Experts say Canada's health-care system isn't ready for an aging population – here's why

Sandy Marsh has been nursing a knee injury for eight months, suffering from a torn meniscus and Baker’s cyst. Although the 66-year-old from Okotoks, Alta., says her condition is improving, recovery is a struggle without support from a family doctor.

Marsh has not had a primary health-care provider since August, after her family physician left their local health clinic to pursue a new career path.

“There are so many people and so few doctors,” Marsh told CTVNews.ca in a telephone interview.

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She is one of a handful of seniors across the country who wrote to CTVNews.ca about their struggles with finding a family doctor. Particularly since the start of the COVID-19 pandemic, health-care systems throughout the country have been facing staffing shortages caused by an exodus of nurses and other health-care workers who left the profession.

As a result, some Canadians are unable to secure a family doctor or book surgeries within a reasonable time frame, says Dr. Lesley Charles, a professor in the department of family medicine at the University of Alberta. With the senior population expected to rise to new heights in the coming decades, experts are warning that Canada’s health-care system is not ready for an aging population and may leave seniors behind.

Sandy Marsh has been nursing a knee injury for six months now, suffering from a torn meniscus and Baker’s cyst. Although the 66-year-old from Okotoks, Alta., says her condition is improving, recovery is a struggle without support from a family doctor. (HANDOUT / CTVNews.ca)

New statistics from Environics Analytics, a marketing and analytical services company owned by Bell Canada, show the country’s senior population is projected to surpass 11 million by 2043. The data, based on a special analysis for CTV News, paints the senior population as the fastest-growing age group in the country. This increase in the number of Canadians aged 65 and older will have far-reaching implications, particularly on the country’s health-care sector, said Charles.

Amid a shortage of health-care workers, Charles said she expects to see more seniors struggling to obtain a family doctor and access related services.

“Without seeing an increase in physicians … you have to imagine that with an increased number of seniors needing all different kinds of consults for different services, there are going to be longer wait times,” she said.

Caring for seniors can also be difficult considering the amount of health problems they may have compared to younger patients who are less frail. For this reason, some physicians may not want to take on additional senior patients, said Charles, who is on the Canadian Geriatrics Society’s board of directors.

STATISTICS ON SENIORS WITH DISABILITIES:

• More than six million Canadians had a disability, according to data from Statistics Canada’s Canadian Survey on Disability published in 2017. Of these six million people, 38 per cent were aged 65 and older. Updated figures are expected to be released later this year
• The same report shows the most common types of disabilities among seniors were associated with pain, mobility, flexibility and hearing
• Chronic conditions such as high blood pressure, high cholesterol, diabetes and heart disease are more prevalent among senior men than women, according to Statistics Canada’s Canadian Health Survey on Seniors from 2020
• The same survey shows arthritis and osteoporosis are more common among women

It’s also possible that without enough health-care workers to meet demand, seniors may die more quickly than if they received the care they needed sooner, Charles said. She uses the example of someone who has problems swallowing, but no symptoms that would signal something more serious. After months, that person may notice their condition has gotten worse and they are unable to drink or eat. After undergoing an endoscopy, they might discover they have esophageal cancer, which is common among seniors.

The cancer may spread throughout their body and force them into palliative care. Seeing as immune systems weaken with age, seniors may be at higher risk of death if they are unable to quickly access the care they need, Charles said.

“By not being seen and not being assessed and managed and supported, progression will happen quicker and there will be adverse effects from that, including, more likely, a quicker death,” she said.

CTV News · Fewer family doctors, longer wait times

With nearby health clinics unable to accept new patients, Marsh will travel to a walk-in clinic in Calgary to renew her prescriptions and meet her other health-care needs, she said. She is also doing yoga and visiting a chiropractor to care for her knee while hoping it doesn’t get worse.

“If the care is not there when you need it, it’s not accessible at your fingertips and you have to go hunting it down, some people might not make it,” Marsh said.

‘YOU MIGHT AS WELL GO TO THE MOON’

For Jill Beaulieu, the question of whether she has a family doctor is a complicated one to answer. Her original doctor in Sussex, N.B., went on maternity leave in January. Since then, several doctors have cycled through the clinic in an effort to provide care to patients.

Ultimately, the 70-year-old said she does not know if she can rely on her clinic for assistance or if a family doctor will be available to help her on any given day.

“I’m more concerned about a fall,” she told CTVNews.ca in a telephone interview. “Small things make me anxious.”

Jill Beaulieu's doctor in Sussex, N.B., went on maternity leave in January. Since then, several doctors have cycled through the clinic in an effort to provide care to patients. (HANDOUT / CTVNews.ca)

Beaulieu’s main concerns are making sure her prescription medications are refilled and avoiding visits to the emergency room.

In New Brunswick and virtually all provinces and territories across Canada, residents are reporting high average wait times at hospital emergency rooms. A study published by the Canadian Institute for Health Information (CIHI) in August shows patients admitted to ERs in Canada are waiting longer for an acute care bed now than they were between 2021 and 2022.

CTVNews.ca recently compiled data from a selection of hospitals across the country to deliver a snapshot of wait times in Canada. In Winnipeg, for example, emergency department wait times were as high as 11 hours, according to estimates collected at various times between Aug. 28 and Sept. 3. Fast forward to mid-December and wait times at hospitals in the city continue to be as long as 11.5 hours.

Meanwhile, hospitals in cities such as Toronto or Vancouver have wait times of about one to four hours, according to the latest data from provincial health facilities.

Beaulieu, who suffers from chronic back pain due to herniated discs, said waiting in line at the ER for hours at a time would be a struggle.

“To go to the ER, for me, you might as well say, ‘go to the moon,’” she said.

Expecting to encounter more health issues as she ages, Beaulieu said she is worried about what life as a senior will look like in the future.

“I’m going to get worse faster than this is going to get better,” she said.

‘IF I HADN’T … FOUGHT FOR THIS, I’D STILL BE WAITING’

The staffing shortage within Canada’s health-care sector is also affecting seniors in need of surgery. Diane Middleton said she waited more than two years for a procedure to address a prolapsed bowel that was pinching a nerve in her body. This left the 81-year-old in constant pain and made it difficult to walk, she said.

After speaking with health-care workers at Grand River Hospital in Kitchener, Ont., Middleton was told staff members were sorting through a mountain of paperwork and struggling to get through every patient on the waitlist within a timely manner.

After being told about a cancellation, Middleton was able to get an urgent referral from her family doctor and secured an appointment for late October.

“If I hadn’t gotten on the phone and fought for this, I’d still be waiting,” she told CTVNews.ca in a telephone interview.

Diane Middleton waited more than two years for a procedure to address a prolapsed bowel that was pinching a nerve in her body. In this photo, Middleton, second from the right, is pictured with her children. (HANDOUT / CTVNews.ca)

‘VALUE OF TIME AND MONEY CHANGE PLACE’

Other Canadians have gone as far as leaving the country for a surgical procedure. This includes 72-year-old Keith Braun from Steinbach, Man., who travelled to Puebla, Mexico, for shoulder replacement surgery in mid-June.

After initially damaging his shoulder in 2020, Braun completely tore his rotator cuff after slipping on ice in April 2023, he said. This made it difficult for him to move his right arm and left him in constant pain.

Braun was told the estimated wait time in Manitoba for the surgery he needed was approximately 18 months.

“Our health-care system … is totally dysfunctional (and) does not work,” he told CTVNews.ca in a telephone interview.

Keith Braun from Steinbach, Man., travelled to Puebla, Mexico, for shoulder replacement surgery in mid-June. (HANDOUT / CTVNews.ca)

After contacting a medical tourism company specializing in helping travellers plan medical treatments abroad, he was in touch with a surgeon in Mexico and had the procedure done within two weeks.

Braun paid for his surgery out-of-pocket and said the total cost – including the procedure, flights and hotel stay – amounted to $35,000. Although he looked into the possibility of paying to have the procedure done in Manitoba, he said the surgery was not available through private health-care services.

“There comes a time when the value of time and the value of money change place rather abruptly,” he said. “At my age, a year to a year-and-a-half could be 10 per cent of my remaining life.”

RETIRING PHYSICIANS ADD TO STAFFING SHORTAGES

While burnout has been cited as a key reason why many health-care workers have left their positions, a number of staff members are leaving the workforce due to old age, said Arthur Sweetman, a McMaster University professor who specializes in health and labour economics.

Data from the CIHI shows approximately nine per cent of physicians were 65 years of age and older in 2000, while seven per cent were between the ages of 60 and 64. By 2022, 15 per cent of physicians in Canada were aged 65 and older, and nearly 10 per cent were 60 to 64 years of age.

“We don’t have enough bodies,” he told CTVNews.ca in a telephone interview.

Aside from support offered by health-care workers such as nurses or physicians, aid can also come from caregivers, many of whom are family members who have stepped up to care for older relatives without pay, Sweetman said. This care can include tasks such as providing transportation or helping with housework.

Health support may also come from geriatricians who specialize in treating older adults, particularly those aged 65 and older. But according to CIHI data from 2022, there are 382 physicians in Canada who specialize in geriatric medicine.

While she would like to see more geriatricians in Canada, Charles said she also hopes to see medical schools provide additional training for family physicians so they can better meet the health-care needs of seniors.

According to data from the Canadian Institute for Health Information, there were 382 physicians in Canada who specialized in geriatric medicine in 2022.

Another hurdle to ensuring seniors receive the health care they need is the gap in data collection and knowledge sharing, said Chad Leaver, director of health at the Conference Board of Canada, a national research organization.

Not enough is being done in Canada to monitor patient-reported outcomes after they receive treatment, he said. Health systems should also be doing more to share this data through a central system that various facilities have access to.

According to Leaver, looking at the current state of Canada’s health-care systems, it is “naive” to say the country is prepared for an aging population.

HURDLES TO PROVIDING SAFE LONG-TERM CARE

Older seniors who may require more complex medical care are likely living in residential or related care facilities, data shows. According to data from the CIHI published in September, the average senior in residential care is 81 years old, with 64 per cent being women and nearly 80 per cent having some sort of neurological disease.

Institutional care is the most intensive and expensive form of health care for those who need assistance as they age, according to Environics Analytics, and includes long-term care homes.

One of the key hurdles to providing safe long-term care services is ensuring sufficient staffing levels and proper training, said Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto.

Aging in Canada

• Part One: Senior Snapshot
• Part Two: Health Care in High Demand
• Part Three: Workforce Gaps Grow
• Part Four: Re-Evaluating Living Arrangements
• Part Five: Cultural Diversity

Earlier this year, the Health Standards Organization released updated guidelines around long-term care standards. According to one of the recommendations, long-term care residents should receive at least four hours of direct care each day, which involves help with eating, bathing and dressing. However, recent data from provinces such as Ontario shows the regional average is below that amount.

“No jurisdiction is providing four hours of (direct) care,” Sinha told CTVNews.ca in a telephone interview.

In addition to better pay for long-term care home workers, Sinha is calling on provincial governments to legally enforce the updated guidelines.

“They will only be effective if they are mandated,” Sinha said.

CTV News is a division of Bell Media, which is part of BCE Inc.

Edited by Mary Nersessian, graphics produced by Jesse Tahirali