Monday 13 April 2015

National Community Care Insurance: What's New in Canada

According to the 2014 Global Age Watch Index, Norway is the best country to be a senior citizen or person with disabilities.  Apart from Japan (9), all the top 10 countries are again in Western Europe, North America and Australasia.

Norway shifted health care resources from hospitals to home and they have a huge financial, national nest egg from oil revenues to spend on community care.  Canada ranks 4th and the USA 8th.

In Canada, we have national health, but home care is a provincial matter and supports vary widely across the country.  Individuals with higher needs must spend private funds for the care they require in order to live at home.  Recently, I learned about an effort to create a national insurance scheme to support the community care needs of Canadians with disabilities (the vision does not yet include seniors, but more on that later)– it’s called Every Canadian Counts and it’s based on an Australian model.   Here, Jess McCuaig speaks for Every Canadian Counts, or ECC:

Q:  Tell us about Every Canadian Counts.  What is the model of support?

The Every Canadian Counts Coalition is advocating for a national system for funding and setting delivery standards for essential disability supports. We envision cost-sharing between the provinces/territories and federal government, with the federal portion representing new funding to the sector. The "essential supports" covered by the program will be defined by our Coalition members.  Recipients could choose personal care budgets or agency support.

Q:  Where did the model originate?

The model that inspired ECC originated in Australia. The Every Australian Counts movement emerged in response to conditions similar to those in Canada (underfunded support programs, long waiting lists, inequitable access). Through grassroots organizing, cross-disability coalition building, and comprehensive research they built the awareness and political pressure necessary to have a national supports program created.

Q:  What are the benefits to Canadians?

While we don't have exact numbers (yet), we know the waiting lists for support programs across Canada are long and provinces are spending a lot on crisis interventions rather than investing in sustained supports, which are cheaper over the long-term. We also know many family caregivers and individuals are out of work because of unmet disability support needs, which is shrinking our workforce and tax base. 

This program will benefit ALL Canadians by investing taxpayer dollars in early intervention, sustained supports that grow our workforce, improve personal outcomes, and remove high-cost crisis spending. It will also ensure any Canadian who is born with or acquires a long-term disability through accident or illness has all essential support needs covered so they do not fall into crisis. No matter their income, where they live, or their ability to self-advocate, every Canadian will be covered.

Q:  How far along is your organization in realizing this dream?

Based on the experience in Australia, we expect the advocacy process to take five years, and we are one year in. At this point, the Coalition is steadily gaining new members from across the disability spectrum and attracting public supporters from across Canada. We have brought together leading Canadian research organizations (Centre for the Study of Living Standards, Canadian Council on Social Development, Canadian Centre on Disability Studies, and The Caledon Institute) to build a comprehensive research agenda to inform development of a program model for Canada. The Coalition has also begun to identify politicians who will champion ECC's vision at both the provincial/territorial and federal levels.

This year (year 2) we plan to focus on fundraising to build our core organization's capacity to support Coalition work, to produce new advocacy and education materials, and to further diversify our membership and support base.

Q:  What about seniors?  Are their needs covered in your vision?

The model in Australia only serves the ageing population if they enter the program prior to age 65. Those who develop disabilities later in life are not eligible. It's becoming a controversial issue there and it's something we've noted will need to be explored in advance (so creating two models: one that includes people who are older than 65 years of age with disabilities and one that doesn't, to compare costs). In terms of serving the population that ages with a disability, this model should serve them better than the old system as disability supports are fully integrated into long-term care. 

Q:  What would be the cost to Canadian taxpayers to implement Every Canadian Counts? 

As for the cost to Canadians, the method for funding this program would need to be determined by the federal government in partnership with the provinces/territories. In Australia the population did agree to a 0.5% medicare tax increase (which per household, on average, totals about $350 per year). We could look at a tax levy in Canada to fund this program, but the Coalition suspects the federal portion of the funds can be drawn from the existing tax base. This would just mean shifting funds around, and the most effective options for this need to be fully explored.

My research didn't reveal any new ideas for national long term care insurance in the USA.  Readers, let me know if I've missed something!  It's worth adding though, that the wonderful Howard Gleckman in his Forbes column today muses on the future of individual long term care insurance.  Read his excellent article HERE

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