We know Canada’s population is aging. In 2015, the proportion of seniors surpassed that of youth under 15 for the first time. And the gap will continue to widen over the next 20 years. But who will look after them?
There has been much discussion about how to prepare for this bulge of aging baby boomers. Media and policy reports detail strategies for aging in general, dementia care, aging at home and home care, integrated care, end of life and more. Most of these are well thought out but frequently overlook one very important implication: what kind of health workforce will be needed to deliver on these strategies?
If we are serious about preparing for an aging population, we need to get the health workforce, and its capacity to deliver care, right.
The workforce is the elephant in the room during health policy discussions – a large, pervasive issue that too often goes unaddressed. The workforce is a pillar of the health system but, like the foundation of our homes, it can sometimes go unnoticed. But if we plan on reforming services, we need to know if the health workforce foundation can support the changes. Failing to address foundational workforce issues can leave otherwise thoughtful policy without a basis from which to succeed.
A common recent theme is the promotion of aging at home to reduce the pressure on institutional long-term care. This also responds to a general preference to stay at home as long as possible. While this is laudable, shifting the delivery of care from institutions to the home has significant impacts on the workforce: who will provide this care, how will they work and how many workers will be needed to provide the care?
The workforce for institutional long-term care and home care includes nurses, but largely is made up of personal support workers or healthcare assistants. Informal or unpaid caregivers – spouses, children and friends – also play a significant role, filling the gaps. The vast majority of these caregivers (paid and unpaid) are women, so gender issues must be taken into account.
Taking care to the home can increase the burden on informal caregivers, particularly those in the sandwich generation who support their own children while caring for aging parents. The social and economic implications of overburdened informal caregivers are rarely acknowledged and yet represent a very important element of health workforce planning.
What of the formal health workforce? Do we have sufficient numbers and competently-trained workers to meet the care needs? The health needs of seniors are getting more complicated because people are living longer, resulting in higher rates of dementia and multiple chronic conditions. We need a workforce that can keep up.
Undertaking thoughtful planning is complicated by the dearth of information about the health workforce, particularly when it comes to unregulated workers who provide the bulk of care. Only two provinces – British Columbia and Nova Scotia – have registries for unregulated health workers to track information on employment and training. Ontario’s registry was shut down earlier this year due to concerns about data quality. Alberta plans to launch a registry this fall.
And for professionals such as doctors who are not used to making house calls, it means an important change in practice habits as well as revised payment models to encourage these changes.
So how can we get policy-makers to take workforce considerations into account when developing and implementing policy?
One solution is a health workforce impact assessment tool that can be applied to all new policies, structured around two guiding questions: does the policy address health workers, professionals, caregivers? and, are the workforce implications of the policy highlighted, including recruitment, training, distributing, retaining, motivating and managing?
In Australia, a workforce impact checklist applies to all health policies as they are developed. A call for greater workforce impact assessments was also a key element of the Global Human Resources for Health Strategy 2030, recently passed in the 69th World Health Assembly.
If we really want to improve care for our aging population, we need to address the health workforce foundation.
Ivy Lynn Bourgeault is a professor in the Telfer School of Management at the University of Ottawa and the CIHR Chair in Gender, Work and Health Human Resources.