2P40 - finals review

Health Care

the support needed for people to maintain optimal health

3 Models of Health Care

medical model, social model, health promotion model

Canadas 4 healthcare priorities for the next decade

1)        Improving access to family health services and primary health care

2)        Increasing health workers, decreasing backlogs in care

3)        Improving access to mental health and substance use services

4)        Modernizing healthcare information systems and digital tools

Are seniors drivers for health care cost? YES

75% have one or more chronic conditions

Visit physicians more often

Stay at hospitals for longer periods

Account for almost 45% of national health spending

From 2009 to 2019 spendings have increased and are still on the rise

Are seniors drivers for health care cost? NO

Population aging is a modest cost driver

General inflation

General population increase

Medical technologies

Doctors choice of expensive treatment and drugs

All provinces and territories provide:

no user fees, low cost co-payment drug plan, subsidizing LTC and community care program

What are areas of improvement in health care support

national pharmacare, quality of LTC homes, home care and health promotion programs

3 Principals of “Normalization” of Nursing Homes

1) Keep a normal rhythm of the day, week, and year

2) Pay a normal amount of respect

3) Lead a normal social life (social, cultural, and sexual)

Home and community-based care programs (hybrid of social and medical models)

home care, geriatric day hospital, adult day care, meals on wheels, transportation services, supportive housing and assisted living

Issues for the Future

Availability of services (rural and urban care gaps), accessibility of services (more telehealth), coordination of services: (single point of entry model and case management), need to shift increase social and health promotion models

Health Promotion Model

Focus: prevention and self-care

Place: a variety of settings of everyday life

Methods: education, empowerment, advocacy/policy change

People: everyone

Social Model of Care

Focus: to help independent living seniors with chronic illness and disabilities

Place: community and long term care homes

Methods: provide formal support in personal care, nursing care, recreation and social services

People: a team approach

Retirement Principle

a person leaves work at a fixed age regardless of mental/physical ability

Retirement Wage

A pension paid by the government to support older people in retirement

Average Retirement Age in Canada 2023 and 2024

65.1 in 2023 and 65.3 in 2024

Flexible Retirement

bridge jobs, job sharing, encore career, second career, gender influence of retirement

Canadas Multi-Tier Tension System

Tier 1: government transfers (OAS/GIS/ALW)

Tier 2: public pension plans (CPP/QPP)

Tier 3: private income/investment/savings (RRSP/RPP)

10 CPP/QPP Features

1)        Protects people from inflation by indexing to costs

2)        CPP covers almost all workers

3)        Plan is portable from job to job

4)        Plan locks workers and employers contributions

5)        Pays workers up to 25% of pre-retirement earnings

6)        Applies the same rules for men and women

7)        Survivor and disability benefits

8)        Adjusts pensionable earnings for fairer assessments

9)        Contributors may choose early or late retirement

10)   Indexed to the cost of living

Structural Barriers

Canadians with lower SES have the least chance of having any private saving → cumulate disadvantage

Private Retirement Savings

tax deferral (RRSP) and tax savings plans (TFSA) - still tend to benefit middle and high income earners

What are 2 major challenges for expanding leisure activity in later life?

Getting older people involved and keeping them involved

What influences the selection and level of participation on leisure activities

Health, SES, gender, cohort, loss of spouse, region and weather, social/cultural values, reduced social skills

What percentage of senior Canadians are vulnerable to social isolation?

30%

Risk factors for seniors social isolation

critical life transition, living alone, health problems, lack of transportation, being a caregiver, being an immigrant, low income

Social Prescribing

a means of connecting patients to a range of non-clinical services in the community to improve their health and well-being. It builds on the evidence that addressing social determinants of health such as socioeconomic status, social inclusion, housing, and education is key to improving health outcomes

Health Benefits of Volunteering for Older Adults

Reduce mortality risk, improve cognitive function, improve physical function, social connectedness, reduce depression, increased self-esteem

Barriers to volunteering in Later Life

time constraints, health issues, physical function, financial constraints, lack of transportation, lack of information and opportunity, inadequate volunteer management.

Ecological Model of Housing

people feel most comfort when individuals capability matches the demands of the environment

Home Adaptations

Flex housing, visitability, universal design

Ontario’s Golden Girl Act Bill 69

Passed in 2020, recognizes how seniors co-housing can benefit communities

Types of Housing Alternatives

NORC, supportive housing/assisted living, retirement communities, life lease housing, reverse annuity mortgage (RAM)

Alternative Transportation Programs

More public transportation, transportation brokerage, mobility club, dial-a-ride vans

Transportation Brokerage

matches a person with services that meet their needs

Mobility Club

a volunteer group of older people who provide rides to other seniors

Caregiver Burden

problems and stress due to caregiving

Non-economic social and physical costs of caregiving

affects social activities, changed holidays, less time with spouse and children, affects health

What support caregivers need

financial support, home care, information, help from medical professionals, emotional support, occasional services, community services

Respite Services

Friendly visitors, adult day care, etc.Hosue short stay in LTC homes, homemaker services, transportation services

Houses Classification (1981) Social Support

Emotional Support, Instrumental Support, Informational Support, Appraisal Support

Emotional Support

empathy, love, trust, caring

Instrumental Support

Tangible aid and services

Informational support

Advice, suggestions, information

Appraisal Support

Constructive Feedback, Affirmation

Support Given by Older People

Financial and material support, childcare / grandparenting, help with daily chores, emotional support / being a role model

4 Models of Informal Support

Task specificity model, hierarchy compensatory model, functional specificity of relationships model, convoy model of support

Task Specificity Model

Recognizes which caregiver is fit for the support needed

Hierarchy Compensatory Model

Order of loved ones you rely on (ex, 1-spouse, 2-siblings, 3-parents, 4-children, 5-friends).

Functional Specificity of Relationship Model

the quality of the support depending on the relationship (ex: family can be more emotional support, co-worker can be more advise or financial)

Convoy Model of Support

Support groups (ecological model)

Relationship Status Types:

Married, Widowed, Divorced, Common-Law, LAT, Single

LAT

Living Apart Together

Leading Cause of Deaths 20-24 year old’s

1) Accident

2) Suicide

3) Cancers

4) Homicide

5) Heart Disease

Leading Cause of Death 75-84 year old’s

1) Cancer

2) Heart Disease

3) Covid-19

4) Chronic lower respiratory diseases

5) Cerebrovascular disease

Death

Physical / clinical death

heart, lung, and brain cease to function

Dying

Prolonged process involves more than biological change, social, emotional and spiritual changes

Theory of Dying Process

Stage 1: Denial

Stage 2: Anger

Stage 3: Bargaining

Stage 4: Depression

Stage 5: Acceptance

What Do Older People Concern at the End of Life?

1)        Avoiding prolongation of dying

2)        Receiving adequate pain relief

3)        Having control of treatment options

4)        Staying in touch with loved ones

5)        Relieving burden to family

Bill 3-Ontario Compassionate Cate Act (2020)

to develop a framework to ensure that every Ontarian has access to quality palliative care

What does MAID stand for

Medical Assistance in Dying