Originally published at Ottawa Citizen
Important legislative amendments in the past month will assist adult children with the care of their ailing parents. These are also a harbinger for the increased engagement that society will demand of families in providing direct care for seniors in the years ahead.
Federally, employment insurance (EI) will now provide a family caregiver benefit of up to 15 weeks to care for an adult family member whose life is at risk and who has experienced a significant change in their baseline state of health. Ontario has responded with the Fair Workplaces, Better Jobs Act, 2017 (Bill 148), which introduces the concept of critical illness leave of up to 17 weeks for an employee to care for an adult family member. Family medical leave in Ontario is also being extended from eight weeks to 28 weeks for employees to look after a family member with a serious medical condition.
These are welcome changes in the law. They underline three important realities that will demand a greater role of family members in providing direct care to seniors approaching their final years: financial, demographic and moral.
On the financial front, health care is already the largest single budget category in all provinces, and seniors’ care is the fastest-growing segment. Numerous government initiatives have highlighted the role of publicly funded home care in meeting the challenge – the Action Plan for Health Care and Patients First are examples in Ontario.
But home care is geared to seniors who need only a couple of hours of care per day, and it cannot support – financially or logistically – those who need more constant care or monitoring. The long-term care alternative offers 24-hour care, but is even more costly to government, which shoulders a monthly bill of $3,500 per resident. Accordingly, there is scant political will to increase the stock of beds substantially, and wait times in the system regularly exceed the life expectancy of seniors on the list.
Demographically, most of us recognize that older adults are set to expand in number in coming decades, but few are aware just how skewed the old-to-young ratio will become, given our falling birth rates in Canada. This will put the stock of available caregivers, both professional and familial, in short supply and highlight the need for policies that provide incentives to adult children to do their part.
Those who bear the burden of parental care make a sacrifice in time and money for which the new employment insurance and job leave amendments will not fully compensate. But there is a social and moral issue here of equal importance. To what extent should we, as a society, acknowledge a duty of adult children to be the frontline caregivers to their parents?
Consider, by comparison, the social and legal norms that we all observe in caring for our children. Most of us would concede that responsibility for such care resides primarily with the family and only secondarily with our government. Indeed, section 215 of Canada’s Criminal Code creates a legal duty for every parent to provide necessaries of life (food, shelter, clothing) to their children.
Some would argue for a similar legal obligation towards our parents. The Advocacy Centre for the Elderly (ACE) considers the failure to provide the necessaries of life to older adults as a crime in certain cases. Indeed, adult children have a duty under the Criminal Code to provide necessaries to their parents, but only if the parent is already under their charge. The real issue, then, is whether adult children should be required, or expected, to take charge of their parents’ care.
The principle has appeal, but the duties of adult children to their parents is not quite the same as that of parents to their young children. A parent chooses to bring a child into the world – or at least is the cause – and care obligations can generally be traced to two adults with equal and unconditional responsibility. With an aging parent, things are more complex.
There is an element of entropy in the life course that can create a separation between an adult child and his parent over time, sometimes locational and sometimes relational. Should the child be expected to return to the roost? And what is the relative responsibility of sibling children towards their parents, as emotional ties, financial wherewithal, and geography diverge? There is evidence that parent-care falls disproportionately on those who are local or female, or both.
However the obligation is framed, we should expect to see more adults stepping up to care for their aging parents as the seniors’ population balloons and public coffers are depleted. We may not see the model of the traditional family re-emerge any time soon. But the legislative nudges of the past month should help reinforce familial ties and duties as Canadians strive to age in place.