senior man kissing his wife while gardening

Many Canadians are proud of their country's health care system and rely on it to support them if they get injured or sick. However, not all medical costs are covered, including the unique treatments and support we may have as we get older.

"What a lot of people don't realize, when it comes to long-term care — in particular, home care — is that these are not guaranteed government-subsidized programs," says Michael Nicin, executive director at the National Institute on Ageing (NIA) at Ryerson University, a think tank focused on the realities of Canada's ageing population.

"In a lot of cases, if you want to age at home with independence for as long as possible, you might get a little bit of support from government programs, but a lot of that has to come out of your pocket... having the resources is absolutely necessary."

Covering health care expenses as we age is a growing concern given rising medical costs, longer life expectancies and the increasing number of seniors in Canada.

According to the NIA, the number of Canadians over age 85 is expected to rise to 2.6 million by 2050, up from about 844,000 today. NIA research also shows spending on long-term care is expected to more than triple to $71 billion by 2050.

And while Canadians can expect to live longer, healthier lives, than previous generations, Nicin says they should still expect to require some level of care as they reach their 80's.

"Because we're living longer lives, you could still expect, for any given situation, that you'll spend 10, 15 years, where you'll need some level of care," he says. "No one goes from being ... fully independent and healthy into a nursing home. There's usually a progression and it might start with a few hours of home care." Support may then increase, depending on your specific needs.

Planning for dignity

Nicin and the NIA encourage Canadians to plan ahead for the costs of ageing, including figuring out what level of care you want and what role your family might play. Nicin says the thought process involves asking the question: "What does a dignified life mean to me?"

"I think it's important to start having those conversations early, meeting with financial advisors, talking to your doctors who could give you advice on planning for your own care; and then, of course, bringing your family into that discussion to say, 'These are my desires. These are my wishes,'" Nicin says. "Dignity starts with taking control of your life."

He recommends people start planning in their 30s and 40s, as they begin to advance in their careers, earn more money and save for their future.

"I think it has to start sooner rather than later, and it's not just a cliché," Nicin says. "If you're waiting for your 50s and your 60s to figure out where your resources are going to come from for health care, you've probably waited too long."

Also, the longer you wait to plan for how you'll live later in life — for example, in a long-term care home or receiving at-home care — the greater the potential someone else may have to make the decision for you.

"Part of an empowered, dignified later life is ... taking the reins and saying, 'this is the kind of life I want to have,'" Nicin says. "We do that with almost every aspect of our lives, whether it's your own family planning or the schools you choose to go to, or the kind of people you spend time with. But for some reason ... we don't do that in our own later lives."

The best way Canadians can empower themselves to achieve their retirement and ageing lifestyle goals is to work with advisors, says Leanne Kaufman, president and CEO of RBC Royal Trust, a division of RBC Wealth Management. RBC Wealth Management recently formed a partnership with the NIA to help Canadians prepare for financial and health issues as they age.

Kaufman recommends people work with a wealth advisor to ensure they have sufficient funds, if needed, to cover health expenses such as long-term care. Advisors, working with lawyers and other professionals, can also help people draw up health directives, Wills and power of attorney documents that are an essential part of any comprehensive health and wealth management plan.

"It means having choices about how and where you live in the last chapter of your life," she says.

Kaufman also recommends people revisit their health and wealth management plans regularly, particularly if there are major life changes, such as a marriage, divorce or an inheritance.

"It's a really important point that [the plan] needs to keep continually coming back and being revisited as circumstances change," she says.

Having the uncomfortable conversation

Talking about how you want to live in the last chapter of your life, and what happens when you die, is uncomfortable and considered taboo in many families, Nicin says.

"We have a morbid fear of death and talking about it," he says. "We are a polite society... [We] have to confront this sort of mental barrier to talking about the fact that, yes, you're getting older. It's not always going to be pretty."

Some parents are reluctant to start the conversation with adult children because they don't want to be a burden, while some adult children don't want to think about their parent's ageing.

"[They] want to think that things are going to be great and perfect forever," he says. "We have to get over our lack of willingness to talk about it."

Having the conversation sooner also gives people more time to plan for what they need and want later in life.

"Presumably, you're in a position today to do something about your own future, even if it's just that opening conversation with your spouse, with your adult children, with a family friend," Nicin says. "Have it today, and then you don't have to be worried about it later, when you may be unable to."

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