The cost of care
- Kicker
- Jun 12, 2019
- 5 min read
Updated: Jun 17, 2019
Health care costs in Newfoundland and Labrador continues to grow despite a shrinking tax pool and aging population.
Rebecca Blake
Kicker
Stuck between a rock and a hard place, Newfoundland struggles to keep young people and their tax dollars, needed to support an already stressed health-care system.
The Harris Centre’s Population Project predicts Newfoundland and Labrador’s population will continue to shrink by eight per cent from 2016 to 2036. A shrinking taxpayer pool and aging population does not bode well for health-care spending, which is $3 billion per year.
Stephen Bornstein, a professor at Memorial University and director of its Centre of Applied Health Research, says seniors are not the sole cause of stress upon the health-care system; it’s also the economy.
“There's a lot of generalized panics out there,” said Bornstein. “As our population ages, and it's aging rapidly, and as the young people who pay into the tax system are becoming a smaller part of the population, our health care will become more costly.”
However, Bornstein says health care costs in Newfoundland and Labrador aren’t as high as some other parts of Canada.
“Our economy is in big trouble, and it’s not because people are getting old.”
Although Bornstein says health-care spending in Newfoundland and Labrador isn’t as high as that in other provinces, MUN economist and professor Wade Locke says the cost can still cause problems.
In a 2017 presentation, Locke wrote, “Health-care cost is and will be one of the biggest drivers of public expenditures within Newfoundland and Labrador. To control these costs and to mitigate their significance without compromising health outcomes, we need a Royal Commission.”
Locke went on to say, “Young people and prime-age workers have been declining and are expected to continue to decline in both absolute and relative terms. This does not bode well for labour supply and for the provision of public services (especially health care).”
Footing the Bill
According to the Canadian Institute for Health Information, the national average spending on health care alone is $253.5 billion. Health care makes up an estimated 11.3 per cent of Canada’s gross domestic product (GDP).
Newfoundland and Labrador spent 12 per cent of its GDP on health care. At $3 billion dollars, health-care expenses account for 38 per cent of the provincial budget and is growing.
In a report published in 2013, the Health Council of Canada stated, “(T)here was no commitment to address the longer-term needs of people with chronic conditions, particularly seniors, or the needs of family caregivers. Access to home care services continues to vary across the country, and demand is growing.”
However, the provincial government is working to meet demand outside the Avalon-East Coast area.
Finance Minister Tom Osbourne said in a press release that a new long-term care home with 145 beds is under construction in Corner Brook, more beds were opening in Carbonear and even more long-term care beds were opening in Central Newfoundland to meet demand.
Despite the demand, the price tag is hard to stomach.
In Locke’s presentation, he says Newfoundland and Labrador’s health care spending is at the top of the ‘bad column.’
“On average, it costs Newfoundland and Labrador $5,060 per capita for health care costs in 2014, which compares to $3,975 per capita Canada-wide or we were 27.3 per cent higher in per capita terms in 2014. We exceed all other provinces on average – closest is Alberta where we were 8.5 per cent higher in 2014,” Locke wrote.
The province doesn’t receive equalization payments from the federal government. Therefore, Newfoundland and Labrador must pay for its enormous health-care bill by itself. The money for the $3 billion budget comes from taxpayers and oil royalties
Oil royalties and personal income tax make up the majority of the government’s revenue fund.
Both are going down.
In 2018, Newfoundland and Labrador brought in $1 billion in oil royalties, compared to 2015 when it made $1.5 billion from oil royalties. As well, with a shrinking working-age population, the tax pool shrinks with it. To add insult to injury, Newfoundland and Labrador’s net debt is $13 billion dollars.
50/50
Health-care spending affects even semi-private care homes. The provincial health authority assesses whether residents will receive a subsidy or pay completely out of pocket. Loralee Wettlaufer, executive director of Cambridge Estates in St. John’s, says 60 per cent of its residents are subsidized.
“We’re seeing changes,” said Wettlaufer. “And part of that is being driven by the home-first policy.”
The home-first policy, otherwise known as the provincial home support program, is a provincial program established in 2018 to keep seniors in their homes longer. The program does so by sending aid such as nurses to assist with daily living for seniors. According to Wettlaufer, it’s bringing in older residents.
“It used to be you could come in at any stage in your retirement. Now, particularly with residents receiving subsidies, you have to require some assistance activities for daily living.”
That’s the case for Jean and Vic Fildes, both seniors in their late 80s. Victor’s two artificial hips make it hard for him to play hockey, help his wife with the dishes and dance.
Jean’s Parkinson’s disease makes it hard for her to live on her own, too.
The two lovebirds met by bumping into each other at a general store in Central Newfoundland. They moved to St. John’s a year ago to live in a personal care home when Jean’s Parkinson’s progressed.
They split the bill for their semi-private room at Cambridge Estates 50/50 with the provincial government.
Through sickness and health, Vic and Jean still have hope for senior care in Newfoundland and Labrador.
“I’m sure the good Lord won’t let us all go away,” Victor said. “I’m sure they’ll take care of the neediest folks.”
“I’m sure the good Lord won’t let us all go away,” Victor Fildes said. “I’m sure they’ll take care of the neediest folks.”
‘We need to bring in people who know what they’re talking about’
Colleen Morrissey is one of two licensed practical nurses at Cambridge Estates. The private personal care home houses more than 100 residents. The workload for Morrissey is backbreaking.
“It’s a heavier workload,” said Morrissey. “Now you’re expected to do more than you can do, and I’ve been pulled in so many different directions. I’m exhausted.”
Morrissey thinks more staff is a better investment.
“You don’t need more managers,” said Morrissey. “You only need more staff.”
Morrissey is one of two LPNs at Cambridge Estates. Only one LPN is available at time. Each can work up to 12 hours per shift. When there is no LPN on site, there are nursing assistants.
According to Eastern Health, personal care homes such as Cambridge Estates are required to provide a minimum of one hour and 30 minutes of supervision and care per resident per day.
“I think that we need more people, more staffing, so we can do what we need to do and not rush into things,” said Morrisey. “Like, if you only have seven minutes to do a client, that’s absolutely ridiculous. You can’t do that. You just can’t.”
‘It’s exhausting work’
In Locke’s presentation, he suggested a Royal Commission investigate Newfoundland and Labrador’s health-care spending.
But Morrissey says a committee of nurses is a better idea.
“We need to sit back and think, ‘What can we do to improve it (senior care)?’ We need to bring in people who know what they’re talking about, not people who sit behind a desk.”
With the exportation of young people and repatriation of elderly folk, the future of Newfoundland and Labrador’s health-care spending is currently up in the fog.
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