Long May Your Big Jib Draw:
Setting Sail

 

 

Of?ce of the

ADVOCATE

Newfoundland and Labrador september 2019

Message from the Seniors’ Advocate
On November 7, 2017 I had the
honour of being appointed
Newfoundland and Labrador’s first
Seniors’ Advocate. What a busy time
it has been! In addition to calls,
emails, visits and letters, I have been
traveling throughout the province
listening to seniors, their families and
supporters. I have heard stories
which buoyed my spirit and other
times laid me very low.
There is no doubt that many seniors
and aging issues are being
addressed and I applaud these
efforts. Many seniors are living
happy, healthy, productive lives. But
on the other hand far too many seniors face serious challenges.
This report summarizes the major issues I have heard and my plans to move forward to
ensure change. While the matters brought to my attention thus far have been numerous
and varied, some topics come up over and over again. It is clear that these concerns
must take priority.
I believe that at the core of most issues are two refrains: ageism and an absence of
kindness and compassion. We need to stop ageist, paternalistic thinking and begin
viewing aging as a time of positivity and opportunity. Secondly, we need to practice
basic human kindness. Simple principles that are neither costly nor onerous.
It seemed fitting to use a nautical theme for this first report. We are on an incredible
voyage. As seafaring people, Newfoundlanders and Labradorians know the importance
of a drawn jib that is full of wind to propel us forward; moving swiftly toward a goal.
Sincerely,

Suzanne Brake, PhD
Seniors’ Advocate
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Long May Your Big Jib Draw: Setting Sail

 Table of Contents
Casting Off ................................................................................................................................................. 1
Navigating .................................................................................................................................................. 3
What We Have Heard............................................................................................................................... 6
Aging in Place ....................................................................................................................................... 6
Age-Friendly Communities ............................................................................................................ 6
Housing............................................................................................................................................... 8
Home Support Services.................................................................................................................. 9
Homelessness................................................................................................................................. 10
Safety and Security ....................................................................................................................... 11
Transportation ................................................................................................................................ 12
Healthcare ............................................................................................................................................ 13
Residential and Health Care ........................................................................................................ 13
Primary Health Care ...................................................................................................................... 15
Dementia........................................................................................................................................... 15
Dental, Hearing and Vision Care …………………………………………………………………………………………. 16
Access to Appointments and Medical Transportation......................................................... 18
Labour Force Participation .............................................................................................................. 20
Continued Attachment .................................................................................................................. 20
Pension Stability ............................................................................................................................ 21
Access to Benefits ......................................................................................................................... 21
Setting the Course ................................................................................................................................. 22
Conclusion ............................................................................................................................................... 26

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Long May Your Big Jib Draw: Setting Sail

 Casting Off
The Office of the Seniors’ Advocate was created through the Seniors’ Advocate Act.
On November 7, 2017 Newfoundland and Labrador appointed its first Seniors’
Advocate.
The Act gives legislative authority for the Seniors’ Advocate to address systemic issues
impacting seniors and to make recommendations for change. Specifically, Section 3 of
the Act states the Office of the Seniors’ Advocate was established to:
(a) identify, review and analyze systemic issues related to seniors;
(b) work collaboratively with seniors' organizations, service providers and others
to identify and address systemic issues related to seniors; and
(c) make recommendations to government and government agencies
respecting changes to improve seniors' services.
Although the scope of the issues under the Seniors’ Advocate’s authority are quite
broad, all fall within five categories: health care, personal care, housing, transportation
and finances.
The Office of the Seniors’ Advocate works with seniors' organizations, public or private
service providers (as per the regulations in the Act) that fund or deliver seniors'
services, and others to identify and address systemic seniors’ issues.
While this Office is not mandated to address individual seniors’ issues it does receive
numerous calls which are individual issues. When the Seniors’ Advocate becomes
aware of individual matters, the issues are tracked and referred to the Office of the
Citizens' Representative or other appropriate resources.
Seniors who need information on programs or services are referred to SeniorsNL which
can help seniors anywhere in the province. SeniorsNL records the details from all calls
on its electronic tracking system. This Office works closely with SeniorsNL to identify
current and emerging issues.
One duty of the Office of the Seniors’ Advocate, as outlined in Section 16 (g) of the Act,
is to inform the public. As well, Section 20 authorizes the Seniors’ Advocate to publish
reports relating to the exercise and performance of powers and duties.

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 The purpose of this report is to provide a summary of what was heard since the
establishment of the Office. This report will also outline a plan for the future.
It is essential to remember that systemic issues are complex and multi-faceted. In order
to address systemic issues we must look at the operation of the system as a whole and
develop responses that go beyond the actions of individuals. As noted recently in
Ontario’s Public Inquiry into the Safety and Security of Residents in the Long
Term Care Homes System, an effective systemic response requires all those in the
system, both individuals and organizations, to work together to address systemic
issues. This requires collaboration, co-operation, and communication.
Whenever possible, documents produced by this Office follow clear language guidelines
by using plain text and setting up pages with a left-side alignment. Documents also
follow Canadian National Institute for the Blind’s accessibility guidelines. In this report,
bold fonts are primarily used rather than italics or underlining. As well, the font is a sanserif style in a minimum 12-point size.

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 Navigating
The world’s population is aging due to lower fertility rates, longer life expectancy and the
aging of the baby boomers. Most developed countries in the world are experiencing
population aging. According to the most recent census (2016) 16.9 per cent of Canada’s
population is 65 years and older. In Newfoundland and Labrador, almost 20 per cent of
the population (about 108,000 individuals) is 65 years or older.
Interestingly, if 20 per cent of the population is 65 years and older, then 80 per cent of
the population is 64 years or younger. From this perspective, the size of the older
population does not seem quite as catastrophic; certainly not something worth being
viewed as a “tsunami”! Small but consistent increases will be seen in this population
group for the next 25 years. These increases are not surprising as they have been
predicted since the last of the baby boomers were born in 1966.
Seniors are concerned about being marginalized. Seniors feel that too often negative
stereotypes about aging taint perceptions, especially amongst youth. The focus on a
crisis approach to policy development has led to something the Seniors’ Advocate
refers to as “generational angst”; where competition for limited resources pits younger
and older generations against each other. This attitude needs to change.
Seniors - all people in fact - want due respect and recognition. While most negative
“isms” like sexism and racism are globally denounced, ageism is too often regarded as
less serious.
As a population group, seniors share some qualities and concerns but this group is far
from homogenous or all the same. In fact everyone is so different. The Seniors’
Advocate recognizes that seniors are geographically diverse, living in urban, rural and
remote communities. The Advocate has met Indigenous seniors and Elders who
embrace an intergenerational and land-based culture; seniors who are financially stable
and others who are struggling; seniors who identify as lesbian, gay, bisexual,
transgendered, queer, intersex and 2-spirited (LGBTQI2S); seniors who are single or
living as a couple; seniors who have immigrated to Canada and embraced
Newfoundland and Labrador as their home; seniors who are living with disability;
seniors who are lonely and those who are fully socially engaged; and seniors who are
from a broad range of ages. The bottom line is that seniors are as diverse as the whole
population but with more life experience.
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 The definition of a “senior” continues to be debated. The Act considers seniors to be 65
years and older but also includes those from age 50 upwards who access seniors’
services.
There is no other population group with as large an age span. Seniors can be further
subdivided by younger seniors, older seniors and the very old. Within each grouping
there are very different traits, abilities and needs.
Even the United Nations recognizes that there are, and will be, impacts on labour and
financial markets, on goods and services as well as family structures and
intergenerational ties. How we approach these impacts speaks to who we are as a
society.
Although it is inevitable to experience health issues in older age such as declining
vision, hearing, oral health and mobility challenges, people are beginning to move into
older age with better health and are living longer. These are facts which should be
celebrated!
While some seniors retire and live with good health and financial stability, other retirees
live with health problems and/or poverty or low income. Sometimes a health challenge
can generate other problems such as financial instability or social isolation. For
example, a senior with health issues may stay at home more. They may not feel well
enough to socialize or simply cannot afford it. Living apart from family and friends with
few social interactions can worsen health challenges.
Recent income statistics reveal that this province has approximately 30,000 senior
couples (both aged 65 or older) with annual median incomes of $41,200 (therefore
15,000 of these couples have income between $27,000 and $41,200). Also 22,000
single seniors have a median income of $24,300 (therefore 11,000 of these single
seniors earn between $18,000 and $24,300 a year). These numbers are significant. The
financial burden on these individuals must not be ignored.
In 2007 the Province released the Healthy Aging Policy Framework followed by a
Status Report in 2015. It contained five priority directions and 28 goals. The
Framework has not been revised or updated since its release and is no longer
referenced as a guiding tool. In June 2017, the province’s Auditor General released the
Report to the House of Assembly on Performance Audits of Departments and

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 Crown Agencies. The Auditor General examined government’s preparedness for the
changing demographics and found that Government is not prepared for the impact of
changing demographics and has not assessed future service needs, nor planned for
future costs. Government is expected to address these issues by Fall 2020. The
Seniors’ Advocate will be monitoring government’s response to the Report and is
prepared to work with government to ensure this province provides the programs and
services required by its citizens.
Regardless of how we view aging, there is no doubt that as the population ages there
will be socio-economic implications and adjustments for decision-makers in all sectors
of society. It is the role of the Seniors’ Advocate to identify the issues which impact
seniors as they age and make recommendations to support aging in a healthy and
inclusive way.

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 What We Have Heard
Since the establishment of the Office of the Seniors’ Advocate, the Seniors’ Advocate
has participated in numerous public engagement events throughout the province. These
sessions engaged seniors, their families and supporters, and provided learning and
sharing opportunities for everyone. The provincial outreach is not limited in scope, so all
regions of the province will be visited during the Advocate’s tenure.
This past year has afforded the Seniors’ Advocate many opportunities to discuss the
role of the Office; but more importantly, the Advocate has been listening.
The Seniors’ Advocate has heard many positive stories about living well and being
included in society. She has attended 50+ Federation Club meetings and recognizes the
strength and support seniors’ organizations and retiree groups provide. But she also
has heard about the challenges faced by many seniors. She heard the gentleman who
feared he would lose his sight while waiting for eye treatment. She heard the lady who
was upset about the treatment her aunt received while living in a long term care facility
and she heard the older worker who would lose his health benefits when he turned 70.
She met the lady who showed her broken dentures because she could not afford the
repair bill. She has been listening carefully and has taken note.
This report highlights some of the many issues that have repeatedly and consistently
been brought to the attention of the Seniors’ Advocate. There are other issues emerging
which the Advocate expects will garner more attention in the future. The following
issues have been categorized alphabetically, not in order of importance.

Aging in Place
Age-Friendly Communities
An age-friendly community benefits all citizens regardless of age. Age-friendly
Communities is an international movement where communities assess their overall
“age-friendliness” and work toward making positive changes. An assessment examines

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 outdoor spaces and buildings, transportation, housing, social participation, respect and
social inclusion, civic participation and employment, and communication and
information. A number of municipalities in Newfoundland and Labrador have completed
self-assessments and moved forward with implementing initiatives.
Being socially included may be through families, friends, community events, church
services, volunteering, and participating in recreational and social programs. Seniors
report that participating in seniors’ organizations and retiree groups, such as the 50+
Federation with its 130 clubs and over 6,000 members throughout the province, helps
with positive mental and physical health. However, in this province, long difficult winters
can hinder socialization opportunities.
Finding out about programs and services, or changes to them, can be challenging for
seniors. SeniorsNL provides information and referral services. This organization
requires ongoing support in order for it to be sustained and expanded throughout the
province.
Seniors report that once they learn about programs they encounter hurdles navigating
the system such as wading through bureaucracy and paperwork. As service providers
depend more on technology to communicate, the challenges can be compounded for
seniors. It is critical for governments and the private
sector to consider the technological abilities of seniors
We need a range of
which range from being highly computer literate to no
options which support
computer experience at all. Further, even seniors with
our changing needs.
high computer skills may have limited access to
computers and to the internet.
Even in a technologically advanced society many people, particularly older seniors, are
challenged by low levels of reading and writing skills. Service providers need to
constantly monitor their methods of communication to ensure their messages are being
received and the needs of seniors are being met.

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 Housing
Seniors are concerned about where they will live as they age. They are concerned
about their ability to live independently while living on fixed incomes in the face of rising
costs and increased taxes. Seniors want to be able to age in the place of their choosing.
In Newfoundland and Labrador more than 80 per cent of seniors own their own homes.
Many expressed concern that as their financial situations and care needs change, their
ability to age in place is compromised.
Seniors expressed concern about the availability of affordable, accessible and energy
efficient housing options. Maintaining a house becomes more challenging as we age.
While downsizing may be more appealing, access to smaller more affordable homes is
not always possible.
Low income seniors may be
eligible for a rent subsidy from
Newfoundland Labrador
Housing. These subsidies are
mostly “fixed” which means
the subsidies are attached to
certain dwellings. A pilot
project is underway to explore
the option of “portable”
subsidies so that the subsidy
is attached to the person and
not the dwelling. In this case,
seniors can choose where
they want to live and the
subsidy moves with them. The Seniors’ Advocate will be watching for the results of this
pilot, as self-determination plays a key role in maintaining independence.
Accessibility is essential to living independently regardless of age, yet construction and
renovations continue to take place without considering the principles of universal
housing design. Simple adjustments such as wider doorways, lower light switches,
accessible sinks and showers can mean the difference between continued independent
living and institutionalization. Legislation to ensure these principles are automatically
integrated into building should be considered.

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 People who wish to continue to live at home often require funding assistance to make
renovations to their homes. They have expressed concern about eligibility and long
waitlists for Newfoundland Labrador Housing’s Home Repair Program. This program
serves about 350 clients (mostly seniors) each year. Seniors report that the funds
released on April 1 were depleted by June 15. Seniors must wait until next fiscal year to
apply again. The Seniors’ Advocate learned that this year additional funds were
secured, however the demand continues to exceed the budget.
In addition, seniors report that the wait time between an initial application for repairs and
a subsequent approval can be lengthy; too long for any person but more so for older
homeowners. If successful in receiving a grant, a person must wait seven years to be
eligible again. The availability of these programs are barriers to aging in place and can
influence a person’s decision to move into a personal care home or long term care
facility prematurely or leave the community in search of alternative housing.
I got my power bill this
week and I was shocked
to see that it has now
increased by $40.00. I
don’t have that much
more money so what do
I do?

Many seniors, especially those in low income, are worried
about the increasing cost of electricity. They simply cannot
afford increases and although assurances have been given
that mitigation will occur, seniors are not convinced this is
possible and seek clearer explanations. Some seniors are
interested in programs that help them lower their electricity
use such as energy efficient lights and heat pumps;
however purchasing up front (even with a plan to pay off
over time) is a burden for an older adult on a fixed income.

Home Support Services
Most seniors prefer to age in their own homes. However, they sometimes require
assistance with a range of supports and activities. The Provincial Home First Initiative
promotes access to home support services, equipment and supplies and health
professionals. This cost effective approach helps seniors remain independent in their
homes and communities, and avoids unnecessary hospitalization and/or long term care.
For this approach to be fully implemented, changes must occur in the way the system
currently operates.
Seniors are pleased with the changes to the financial assessment process whereby
contributions are now based on “income only”. However, this approach has not been
implemented universally throughout the system. For example, funding for hearing aids
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 and vision care is still based on income and assets. The transition to assessments based
on income only for all services must occur as soon as possible.
The Provincial Home Support Program, released in 2017, supports a Home First
philosophy. Proposed improvements are in four broad areas: program intake and referral;
assessment, planning and coordination; home supports delivery; and monitoring and
policy development.
While work is underway to implement changes to the Provincial Home Support
Program, seniors are still expressing concerns about a range of issues including the
length of time to complete an assessment and re-assessment, consistency of staffing
(including home support workers, nursing and social work), lack of management/
oversight, training of staff, difficulties in accessing information and lack of case
management.
Seniors in Labrador report that accessing home support services is almost impossible.
With no private home support agencies in Labrador many seniors and families must
make difficult decisions to move in order to access care outside of Labrador.
A strong philosophical approach focusing on aging in place and a well-integrated home
support program is essential.

Homelessness
The Seniors’ Advocate also heard about and is very concerned about the growing
number of seniors who are experiencing homelessness or living in substandard living
arrangements. Seniors are living on the streets, in slum conditions or couch surfing. The
Gathering Place in St. John’s reaches out to the most vulnerable people in society; they
provide meals three times a day, seven days a week, provide clothing, address dental
issues, offer foot care, and provide information and connect guests to supports and
resources. One in two registered guests is age 50 years and older while one in four is
age 65 years and older. Many live with chronic mental health challenges and/or
addictions. These are some of the most vulnerable citizens in our province.
The Seniors’ Advocate has received reports about seniors being evicted from personal
care homes and left homeless. While the Advocate appreciates and understands the
challenges of providing services to residents living with complex needs, a more
comprehensive and supportive process should be implemented.
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 There are homeless shelters that
accommodate older adults.
Connections for Seniors, located in
St. John’s, is an example of a
seniors-only shelter that offers
temporary accommodations as well
as wrap around services and
support. This ensures seniors’
needs are addressed and they are
able to transition into more
permanent housing. Much more
support is required to expand this
model.
To fully understand the scope of
homelessness among seniors in our
province the Seniors’ Advocate is currently reviewing the status of seniors and
homelessness in Newfoundland and Labrador. Findings and recommendations will be
shared later this year.

Safety and Security
Vulnerability – real or perceived – means being susceptible to violence due to
dependence on others for assistance and support. Unquestionably, this is an area of
concern for seniors.
While there is legislation that reaches out to very vulnerable adults including seniors
(Adult Protection Act, 2014), protection under this Act is limited to those adults who
are being abused or neglected and are incapable of understanding and appreciating
risk. Seniors and families report there are seniors who are capable however still very
vulnerable and experiencing abuse or neglect. There is a need to further explore how
these individuals can be better supported.
Violence Against Older Persons (elder abuse) continues to be a concern. While it has
been recognized that nine main types of violence are experienced by older persons:
physical, psychological, emotional, verbal, sexual, financial, neglect, spiritual and
cultural, there is still a need to create greater awareness. The Seniors’ Advocate
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 applauds SeniorsNL as a leader in providing information and knowledge through
ongoing education and research.
Discussing illness and death is an uncomfortable conversation that many people avoid.
However, one of the best ways to ensure seniors are less vulnerable is through future
planning. Completing an Advance Health Care Directive will ensure that your medical
wishes are clear and carried out by a substitute decision maker of your choosing. An
Enduring Power of Attorney will ensure that your financial affairs are managed by the
person of your choice. Lastly, a Will ensures that your estate is distributed as you wish.
The number of seniors who complete these documents is too low. While people may be
uncomfortable discussing these issues, cost is also a deterrent. The Public Legal
Information Association NL (PLIAN) is a non-profit organization which provides general
information including information about wills and estates. Some lawyers occasionally
offer to complete this work for seniors, free of charge.
The time has come to normalize this conversation through raising awareness and
providing opportunities for seniors to access affordable legal advice and services.

Transportation
Access to transportation means independence. Staying at home, running errands,
getting to appointments and socializing are all very important to
a person’s health and well-being.
We need to get
For seniors who do not have their own vehicles, finding reliable
transportation means depending on a friend or relative or paying
transportation fees. There are few public transportation options,
although models are slowly emerging throughout the province
especially through funding and support of the Newfoundland
and Labrador Community Transportation Program.

out to buy
groceries, go to
drug store or
meet with
friends. No
transportation
bars us in.

The Random Age-Friendly Transportation Program in Clarenville
is an excellent example of how community, with support of government, can provide a
transportation program that supports seniors and others to access social and
recreational events, everyday activities such as shopping and access to medical
appointments. Also, MetroBus in St. John’s, with support from the same provincial

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 program, has implemented a small bus service which visits seniors’ apartment buildings
on a regular basis and again allows seniors to access services and programs and
remain independent. This need exists throughout the province and seniors note that one
size does not fit all. Options need to be innovative and fit the clientele of the diverse
geography of the province.
Seniors who do have their own vehicles have to be able to afford to maintain and
operate the vehicle and remain healthy to retain a driver’s license. Mandatory tests to
determine a senior’s fitness to retain their driving privileges begins at age 75. Although
there is a fear of driving restrictions, most seniors are not complaining about the need
for these assessments; the complaints center on the fees. The Medical Care Plan
(MCP) does not cover the cost of these assessments and the fees paid to physicians
range from $0-$100 which can be unaffordable for many seniors. The province should
consider inclusion of this fee within MCP as the unavailability of transportation services
or losing one’s ability to drive, is one of the greatest contributors to loss of
independence and social isolation.

Healthcare
Residential and Health Care
The Seniors’ Advocate has heard that issues within residential and health care facilities
are complex, varied, numerous and inter-related, and are summarized as follows:
Policy

Care and Treatment

Staffing

• Institutional or
community based ways
of living
• First available bed
policy
• Keeping couples
together
• Sensitivity and respect
for culture, religion and
sexual orientation

• Medication use
• Urinary tract infections
• Use of restraints
• Oral health care
• Foot care
• Bathing
• Meals
• Aggression and injuries

• Resident-staff ratio and
skills mix
• Education and training
• Access to medical
professionals
• Records management
• Hours of care
• Management/Oversight
• Communication
• Respect and kindness

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 There has been significant concern expressed by seniors and their families regarding
care in hospitals, personal care homes and long term care facilities. The Seniors’
Advocate is especially concerned about repeated reports from residents and families
about fear of reprisal if they report their concerns. It is extremely concerning that
families feel unable to speak about the issues with staff and management as they do
not wish to be labelled a “trouble family” and fear
repercussions toward their loved one. This highlights
the need to create a forum where residents and families I live in Labrador and when
my wife got sick they
can express their concerns or suggestions in a nonmoved her to a home in
threatening way. It is important to reach out to those
Central Newfoundland.
individuals and families who have lived experience. The There is no home care
Advocate is committed to completing a confidential
here. My heart is broken.
survey with residents who live in care facilities and/or
their next of kin.
Concern is expressed over the “first available bed” policy whereby a person who is
waiting to enter a residential care facility must take the first facility opening offered, even
if it is not a preferred location. A resident can apply to be transferred but that may take
time and research shows that multiple transfers, even within the same facility, can have
very negative effects on residents and loved ones.
Policies which separate senior couples with differing care needs are distressing for
families. Sometimes senior couples may have to wait a long time to find a home where
both can live in the same facility or at the very least in the same community.
If I need to live in a long
term care home I am
worried that a straight man
might not want to share his
room with a gay man….and
will the staff accept me for
who I am?

LGBTQI2S seniors and visible minority seniors have
expressed vulnerability concerns related to
discrimination and general comfortableness, especially if
they are living in a residential care setting. The fear of
having to hide one’s sexuality or suppress one’s culture
or beliefs, while living in close quarters with a stranger, is
very real.

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 Primary Health Care
Seniors support a primary health care system where they can access services that
promote health and wellness, prevent illness, treat health issues or injuries, and
diagnose and manage chronic health conditions. This includes meeting dietary, medical,
nursing, pharmaceutical, social work and other health needs. The commitment to
expanding primary health care teams throughout the province is important.
The lack of geriatric specialists, community-based occupational therapists and
physiotherapists is especially concerning. As people grow older, health needs may
become more complex and require a team knowledgeable and skilled in aging issues.
Seniors appreciate opportunities to receive the flu shot, free of charge. However it must
be noted that the uptake is not as high as in other provinces. Efforts to advertise the
importance of vaccinations, when and where clinics are located, and sessions to
educate seniors must continue.
Seniors recognize that shingles is a debilitating disease that can cause much suffering
as well as increased costs to the health care system. Most health care plans do not
cover this cost including the pharmaceutical care plan. Many seniors report that the cost
is up to $300 for the two inoculations; many cannot afford this cost.

Dementia
As the number of older adults increases, so will the number of people living with a form
of dementia. Caregivers/supporters report that they are seriously challenged when
addressing the complex behaviours of their loved ones living with dementia. Yet,
research shows that by supporting families and caregivers,
institutionalization can be reduced. There are few adult day programs
I was never
and respite is almost non-existent. Families report that paid caregivers
trained to
are not always trained appropriately to care for a senior living with
know how to
care for mom. dementia. While the Alzheimer Society of NL focuses on education
I am lost.
and support to families and others regarding all forms of dementia,
they are seriously under resourced and do not have multi-year
funding.

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 The Seniors’ Advocate was pleased to see the Federal Government release A
Dementia Strategy for Canada: Together We Aspire. It has three primary objectives:
prevent dementia, advance therapies and find a cure, and improve quality of life of
people living with dementia and caregivers. Newfoundland and Labrador must now
move forward with how to best integrate these objectives. The Seniors’ Advocate is very
interested in how the provincial government will move forward to implement these
objectives.

Dental, Hearing and Vision Care
As people age, health care needs change. Most people will experience challenges with
dental, hearing and vision care. For people without sufficient health insurance coverage
or eligibility for government assistance, access to oral health care, eyeglasses, and
hearing aids is simply too expensive
The Canada Health Act does not include dental, hearing or vision as required health
care services unless a procedure takes place in a hospital. Therefore, provinces and
territories may provide different services.
Low income seniors have reported concern about
the lack of a dental care program. Age-related
illnesses and medications may damage teeth,
highlighting the importance of preventative
measures.
The Seniors’ Advocate has heard from a large
number of seniors about affordability of dental
services including cleanings, fillings, extractions,
dentures or denture repairs. It would appear that
while a few dentists offer a repayment program,
this is not the norm and bills are expected to be
paid immediately.

My sister, who, at 83, is
subsisting on OAS and GIS
monthly and is now faced with a
dental bill of over $2500 because
she requires all of her upper
teeth to be extracted, has an
infected bone in her mouth, and
will need dentures. She will have
to borrow the money.

It is positive that dental services are being provided free of charge by volunteer dentists
at The Gathering Place to a very small number of the most vulnerable people, including
those homeless or those living in precarious situations. Unfortunately, a large cohort of
the senior population remains without dental services.

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 It’s like my mouth is divorced
from the rest of my body;
health care addresses the rest
of me but not my mouth.

As people live longer, the demand for oral health care
will increase and for many seniors, out-of-pocket
dental care is out-of-reach. Oral health care goes
beyond cosmetics, as the links between oral health
and general health are irrefutable and influenced by
income and social status, education, employment and
personal health practices.

Research has linked acquired hearing loss to a number of health conditions including:
cognitive decline and/or an increased risk of cognitive decline, diabetes, heart disease,
chronic kidney disease and depression. Recently, a link has been made between
hearing loss and falls.
Seniors who develop hearing loss sometimes do not seek help because they are
embarrassed, accept it as a “downside of aging” or are put-off by the cost of hearing
aids. Any or all of these barriers can contribute to seniors becoming socially isolated.
Untreated/undiagnosed hearing
loss can negatively skew the
results of cognitive tests causing
inaccurate results. Hearing aids,
devices and batteries are
expensive. Like any piece of
electronic equipment that is used
daily, hearing aids may need
repairs or complete replacement
after a number of years. Depending
on the type of device, the cost can
be thousands of dollars.
Batteries and regular maintenance
is another fee, if not included with
the purchase of the devices. Some seniors can receive financial assistance through
private pensions or the provincial government. All other seniors must pay out-of-pocket.

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 Vision care issues fall within several categories. Many seniors report concerns
regarding cataract surgery, particularly the lengthy wait list. In a preliminary review, the
Seniors’ Advocate found that sometimes it takes up to a year for a patient to be seen by
an Ophthalmologist. After the diagnosis, wait times for cataract surgery may be up to
two and half years, depending on which Ophthalmologist is performing the surgery.
Seniors are confused about what constitutes a “wait time”; that is, the length of time to
see an Ophthalmologist, followed by the wait time to have surgery. Having a central
intake, where a patient is referred to the next available Ophthalmologist, could
potentially speed up the process. The process must be as fast as possible because
having cataracts untreated can lead to significant stress and limitations in general life
activities as well as vision loss.
Macular degeneration is another eye disease that is often age related and if untreated
can lead to loss of central vision. While there is no cure, progression of one form of the
disease (wet) can be slowed. Seniors report that coverage through the Newfoundland
and Labrador Prescription Drug Program is limited to a lifetime maximum of 15
injections. This is also true of for some private insurance plans. Any additional injections
must then be paid for by the patient. A preliminary review by the Seniors’ Advocate finds
that no other province limits the number of funded injections. Seniors report that they
simply cannot afford any additional cost; the result of which is blindness.
The cost of eye glasses continues to be of concern as often age related changes
require multi-focal lenses which are expensive. Many seniors do not have health
insurance which covers at least a portion of the cost.
In summary, as we grow older we experience dental, hearing and vision challenges.
Currently, seniors struggle to totally or even partially cover these costs, which leads to
increased dependence, other health issues and poor quality of life.

Access to Appointments and Medical Transportation
Seniors describe lengthy wait times to avail of many programs and services. Even when
a specialist is available to visit a remote area of the province to hold clinics, often times
not everyone has an opportunity to be seen.
The distance to travel for appointments is a deterrent; seniors in Labrador and other
rural and remote areas are especially impacted.
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Long May Your Big Jib Draw: Setting Sail

 Seniors report that the Medical Transportation Program does not meet their needs.
Even when travel costs are supported through the medical transportation program, it
can takes months to be reimbursed. Low income seniors describe situations where they
are forced to cancel the appointment as they cannot afford the cost up front or wait for
reimbursement.
Seniors suggest that consideration be given to streamline the process to ensure speedy
reimbursements and consider alternative options such as flights be paid for by
government directly.

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Long May Your Big Jib Draw: Setting Sail

 Labour Force Participation
Seniors are concerned about how to stay attached to the labour market. There is no
mandatory age of retirement. People choose to retire at different times dependent on
their economic situation as well as their interest in continued attachment to the
workforce.
As the current population trend continues, it is realistic to expect people to work well into
their 60s and 70s. Yet, too often older workers are perceived to be less productive, less
receptive to training, not cost effective, more resistant to change and at greater risk of
accident or illness. However, research shows that these myths and stereotypes are
false. Employers need to continue to retain and recruit older workers.
Seniors’ concerns fall within three categories: continued attachment to the workforce,
the stability of pensions and access to benefits.

Continued Attachment
Seniors who choose to remain attached to the workforce likely fall within two groups:
people who want to continue working and people who must continue working.
Seniors have relayed incidents of being “forced” into taking retirement offers or being let
go from their position. For seniors who have tried to rejoin the workforce, some have
found employers looking to hire older workers, while most have found that employers
hesitate.

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Long May Your Big Jib Draw: Setting Sail

 Pension Stability
The Human Rights Act identifies “age” as a prohibited ground for discrimination. The
Act, however, exempts retirement or pension plans.
Retired or soon-to-retire seniors with private pensions are expressing serious concerns
over the stability of those pensions as pension plans become underfunded or
companies declare bankruptcy. There is provincial legislation (The Pensions Act) and
a Superintendent of Pensions who provides oversight to ensure pensions are
administered properly. However, there have been instances when a company goes into
insolvency and retirees are impacted. For example, in 2014 Cliffs Natural Resources
(Wabush Mines) went into creditor protection and left the pension and medical plans
underfunded, resulting in retirees losing up to 25 per cent of their payments. The
pension plan was considered an unsecured creditor and not a priority of the company’s
debtors. After years of legal battles, a deal was approved and funds were put back into
the plan. There is concern about the lack of legislation protecting retirees under these
types of circumstances.

Access to Benefits
As noted above, the Human Rights Act identifies “age” as a prohibited ground for
discrimination. The Act, however, exempts group or employee insurance plans.
Seniors have expressed great concern that some workplaces do not offer benefits upon
reaching a certain age. Seniors reported losing their long term disability and health
benefits at age 65 and 70 even though they continue to work. They also note that some
employers do not offer any type of program where they can continue to purchase those
health benefits. Seniors are especially concerned about the loss of health benefits
including vision and dental as this can be devastating when living on fixed incomes.

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Long May Your Big Jib Draw: Setting Sail

 Setting the Course
The Seniors’ Advocate is legislatively obligated to bring attention to areas where
improvements are needed and, if necessary, offer recommendations. The Advocate is
also committed to supporting and highlighting the efforts of government and other
service providers when programs are meeting seniors’ needs. In both instances, the
public will be informed.
The Seniors’ Advocate has conducted numerous consultations throughout the province.
The Advocate has met face to face and via telephone, received reports via email,
submissions on website and via regular mail. A number of preliminary reviews,
presentations and opinions on issues have been completed.
The following concerns have emerged as priorities for the Seniors’ Advocate, with
several clearly requiring immediate attention.

AGING IN PLACE
1. The Seniors’ Advocate recognizes that an age-friendly community is friendly
to all its citizens regardless of age.
Action: The Advocate supports and encourages all efforts to enhance, expand and
maintain age-friendly communities throughout Newfoundland and Labrador.

2. The Seniors’ Advocate is committed to better housing options for seniors.
Action: The Advocate will work with partners, service and program providers to
improve housing options and housing programs for seniors.
Action: The Advocate will monitor results of Newfoundland Labrador Housing’s
portable versus fixed subsidies pilot study.
Action: The Advocate will encourage the integration of accessibility principles into
building codes for all private and public buildings.
Action: The Advocate supports an expanded and enhanced Home Repair Program.

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 Action: The Advocate will continue to monitor electricity rates and the impact on
seniors.

3. The Seniors’ Advocate is committed to a home first philosophy whereby home
support services, equipment and supplies, and appropriate health
professionals are available to people in their own homes.
Action: The Advocate is closely monitoring the implementation of the Provincial
Home First Initiative as well as the recommendations from the Provincial Home
Support Program Review.

4. The Seniors’ Advocate recognizes the growing number of seniors who are
experiencing homelessness or living in substandard living arrangements.
Action: The Advocate is currently reviewing the status and scope of homelessness
among seniors in Newfoundland and Labrador.

5. The Seniors’ Advocate recognizes the importance of balancing vulnerability
with independence and self-determination.
Action: The Advocate encourages a review on how to best support vulnerable
seniors’ and others who have capacity to understand and appreciate risk however
are being abused and/or neglected.
Action: The Advocate encourages raising awareness and providing affordable
opportunities for seniors to access Advance Health Care Directives, Enduring
Powers of Attorney, and Wills.
Action: The Advocate encourages the integration of the cost of driving medicals for
those age 75 years and older into the Medical Care Plan.

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Long May Your Big Jib Draw: Setting Sail

 HEALTHCARE
6. The Seniors’ Advocate is committed to improving living and working
conditions within personal care homes and long term care homes.
Action: The Advocate recommends a significant review of the province’s personal
care homes and long term care homes.

7. The Seniors’ Advocate supports the expansion of primary health care
throughout the province.
Action: The Advocate recommends concrete actions be taken to increase the
number of health care professionals with gerontology expertise (specifically, geriatric
specialists) and community-based occupational therapists and physiotherapists.
Action: The Advocate recommends that the shingles vaccine be offered free of
charge to low income seniors and others with compromised immune systems.

8. The Seniors’ Advocate recognizes that the number of older adults living with
dementia is increasing.
Action: The Advocate will be closely monitoring the development and
implementation of a Provincial Dementia Care Plan.
Action: The Advocate supports the work of the Provincial Alzheimer’s Association
and encourages consideration of multi-year funding.

9. The Seniors’ Advocate is committed to dental, hearing and vision care for
seniors.
Action: The Advocate encourages policy-makers to include dental, hearing and
vision care as part of overall health care and chronic disease strategies.

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Long May Your Big Jib Draw: Setting Sail

 Action: The Advocate will conclude its review of adult dental health services for low
income seniors.
Action: The Advocate will review vision care needs of seniors.
Action: The Advocate will review hearing needs of seniors.
Action: The Advocate will explore how dental, hearing and vision care needs of low
income seniors be included under the Canada Health Act.
Action: The Advocate recommends that the transfer of funding responsibilities for
the hearing aid and vision care programs be expedited (that is, moved from the
Department of Advanced Education, Skills and Labor to the Department of Health
and Community Services).

10. The Seniors’ Advocate recognizes that low income seniors cannot afford the
cost of medical transportation.
Action: The Advocate recommends that a review of the Medical Transportation
Program be completed.

LABOUR FORCE PARTICIPATION
11. The Seniors’ Advocate is committed to older workers and age friendly
workplaces.
Action: The Advocate will partner with stakeholders to host a summit on older
workers in November 2019. It will bring together employees, employers, policy
makers and others to explore the changing landscape of the workforce.
Action: The Advocate will further examine “age” within the context of the Human
Rights Act and its impact on pension/retirement plans, as well as employee
insurance plans.

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Long May Your Big Jib Draw: Setting Sail

 Conclusion
The work of the Office of the Seniors’ Advocate has only just begun. The concerns
outlined in this report are certainly priority concerns at this time but as priorities evolve
and shift, so might the Seniors’ Advocate’s focus.
Issues reviewed by the Seniors’ Advocate may result with reports accompanied by
recommendations, reports with findings but without recommendations, opinion pieces,
correspondence and presentations. The work may take weeks or many months.
Regardless of how findings are presented, the Seniors’ Advocate will expect suitable,
timely responses. Recommendations will be closely monitored to ensure changes are
implemented. Further, all reviews conducted by the Advocate and regular updates on
progress will be made public, circulated amongst stakeholders when possible and easily
available on the website of the Office of the Seniors’ Advocate.
Every Newfoundlander and Labradorian should be very interested in the work of the
Office of the Seniors’ Advocate. If you are not a senior now, hopefully you will be one
day. There is no doubt that achieving positive, lasting improvements takes time. But
with commitment, effort, and collegial partnerships, advancement is certain. It is
incumbent on each of us to ask questions, raise our voices against injustices and never
stop seeking a better way; the work must never cease.

Fair winds and following seas
and long may your big jib draw.

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Long May Your Big Jib Draw: Setting Sail

 (709) 729-6603
1-833-729-6603
2 Canada Drive
Sir Brian Dunfield Building
P.O. Box 13033
St. John's, NL A1B 3V8
seniorsadvocate@seniorsadvocatenl.ca
www.seniorsadvocatenl.ca