Friday, January 08, 2010

Bracing for the soaring dementia toll

 Many of us are going to end up needing care.

Sure, some people will be lucky and live long, independent lives before dropping dead quickly and without a fuss. Others will be less fortunate and end their days early in a car wreck.

But the rest of us will likely need care or be involved in seeking residential care for a family member.

And unless things improve, that will be a daunting prospect.

Two recent reports - one from B.C.'s ombudsman and one from the Alzheimer Society of Canada - have highlighted how difficult things could become for people needing a safe, caring place when they can't live on their own.

The society's report was called Rising Tide: The Impact of Dementia on Canadian Society. It painted a scary picture, for individuals and society.

Today in B.C., about 70,000 people have been diagnosed with dementia. Alzheimer's disease is the major, but not the only cause.

The study forecast that by 2038 the number of people afflicted with dementia would more than double to 170,000. The increase will be similar in other provinces. Across Canada, the direct costs of dementia will rise from about $8 billion a year in 2008 to $93 billion in 2038.

In this, as in so many issues, the big factor is demographics, more specifically the aging of the giant bulge of people born after the Second World War.

Today in B.C. about one in five residents is 65 or older. By 2038, one in three will be in that age bracket. About four per cent of us are 80 or older; based on BC Stats projections that will increase to 7.5 per cent.

Given the overall population growth forecasts, the number of people in the province 80 or older is forecast to increase from 191,000 today to 460,000.

Dementia is largely a disease of the old. Barring other changes, the disease will afflict many more people for a longer period.

And at the same time, the ranks of those available to provide care - or pay taxes to support it - will have shrunk.

That's critical because the study found "informal care" - that is, unpaid - is currently huge.

Spouses, other family members and friends are providing 47 million hours - more than 22,000 person years of support - caring for people with dementia before they are receiving any formal supports. They are spending something like three times that amount of time helping dementia patients who are receiving some community care supports.

Even when people are in residential care, families and volunteers are spending millions of hours helping the patients.

That's just what families have always done, you could argue. But even a generation ago people died younger, reducing the toll of dementia. Families were stable and more likely to live close to aging relatives. Often, a stay-at-home mother was available to help a parent.

That's already changed. In 30 years, it will have changed still more.

And without that support, more support and residential care will be needed. The study looked at the expected increase in the number of long-term care beds and concluded that - just in terms of dementia cases - there will be a national shortfall of 157,000 beds by 2038.

The report recommended a number of actions, starting with a national dementia plan. It urged more research and support for families in navigating the system. And it said prevention should be a focus - exercise, especially by those over 65, can delay the onset of dementia and slow its advance. (You can read the report at

It should all be alarming, whatever your age. For those in the Baby Boom cohort, it is a reminder of the challenges that might lie ahead and the gaps that could make life more difficult and painful.

For those much younger, it's a warning of big health-care costs to come.

Unless we act now.

Footnote: The Alzheimer Society has an obvious special advocacy role. And the money for the study came not only from Health Canada and the Canadian Institutes for Health Research, but also from pharmaceutical companies with their own special interests.

Monday, January 04, 2010

Domestic violence victims not a B.C. priority

Based on Solicitor General Kash Heed's response, don't expect any real action as a result of the inquest into a murder-suicide that claimed five lives in the capital.

Domestic violence isn't a government priority.

The jury at the coroner's inquest did their job. They sat through terrible testimony in a process that dragged on for almost two years as government lawyers fought to suppress evidence. And they delivered thoughtful recommendations.

But Heed, the government's chosen spokesman, wouldn't commit to act on even one of the 14 recommendations from the coroner's jury. The former West Vancouver police chief, who had been promoted as a star candidate and touted as a future premier, just waffled. Even when the jury's recommendations were identical to similar proposals made by police more than two years ago, after the tragedy, Heed would not commit to any timeline for action.

The case is horrible. In September 2007, Peter Lee killed his six-year-old son, his wife, her parents and then himself. He was out on bail after crashing his car in what Sunny Park, his wife, said it was an attempt to kill or injure her. He had a history of violence. Park also told police about past abuse. Lee would kill her and son, she warned.

Police who interviewed after the car crash were alarmed enough to take the unusual step of meeting with the Crown prosecutor to urge Lee remain in custody.

But he was released and remained free despite reports he had violated bail conditions. Park, a Korean immigrant with limited English, received little help, support or information on her options or how to keep herself safe.

It was a horrible, preventable mess. But they all died. A lot could have been done to help the family. But the basic supports weren't there.

Park had to report the abuse to three separate police departments in the capital region - one RCMP detachment covered the hospital; another police force her home in Oak Bay; and the Victoria department had jurisdiction over the car crash. All three locations are within 10 kilometres.

Back in 2003, then solicitor general Rich Coleman promised to bring the 13 police departments in the region together to reduce crime. Politics sunk the good idea.

None of three departments had domestic violence units, despite research showing their effectiveness.

In 2002, the government fired the 35 people in prosecutors' offices across the province who worked with crime victims. The cost - less than 90 cents a year for each British Columbian - was too much. The core review concluded this wasn't a role for government.

Victim services officers helped families through the ordeal of a trial when their son or daughter was killed. They told rape victims what to expect. They made sure family violence victims knew how to stay safe and their legal rights. If victims were in danger, the workers were experienced advocates who understood the system. And they were considered a luxury to be discarded to pay for a two-cent-a-week tax cut.

The defining witness at the inquest was Robert Gillen, an assistant deputy minister in the Attorney General's Ministry. His directness was refreshing.

Yes, he said, government could be doing more to keep people safe from domestic violence. Better risk assessments could be required, for example, before people like Peter Lee got bail.

But that would cost money, he said, and domestic violence is not really a government priority. "There's no sense pretending we can afford a Cadillac when we're lucky to get a used Ford," he told the jury.

Yet domestic violence is the second largest caseload for Crown prosecutors, after impaired driving. Just in the capital, police respond to more than 3,000 cases a year. Many more go unreported.

Heed could have accepted the recommendation for risk assessments in domestic violence cases before suspects are released on bail. He didn't. He could have accepted the jury's call for services for alleged victims and abusers as soon as offences are reported. He didn't.

It all raises a basic issue. Are things like the supports to keep Sunny Park and her little boy safe a legitimate role for government, or should they people like them be left on their own?

The government has made its choice. Heed made that clear.