NACA's Report Card:

Measuring Progress on the Seniors Front

In 1999, the National Advisory Council on Aging began developing a tool to assess and monitor progress on key issues that affect seniors' daily lives. With the help of gerontology experts and other stakeholders, NACA prepared and published the first Report Card: Seniors in Canada in 2001. This article explains why the Report Card was developed, what its objectives were and what can be expected of future Report Cards.

Why a Report Card?

Seniors in Canada: A periodic Report Card of the National Advisory Council on Aging. A year earlier, NACA had released “1999 and Beyond: Challenges of an Aging Canadian Society”, its contribution to the International Year of Older Persons. This publication provided a snapshot of seniors’ lives in 1999 and attempted to gauge what seniors’ problems might be 5, 15 or 25 years later.

The report examined five key areas affecting seniors’ daily lives – their health, economic situation, living conditions and participation in society, and how the health care system serves seniors – and identified their significance on both individuals and society as a whole. It urged governments and policy-makers to address the issues with more vigour and suggested indicators that could measure changes and progress. While 1999 and Beyond proved useful in assessing current issues facing seniors and anticipating future ones, it did not provide the means of monitoring and reporting progress. Thus, the need for a Report Card was born.

The report card formula adopted by NACA reviews data and trends and reports on progress made (or not made) on five key policy questions: How healthy are seniors? How well is the health care system serving seniors? How well are seniors faring economically? How supportive, enabling and safe are seniors’ living conditions?, and finally How fully are seniors participating in society? The objectives of the Report Card were twofold : first, to stimulate policy discussion and action on seniors’ issues at all levels of government; and, second, to increase public awareness of Canadian seniors’ situation and dispel myths about aging.

Drawing on the expertise of gerontology experts, seniors’ organizations and governmental bodies working in the field of aging, indicators were developed to monitor progress over time in those five key areas. The indicators were defined using the following criteria: information had to be collected nationally; it had to be collected regularly to allow for ongoing tracking; collected data had to cover the key issues sufficiently; and the indicators had to have the capacity to influence policies and programs. A decision was eventually made to focus on a minimum set of indicators, providing NACA with the flexibility to adapt to changing and emerging issues. The first report, Seniors in Canada: A Report Card, was released in 2001.

Initial Findings

After analysis and interpretation of the indicators, grades were assigned to each of the five areas being measured. Trend directions were noted for each area (improving, worsening or stable) and highlights illustrated areas with good outcomes or areas where improvements were needed. Additionally, priorities for immediate action were identified for each issue. In that first Report Card, NACA was able to grade only four of the five areas. One area, the performance of the health care system for seniors, could not be graded due to inadequate indicators and lack of reliable national data.

The resulting overall grade of ‘C’ meant that, although the condition of seniors was found to be satisfactory, there were still significant improvements required. The 2001 Report Card noted that good progress had been made in improving the quality of life for seniors since the 1980s, particularly in the areas of health status and economic security. It reported that most seniors lived in affordable housing, had access to transportation and were involved in their families and communities.

There remained, however, several areas of concern. Notably, too many seniors were experiencing unintentional injuries, too many were victims of fraud and not enough seniors were getting the health benefits associated with adequate levels of physical activity. It was found that some seniors were being forced to leave the labour force due to mandatory retirement policies in some jurisdictions and social well-being was not shared equally among all seniors.

NACA recommended priorities for action in the areas of injury and suicide prevention, promoting physical activity for older persons, addressing the economic security issues of older women living alone, increasing the number of affordable housing units available for seniors and abolishing mandatory retirement. Finally, NACA undertook to publish a full Report Card every five years and regular progress reports in between.

As part of the production of the Report Card, NACA instituted an evaluation process to determine the Report Card’s effectiveness. Tear-off sheets were attached at the end of the publication to obtain readers’ comments and suggestions on the content and presentation of the Report Card. Additionally, an expert advisory group, composed mainly of gerontologists and academics, was asked to submit an evaluation of the Report Card. Most of the comments were positive, in that readers found the report useful, easy to read and felt that it achieved its objectives.

Building on the Foundation

Armed with a base tool, NACA set to work collecting and analyzing data for the Interim Report Card : Seniors in Canada (released in October 2003). It was decided that no grades would be given in the interim report, that it would instead provide an update on the priority concerns identified in the 2001 Report Card and look at emerging trends – both promising and worrisome.

In the intervening years between the first Report Card and the Interim Report Card, the United Nations had held its Second World Assembly on Ageing in Madrid, where Canada endorsed the Madrid International Plan of Action on Aging (April 2002). The Plan addressed three key policy themes: older persons and development, advancing health and well-being into old age, and ensuring enabling and supportive environments.

There is growing evidence of the impact of population aging on all societies and additional momentum was built at the Second World Assembly on Ageing. Since only two years separate the inaugural Report Card and the first progress report, NACA was not surprised to find few positive changes for Canadian seniors when compiling data for the Interim Report Card in 2003. There were, however, new data on health services that provided hard evidence to justify action in the area of health, such as ensuring appropriate and effective drug practices, improving access to and adequacy of home care, and increasing the number of health professionals, particularly geriatricians.

Areas that did show improvement included some aspects of seniors’ safety and health, such as a slight decrease in the number of unintentional injuries and falls, a slightly higher rate of physical activity in seniors aged 65-74, and a minimal decline in an already high suicide rate among men aged 85 and older (from 34.3 per 100,000 men to 31.0 for every 100,000 men). NACA was also pleased to note that recent federal, provincial and territorial initiatives put in place to improve the accountability of the health care system had resulted in new studies related to seniors’ access to health care and their level of satisfaction with the care they have received. There had been insufficient information available on this issue in 2001.

In its Interim Report Card 2003, NACA noted that Canada is still ill-prepared for the important demographic changes that will accelerate starting in 2011 when the frontrunners of the baby boom generation will be reaching 65 years of age. It saw an increasingly urgent need to improve health care for seniors, including health promotion and disease prevention programs. It also reported on the need to monitor and act upon disturbing trends in the effects of rising costs on economically vulnerable seniors. Finally, it urged the federal government to exercise leadership in implementing the UN Plan of Action on Aging in Canada.

What Next?

So where does the Report Card go from here? NACA will continue to carry out research and to compile data on the five issues it uses to monitor the situation in preparation for the release of the next full Report Card on Seniors in Canada in 2006.

Important emerging issues that will likely be raised in the next Report Card include the growing need for more home care services and for standards of care for seniors living in long-term care institutions and nursing homes. There are also indications that unattached senior men and senior families are now becoming more economically vulnerable. While their situation is not as precarious as that of unattached senior women, the trend noticed in 2003 is cause for concern. The impact of rising costs for essential goods and services, such as utilities and insurance costs, on economically vulnerable seniors needs to be further monitored and assessed.

NACA did note in the Interim Report Card that there have been some federal initiatives to address seniors’ well-being, such as pension reform, health care renewal and the creation of the Canadian Institutes of Health Research - Institute on Aging. While these measures are undeniably positive, stated the report, the federal government has forgotten its1997 electoral commitment to promote healthy aging. New government initiatives in healthy living such as the Healthy Living Strategy, in health care, in affordable housing or in lifelong learning could provide benefits for seniors, as long as these programs and policies are developed with a “seniors’ lens,‘’ focusing on seniors’ specific needs.

Two Task Forces of interest to seniors were created since the publication of the Interim Report Card. The Liberal Caucus Task Force on Seniors, created in September 2003, presented its report in February 2004. Its recommendations are in line with many of NACA’s priorities as expressed in the Report Card – ensuring income adequacy, improving home care and addressing mandatory retirement issues. Last December, Prime Minister Martin established a new Task Force on Active Living and Dignity for Seniors. Again, for the benefit of this Task Force and all seniors, NACA will be able to use the tool it created in 2001 to help shape the recommendations that will be developed by the Task Force. Long live the Report Card!