The Federal Budget begins to target Persons Living with Dementia

As seniors outnumber children for the first time in history, I expected the 2019 Federal Budget to be Senior Aware. It certainly spoke to many seniors. Was it enough to make a difference?

The Budget did try to address low-income seniors who need to work. Many seniors retain the bulk of their savings in their home ownership, unavailable in retirement for expenses. Minimizing GIS claw back by increasing the allowable extra income to $5000.00, allowing both partners to claim this and allowing the type of work to include self-employment income are all budget changes of importance to this group. Automatic registration of seniors at 65 for CPP, if eligible, will be a help to the some disadvantaged workers unaware of this income available. These are certainly helpful changes.

Working after 65 is not rare. As an age of retirement, 65 is a relic from the 1880s when the average life expectancy at birth was between 40 and 50! Today, workers find the age of 65 to be less a target for cessation of work and more a target for change of focus. Evidence suggests that some scale back their work lives at age 55 to 65, many however continue or find second careers and are often still working for 15-20 more years.

As we sit on a national crisis in low cost and rental housing, I had hoped to see more incentives for creative multi- generational home options, co-housing, and foster family care for seniors.

As a Geriatric Medicine Specialist, I care for people with Alzheimer’s disease and related dementias. My scrutiny of the Federal Budget therefore targeted this issue. I appreciate that there is a commitment for a National Dementia Strategy, by 2024. The government’s own data details nine dementias diagnosed every hour in Canada. By my calculations, when the Dementia Strategy is released, there will be an additional 394,200 new cases to manage. In 2016, the Senate of Canada, developed an initial federal policy document Dementia in Canada: A National Strategy for Dementia Friendly Communities We DO need to tackle this issue with funding policy changes. The Dementia Strategy if operationalized could do just that. In the field however, we are growing impatient.

Dementia has many causes but it is NOT NORMAL AGING. The evaluation of dementia first occurs at a Family Practitioner’s office which is a Canadian commitment established in four Canadian Consensus Guidelines for the Diagnosis and Management of Dementia. Early diagnosis even if there is no cure is essential. Then, proactive planning, careful advance care directives AND avoidance of unnecessary unwarranted surgeries, emergency visits and hospital stays might become possible. Fewer surprises that derail the goal of living life happily at home is the goal. Though nursing homes continue to be the knee- jerk response to dementia care, my view is that we cannot keep assuming success will follow with expensive building projects alone. Services at home are the most cost effective way to proceed. The hallmark of dementia is that it is impossible to live independently without someone helping on a regular daily and later the help changes to become an hourly regimen. Getting that organized and all the participants engaged is a challenge. Every case of dementia requires both partner and patient to work together – to attend appointments, manage medications, plan activities and keep ahead of the changes as they happen.

Dementia is not only a disease of old age. Individuals aged 40 to 65 with dementia pose special needs as often they are parenting teenagers and have spouses needing to work. Caregivers represent a largely female workforce of unpaid and untrained life partners. They are even MORE INVISIBLE than the person with dementia in statistics and in plans. We actively cheer on these marvelous family partners as they soldier through the decade or more of dementia care. The other unsung hero after diagnosis is the Personal Support Worker (PSW) offering in home companion and health care. PSW’s are precariously employed with low income part time work. We need them to be full time partners in geriatric medical teams. The PSW’s that are part of our Geriatric GAIN teams are stellar. PSW’s are often the ONLY educational resource and instructor to meet with the family on a routine weekly basis. Governments of all stripes and levels of responsibility need to make PSW’s and family carers pivotal in payment, education and recognition.

We have not required hospitals, health care agencies, medical and nursing schools, family practice and health care planners to achieve dementia specific goals or training. Hopefully after the Dementia Strategy of 2024 described in the budget, we shall see a clinically informed policy driven change in funding priorities, in housing, in communities, and in respite services. Until then health care for dementia will rely on personal wealth and family availability which means it just does not work well, for persons with dementia. And it should! The 2019 Federal Budget thankfully makes some strides to create plans around dementia. In my mind, it is still not enough! But it is a start.