President Obama has begun his campaign for re-election in 2012. Several Republicans have declared their intention to consider the possibility of running. Meanwhile, implementation of health care reform proceeds slowly, with threats of defunding and legal action scuttling alongside to keep up. Policy debates about accountable care organizations, medical homes, and other attempts to bring some order into the busy marketplace are mostly about money and control, with very little emphasis on tangible benefits to chronically ill patients and even less emphasis on explicitly helping their family caregivers.
Imagine a national election campaign that lasted 38 days. Imagine further that a major issue in the campaign is the extension of tax, employment, and other benefits to family caregivers. In contrast to the U.S. where we celebrate 2011 as the Year of the Family Caregiver with events, speeches, and praise for “unsung heroes,” early next month Canadians are going to vote on increased support for caregivers.
The most recent government, headed by Conservative Prime Minister Stephen Harper, fell on a parliamentary vote of nonconfidence on March 9. That set the stage for the current campaign, which will culminate in a vote on May 2. The leading challenger, Michael Ignatieff, is head of the Liberal Party, a generally middle-of-the-road party.
Canada, like the U.S., is facing a major increase in the number of older people who need health and social services. And, as in the U.S., the primary providers of elder care are family members. About 2.7 million Canadians over the age of 45—about one in five in this age group–provide care for older people. They provide 80 percent of the long-term care, and their unpaid care is estimated at over $9 billion a year.
A quarter of Canadian family caregivers miss one or more months of work to provide care. Over three-quarters of caregivers are women, who are more likely to have lower wages, less savings, and additional family responsibilities. A recent poll by the Canadian Cancer Society found that 84 percent of Canadians wanted increased financial support for family caregivers to be a priority health care issue in the next election.
Canada does not have a national health service. The Canadian Health Act of 1984 sets out standards that provincial and territorial health insurance programs must meet to receive federal funding. These criteria include universal coverage and free “medically necessary” hospital and physician services. Services from other professionals such as nurses and physical and occupational therapists are covered, but there is a long waiting list for therapists. The level of funding is a campaign issue, with Conservatives saying increases must be curtailed, and Liberals staving off discussion until 2015. What is considered “medically necessary” has been a continual source of debate. In this campaign the New Democrats, a smaller party on the left, are promising to include home care and long-term care in this category.
All the parties acknowledge that family caregivers need more financial support. The Conservative platform proposes a nonreimbursable tax credit of $2,000. This amount, added to existing dependency-related tax credits, the party says, will benefit 500,000 Canadians. People caring for “infirm dependents” in their homes will be eligible. Since the tax credit applies only to those who pay taxes, this benefit would benefit more affluent people.
The Liberal Party’s platform is more far-reaching. It includes spending up to $1 billion a year to implement:
- A new six-month Family Care Employment Insurance Benefit (EI) for caregivers to take time off to care for family members without having to quit their jobs. The current EI “compassionate care” benefit lasts only six weeks and requires a doctor’s documentation that the ill family member is at significant risk of dying within 26 weeks. The proposed benefit would allow the caregiver to take the time off in smaller increments over a year and will change the doctor’s certification requirements. The plan would cost $250 million a year.
- A new Family Care Tax Benefit. Many lower- and middle-income caregivers, such as retirees, self-employed workers, or those who have quit their jobs to provide care, do not currently pay into the EI program and do not qualify for the compassionate care benefit or the proposed new EI benefit. The new benefit would provide a tax-free monthly payment worth up to $1,350 for up to 12 months for caregivers who provide care in their homes. It will be available to family caregivers with incomes under $106,000, including families with sick children. The Liberal Party estimates that this benefit will help 600,000 caregivers every year at a cost of $750 million.
The Canadian Medical Association (CMA) and the Canadian Home Care Association (CHCA) are in favor of additional financial support for family caregivers. However, Dr. Jeffrey Turnbull, president of the CMA, says, “We need more than a simple intervention in one area…We need to bring all the different facets of care together, and bring them to the home.” And Marg McAlister project manager for the CHCA, wants increased support for professional health care services such as nursing, speech therapy, and social work.
The high profile of caregiver support in the upcoming election stems in part from the realities of an aging population and a caregiver population that is straining to meet the demands, as well as the persistent advocacy of the Canadian Caregiver Coalition. But it also may be in part the particular passion of Michael Ignatieff, who is well known in the U.S. as a writer, political scientist, and university professor. His mother died in 1992 of Alzheimer’s disease, and his 1994 novel Scar Tissue portrays two brothers’ struggle to care for their mother devastated by dementia.
What accounts for the higher priority given to family caregivers in Canada? Only a full analysis could answer that question, and the outcome of the election may not result in major changes. Still the fact that this is on the public agenda in a much more visible way than in the U.S. warrants some thoughtful reflection.