The cost of health care in Ontario is huge and rising steadily.  Along with rising costs of prescription drugs.  And advancing steadily is the demographic of the aged, elderly people who become high-need patients, taking up space in hospitals, consuming scarce health dollars, and eventually clogging up full-care, long-term health facilities.  It is all inevitable, and there are administrative recognitions that if people can be kept healthy longer into their advanced age, able to remain at home, sometimes with a little outside assistance, everyone benefits.

An acquaintance we came across yesterday informed us that she had just returned from installing her mother in a beautiful long-term care facility.  Her mother has her own unit, complete with scaled-down bedroom, bathroom, utilitarian kitchen, living area.  The facility houses one hundred, sixty elderly people.  There is medical care available 24 hours a day.  There is a very large dining area where meals are served, and residents have lounges where they are able to socialize.  There is a salt-water swimming pool, hot tubs, and much else.  This is a for-profit enterprise, not a provincially-operated or -underwritten facility.

Her mother, at age 90, finally decided she no longer wanted to look after her one-bedroom apartment, and was anxious for company besides, and this facility suited her needs perfectly.  No, neither she nor her two siblings, she laughed, thought of accommodating their mother in their own homes.  Though they could easily, she mused, have spent money banked from the sale of their mother's previous large family home, to buy a house with a nanny suite.  No, that wouldn't have suited her mother at all, who is independent-minded.  Besides which, living with them would not ease her loneliness; no one would be around at home during the day to give her company.

Her mother was excited, happy and content with her new living arrangements.  Which, with all its superior and glitzy trappings, didn't come cheap.  But her mother had plenty of retirement income and could afford the $4,500 monthly fee.  In any event, at 90 years of age now, how much longer would she live?  She might as well live comfortably, with luxuries she would appreciate, in the company of others like herself.

That's one large whack of money, $4,500 monthly.  Services are costly, particularly when those providing the services expect to prosper handsomely from doing so.  And obviously, it is a slight proportion of the population, elderly or not, that can afford such steeply-expensive accommodation to servicing the geriatric crowd.

A new report was presented to the Ontario government titled Living Longer, Living Well, prepared by Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto, on how the province may better assist seniors remain healthier longer, enabling them to live at home longer.

Among some initiatives to come out of the report is one where the provincial government announced it is prepared to match every older Ontarian who wants one with a primary care provider, and introduce new physician incentives for the care of high-needs patients - including making health-worker/physician house calls.  And recognition of the need to have greater numbers of geriatric specialists.

The province's 1.9-million seniors represent 14.6% of the population, accounting for almost half of present-day health care spending, and set to increase as the population inevitably does.  The number of Ontarians aged 65 and older expected to double within the next 20 years.  "If left unaddressed, our demographic challenge could bankrupt the province" wrote Dr. Sinha.  It is only 10% of the elderly who represent 60% of health care expenditure.

"If you can target the 10% of the most complex and do a better job in helping them navigate the system, through primary care hubs you could provide better care and at the same time reduce cost ... often older adults fall between the cracks", with the four sectors of health care -- primary care, community care, long-term care and acute care -- failing to co-operate.

"The big problem is that people don't have access to their family physician, so they end up in the emergency room" leading to unnecessary hospitalization and admission to long-term care, pointed out Dr. Frank Molnar, medical director of the regional geriatric program of Eastern Ontario. Who also pointed out that one of the recommendations, expecting the elderly to pay up front for their home care wouldn't fly: "That's something that many people will not agree with because people feel they have already paid for health care with their taxes, and should have equal access."

And then, of course, there's the whole other, more complex, somewhat intractable issue of physical health problems exacerbated by Alzheimer's disease patients, who during the average eight years of intensive need, will be under the care of approximately twenty-five different health professionals.