigration as part of the skilled worker priority status. This should be integrated as part of a broader integrated health and human resources aged-care staffing strategy. Recruitment expertise should focus on aging and dementia care. Reinstate the Live-In Caregiver Immigration Program with updated care recruitment needs. Prioritize recruitment expertise in aging and dementia care.

More long-term care residences will be needed to meet the needs of Canada’s aging population, even with robust investment in home care. New federal, provincial and municipal investments must be made in the creation of new residences. New residences should not be institutional. Retrofitting current older long-term care residences or redeveloping other existing housing assets will also be needed to raise the standard of acceptable living for residents and to improve the health and social well-being of Canadian seniors needing long-term care.

Recommendation #81: Build More Long-Term Care Homes

• Canada urgently needs to build more long-term care homes to support our increasingly frail older adult population who cannot have their care needs met in the community.

Recommendation #82: Build More Smaller Residences, Dementia Villages, and Streamline Campus-of-Care Regulation

• Invest in creating smaller residences with approximately 10-25 residents. Create new dementia villages rather than large institutional long-term care homes. Change and modernize long-term care, assisted living, and independent living regulations allowing for campus-of-care models to more easily function. Currently, campus-of-care homes are often subject to upwards of four forms of health and housing regulation resulting in blockages to aging in place.

Recommendation #83: Single or Couples Rooms with En Suite Bathrooms

• Retrofit older long-term care homes and build new ones with the following: one-bedrooms with en-suite bathrooms, along with some couples’ rooms with en-suite bathrooms. Avoid shared or ward rooms with shared bathing facilities. Long-term care homes should increase privacy, dignity, and quality of life, while reducing the risk of infection spreading via shared facilities.

Recommendation #84: Rural, Remote, Northern, and Indigenous Long-Term Care

• Expand long-term care options in remote and Indigenous communities. Develop specific dementia care capacity in these communities, especially in Indigenous communities to prevent losing a generation of elders to urban centres – often the same generation who were taken from their homes and into Residential Schools.

Long-term care is currently highly institutionalized and often based on the medical model of care. This leads to poor health, low quality of life, and staff dissatisfaction. Canada needs to modernize and deinstitutionalize long-term care to particularly meet the needs of an increasingly older, frail, and cognitively impaired resident population.

Recommendation #85: Emotion-Focused Care

• Change the model of care to an emotion-focused or transformative model such as the Butterfly Model (https://www.dementiacarematters.com), the Greenhouse Project Model (www.thegreenhouseproject.org), the Eden Alternative (www.edenalt.org), or similar non-medical models.

Recommendation #86: Residents’ Bill of Rights

• Create a standardized core Residents’ Bill of Rights to be integrated into provincial and territorial long-term care legislation and National Quality Standards.

Recommendation #87: Residents’ and Family Councils

• Embed the requirement for Residents’ Councils and Family Councils in each long-term care home as part of National Quality Standards. Integrate these two types of Councils into provincial and territorial legislation. Ensure that these Councils have substantial rights and direct high-level linkages to long-term care home management and administration.
• Provinces and territories should support and fund provincial governing associations of Residents’ Councils and Family Councils.

Recommendation #88: Keep Couples or Companions Together

• Develop regulations and programs to keep couples or companions together in the same long-term care home, and where possible in the same rooms if that is their preference. Prioritize the relationship over differentiated care needs.

Recommendation #89: Privacy

• Increase physical privacy in long-term care homes to support personal choice and dignity. Ensure that residences have rooms where couples or groups can spend private and uninterrupted time. Invest in creative solutions to dissuade other residents from coming uninvited into a residents’ room. Create appointments and door-knocking protocols to reduce staff entering a resident’s room unannounced.

Recommendation #90: Digital Investment to Reduce Isolation

• Invest in digital innovation and technology for health and social care in order to decrease isolation and loneliness. Invest in robust wifi in resident rooms as a right. Prevention and reduction of social isolation and loneliness of residents in long-term care can be achieved by the implementation of the following: smart-technology integration, video visits, a virtual museum and cultural visits, virtual concerts or modern music online providers, on-demand movies and entertainment, social media, computer and technology-supported communication, and other online activities.

Seniors do not have adequate, publicly funded home care allowing them to age in place affordably, or at all. Home care must be profoundly reformed to provide a meaningful quantity of appropriate, high-calibre care to allow seniors to age in place. Home care workers must be paid a living wage with appropriate benefits to ensure both current workforce sustainability and to attract new workers to the home care field.

Recommendation #91: Transform the Current “Home Care Worker” Model, with an Integrated Multi-disciplinary Team Model of “Care at Home”

• Instead of having only personal support home care workers provide the bulk of home care assistance, transform the model to integrated Care at Home. Invest in expanding geriatric multi-disciplinary team hubs, which provide in-home visits and robust integrated home supports. Bring the care teams to the house of the community-dwelling senior. Add significantly more Care at Home supports, both in terms of hours and type of care provided.

Recommendation #92: Increased Quantity, Quality, and Types of Care at Home

• Invest in providing increased quantity and quality of Care at Home, which is equitable across Canada, and not dependent on postal code or one’s ability to privately pay. Establish Care at Home as the primary model of care for aging in place, covering medical, social, and personal care needs. Adopt the Nordic Model for Care at Home.

Recommendation #93: Directed Federal Funding Transfers Tied to Outcomes

• Directed funding from the federal government to provinces in the area of home care should have specific reportable metrics and spending priorities. While the 2017 federal budget included funding to the provinces of $11 billion over 10 years, beginning in fiscal year 2017‑2018, divided between home care and mental health initiatives, little measurable improvement has occurred. This and any future direct federal funding for home care investment must be targeted, measured, and have reportable indicators, to avoid being subsumed in general provincial revenues.

Some Canadian seniors do not have adequate, affordable, and accessible housing options to allow them to age in place. Housing affordability is particularly challenging in urban centres or where housing stock is limited.

Recommendation #94: Housing Innovation for Seniors

• Support innovative aging in place models such as Homeshare projects, co-housing solutions, naturally occurring retirement communities (NORCs), cooperative housing models, and integrated low-income or affordable seniors’ housing.

Recommendation #95: Homelessness or Risk of Homelessness

• Create appropriate programs including accessible transitional and shelter options for older adults who find themselves precariously housed, at risk of homelessness, or homeless. Provide protection for seniors in assisted living or long-term care residences during periods of extended hospitalization to ensure they don’t lose their housing.

Seniors need policy changes and flexible supports to allow them to age in place.

Recommendation #96: Change the Home Renovation Tax Credit to Per Person

• Amend the Home Accessibility Tax Credit from a $10,000 per dwelling tax credit to a $10,000 per person tax credit. Study and reevaluate the tax credit amount to reflect the increased need in order to age in place. Implement an appropriate higher tax credit amount if required.

Recommendation #97: Government Land Grants and Guarantees for Seniors’ Housing, Including Long-Term Care

• Federal, provincial, territorial, and municipal governments should develop land grant programs to support aging in place housing initiatives, including long-term care.
• Governments should develop and support loan guarantee programs allowing for development of innovative housing models to support aging in place.

Recommendation #98: Update Municipal Bylaws for Age-Friendliness

• Municipal governments should develop age-friendly bylaws including increased opportunity for in-law suites, laneway housing, intergenerational co-housing options, and building codes.
• Age-Friendly Model Bylaws should be developed with aging and law reform experts which can be easily adapted and adopted by local municipalities.

Canadian seniors are living longer. In precarious economic times, they need to make their savings stretch further than ever before. Prior to COVID-19, most Canadian seniors faced a material risk of outliving their tax-deferred savings. This is especially true in the time of COVID-19 where expenses have often risen, and assets may have depreciated or are unstable.

Recommendation #99: End Mandatory RRIF Withdrawals Completely

• Currently, seniors must start withdrawing from their funds at the age of 71. While the minimum required withdrawal for all types of RRIFs has been reduced by 25% for the year 2020 as a COVID-19 response, it does not go far enough. Canadians are living longer and should be allowed to make their own decisions about investment withdrawals, particularly in these uncertain times. The number of seniors who work past 71 (and are thus punitively taxed by forced RRIF withdrawals) increased from 15% in 1995 to 24% in 2015 and is predicted to be higher in the COVID-19 era and in years to come due to increased financial need.

Recommendation #100: Allow Tax-Free Withdrawals of up to $15,000 per year, for up to three years, from RRIFs and RRSPs During COVID-19

• Allow tax-free withdrawals of up to $15,000 per year from RRIFs and RRSPs by persons over age 60. This would provide much-needed access to funds for unforeseen expenses during uncertain financial times.

Recommendation #101: Defer RRSP Capital Gains During COVID-19

• During the time of COVID-19 defer RRSP capital gains taxes for up to three years to allow those in need to access their own funds without taxation penalties.

Recommendation #102: Refundable Tax Credit During COVID-19

• Create a $500 for a single person and $800 for a couple refundable tax credit to offset increased costs for deliveries, transportation, and support services for people over the age of 60 for up to three years.

Canadian pensioners need protection from corporate default, particularly during and post COVID-19. Compared to other jurisdictions, Canada significantly lags in its protection of pensioners. In the UK, 90% or more of pensions up to at least $57,000 annually are protected through a national pension benefit scheme. In the U.S. the Pension Benefit Guaranty Corporation protects pensioners; in 2018 a 65-year-old’s pension is guaranteed up to U.S. $71,431. In Canada, only Ontario offers some protection, and that is only “bottom-up” protection of $18,000 annually.

1.3 million Canadians with corporate defined benefit pension plans are potentially at risk of having their pensions cut. Canada needs pension reform to ensure that pensions of hard-working Canadians are not lost due to insolvency or bankruptcy. CanAge supports the calls of the Canadian Federation of Pensioners and the National Pensioners Federation for needed pension protections.

Recommendation #103: Create Pension Benefit Guarantee Funds Across Canada

• Create Pension Benefit Guarantee Funds for all jurisdictions. Ensure pensioners receive 100% of their deferred wages – the pension their employer committed to. Currently, pension guarantee funds exist only in Ontario.

Recommendation #104: Fully Funded Pension Funds

• Require pension funds to be fully funded to 100%.

Recommendation #105: Recurring Refundable Tax Credit

• Establish a recurring refundable tax credit equal to the annual pension loss experienced by a pensioner. If legislation is amended to ensure pensioners receive their full pension or if a pension insurance program is created, this credit will serve as a backstop to ensure these changes work to protect pensioners.

Recommendation #106: Flexible Pension Reform

• Operationalize modern tax and pension policies to allow for increased options for flexible retirement and a hybrid pension withdrawal and income-earning model.

Consumers, especially vulnerable senior consumers, have very little power to resolve complaints against their financial institutions.

Recommendation #107: Ombudsman for Banking Services and Investments (OBSI)

• Make OBSI the single dispute resolution provider for all banking services and investments in Canada. Provide OBSI with binding authority and a robust systemic mandate. Increase OBSI’s remit from $350,000 to $500,000.

There is a significant increase in vulnerable seniors who have diminished mental capacity or are subject to undue influence and financial elder abuse intersecting with financial institutions. Securities administrators such as the Ontario Securities Commission, the New Brunswick Financial and Consumer Services Commissions and the Autorité des marchés financiers (AMF) have been leading the way in seniors-focused reforms and strategies. While banks now have a recently established Seniors Banking Voluntary Code, it is both incomplete in remit and unenforceable in practice.

Banks must continue to provide services which are senior-friendly. This includes moving towards flexible banking options, such as Open-Banking /Postal Banking. Where banks are closing branches, replacement alternative banking options must be made available such as full-service ATMs, particularly in non-urban centres.

Recommendation #108: Trusted Contact Person

• Update Know Your Client (KYC) protocols to ensure that they can include asking for a Trusted Contact Person. Ensure that the KYC process is accessible and is appropriate as clients age.

Recommendation #109: Training

• Ensure that all people who work in the financial sector have competency-based training on elder abuse, mental capacity issues, undue influence, and how to report concerns to the appropriate designated organization.

Recommendation #110: Change Voluntary Seniors Banking Code into Banking Regulation

• Change the Voluntary Code of Conduct for the Delivery of Banking Services to Seniors (Seniors Code) to a mandatory regulation reportable and overseen by the Financial Consumer Agency of Canada (FCAC). Ensure that the FCAC has the ability, mandate, and resources to levy substantial fines in case of regulatory violation.

As our population ages, our workforce is expanding across generations and employers need to proactively adapt for greater age inclusion.

Recommendation #111: Diversity and Inclusion

• Employers should include age discrimination as part of their Diversity and Inclusion criteria and employment codes. Labour organizations should include guards against, and remedies for, age discrimination in their HR policies and practices.

Recommendation #112: Reduce Barriers

• Reduce barriers to hiring an age-inclusive workforce, as well as promote opportunities for older workers to return to the workforce. Study and adopt transferable best practices from the AARP Multigenerational Workforce Program.

Many seniors do not file their taxes due to accessibility barriers such as the form being too confusing, not being able to afford or travel to an accountant, or lack of knowledge about the importance of filing taxes. This behaviour excludes them from needed programs and benefits.

Recommendation #113: Pilot Program for Automatic Tax Filing for Seniors

• Create and fund a pilot program for automatic tax filing for seniors. Explore with stakeholders whether an opt-in or opt-out is preferable.

Recommendation #114: Embed Prompts in Tax Software for Seniors and Caregivers

• Work with tax preparation and tax software providers to embed easy-to-understand questions and prompts to ensure that seniors and caregivers are able to benefit from maximum tax relief and qualify for needed programs.

Seniors experience the highest degree of loneliness and social exclusion of any age group. The consequences of loneliness significantly decrease life expectancy, physical well-being, and mental health. Being lonely is as harmful as smoking 15 cigarettes a day, and poses a significant risk for mortality.

Canada needs to confront its current epidemic of loneliness face-on. We should consider adopting the UK’s models of safeguarding to address neglect, exclusion, and social disconnection.

Recommendation #115: Create Mid-Range New Horizons for Seniors (NHS) Grants Focused on Social Inclusion

• Allow New Horizons for Seniors Program grant holders to receive up to three years of funding which would give enough time to develop relationships with funders and partners, build trust, and make a positive change with program participants. The federal government should work with philanthropic and grantmaking organizations to support various funding models to allow for greater sustainability and effectiveness of the NHS Program.

Recommendation #116: Community-Based Programs

• Invest in innovative community-based programs that connect lonely or socially isolated seniors to local programs and supports. Adopt the United Way’s CORE program across Canada.
• Invest in inclusive programming such as dementia-friendly public libraries.
• Prioritize investment in culturally and linguistically inclusive programming in both long-term care and community settings.

Recommendation #117: Men’s Loneliness

• To address men’s loneliness, invest in local programming such as Men’s Sheds, sporting leagues, debating societies, and socially connected exercise classes such as the Vancouver-based Choose to Move program which combines fitness and friendship.

Recommendation #118: In-Person Wellness Checks for Isolated Seniors

• Implement well-being checks for isolated seniors, similar to the UK’s and France’s postal programs. Door-to-door well-being checks could be incorporated into Canada Post’s programming alongside other community-based programs.

Digital literacy and the use of technology has never before been so critically important as it has been in the time of COVID-19. Seniors are now having to use technology for everything from social engagement to healthcare visits to ordering groceries and supplies. It is critical to prioritize and develop the capacity for digital literacy and technological inclusion of seniors.

Recommendation #119: Libraries, Schools, and Community Organizations

• Create digital literacy and technology lending and training programs through local libraries, schools, and nonprofit or community organizations. Working with stakeholders, support community-based in-person, and distance digital training for seniors. Invest in digital and technology lending or low-cost technology purchase programs for seniors.

Recommendation #120: Rural Connectivity

• Continue prioritization and investment in rural connectivity, as many rural communities have significantly older populations who have difficulty connecting to health and social services in person. Video-based services like remote healthcare and mental health services require access to high-speed networks.

Lack of accessible transportation options creates isolation and barriers to social inclusion and well-being.

Recommendation #121: Rural Transportation

• Invest in programs that offer inclusive transportation options for seniors in rural areas. Work closely with community-based service organizations to create rural inclusive transportation options such as grants for purchasing community shuttles and supporting van services, delivery services, and cooperative rideshare programs.

Recommendation #122: Rural Roving Services

• Work with community-based organizations to develop regional hubs that provide a range of roving health and social service programs to Northern, Indigenous, rural and remote isolated seniors.

Recommendation #123: Bicycle Pathways and Foot Pathways

• Develop more segregated bicycle and pedestrian pathways to increase transportation options that are age-friendly, safe, and healthy.
• Augment bike-share programs with age/ability-inclusive, senior-friendly “tricycles”.

Recommendation #124: Urban Transportation

• Promote awareness of urban and municipal transportation options including those provided by public and nonprofit organizations. Invest and publicize “travel training” programs to support seniors in learning public transit systems, in a safe, supportive manner. Subsidize transportation costs for low-income seniors.
• Invest in accessible inclusive public transportation infrastructure.

Ageism is the most socially normalized form of discrimination and constantly reduces social inclusion, promotes negative stereotypes, limits social interaction, and reduces economic security.

Recommendation #125: Reduce Workplace Ageism

• Eliminate all forms of ageist mandatory retirement, and provide workplace options for job transformation and accessibility accommodation. Have private and public employers specifically include age and ageism in their diversity and inclusion policies, human resources, and employee engagement programs.

Recommendation #126: Ageism in the Media

• Encourage media and corporations to reject the negative portrayal of older adults and ageist stereotypes, and promote images of positive, diverse imagery of aging.

Recommendation #127: Canadian Anti-Ageism Campaign

• Create a Canadian Anti-Ageism Campaign. Develop anti-ageism modules for inclusion in educational curricula about discrimination and rights.

Recommendation #128: Age-Inclusive Communities

• Amend building codes and by-laws to include age-friendliness and accessibility inclusion appropriate for our aging population. Promote investment in age-friendly and dementia-friendly communities. Encourage retail and grocery stores to have age- and dementia-friendly services and checkout lines.

Over the next 20 years, the number of people aged 75+ is set to grow by three times in NWT and Yukon, and almost six times in Nunavut.

Indigenous seniors are at high risk of experiencing social isolation due to factors such as racism, marginalization, linguistic barriers, geographic location, lack of appropriate cultural inclusion, poverty, poor health status, lack of service provision, and historic traumatic experiences.

Recommendation #129: Traditional Language

• Expand traditional language teaching both intergenerationally and in the broader community to support elder inclusion and linguistic longevity.

Recommendation #130: Community and Health Supports for Elders with Cognitive Impairments

• Develop robust Care at Home programming for elders with cognitive impairment and dementia to avoid re-institutionalization in long-term care dementia units, often far from their local communities. Integrate and embed culturally inclusive training and programming for healthcare and social service professionals.

Recommendation #131: Develop Culturally-Appropriate Elder Programming, particularly in the Territories

• Work with local communities and partners to develop non-governmental sector capacity for the provision of culturally appropriate locally-developed programs to support Indigenous elders, particularly in the territories.

Recommendation #132: Traditions

• Make traditions accessible in long-term care and congregate settings by inviting Indigenous community members for traditional ceremonies, providing traditional food, and providing a space for family gatherings.

Intergenerationalism brings together previously siloed groups artificially divided by age. Blending generations increase physical well-being, mental health, and social inclusion, providing measurable benefits for both older and younger people.

Recommendation #133: Innovative Intergenerational Programs

• Create and support innovative intergenerational programs and opportunities such as Talk2NICE (telephone support), the Queen’s University Community Connections Project (student – alumni friendly phone visits program), the Student Senior Isolation Prevention Partnership (SSIPP), Minds-In-Motion, Adopt a Grandparent / Grandchild, The Big G Program, and Toronto HomeShare, which support deeper relationships and address shared social challenges for all ages involved.

Recommendation #134: Intergenerational Day Programs

• Co-locate child care and senior care day programs. Create crafts and engage in physical activities together. Support literacy, numeracy, arts, and mentorship opportunities between younger and older generations.

Recommendation #135: Friendly Visiting Programs

• Work with community-based organizations to support Friendly Visiting Programs, in-person using video technology or on the phone. Model the United Way’s friendly visitor programs and Better at Home supports for scale across the country. Work with interfaith organizations to support outreach and engagement to older members of faith communities.