A question of priorities


As the population continues to increase in average age, we will be facing challenges in financing health care for those dealing with end of life issues. I began thinking about this after reading an article about trans-sexuals in the National Post, a Canadian newspaper. Ontario’s government healthcare monopoly has decided that sex changes are medically necessary and will therefore be included in the procedures for which the province will pay.

The article, written by one Nina Arsenault, a Toronto-based trans-sexual (or self-described “T-girl”) details just how tough being a trans-sexual can be. Arsenault complains that the actual surgery is only about $20,000 per year, which is a mere drop in the bucket of a $40+billion healthcare budget and uses the argument that since ‘gender dysphoria’ is recognized as a legitimate mental illness in the Diagnostic and Statistical Manual of Mental Disorders, the full cost of a sex change should be covered under the province’s healthcare system.

The full cost of such surgery would include items such as breast augmentation, cosmetic facial surgery, electrolysis and shaving down the Adam’s apple, to name a few.

Let’s change venues for a moment and look what the province of Ontario is prepared to do for its seniors living in nursing homes. Out of the $40+ billion dollar healthcare budget about $2.8 billion goes to long-term care. The residents of these facilities are required to pay about $2,000 per month and in turn receive meals, nursing care and accommodations.

Meals are subsidized by the Ontario Government to the tune of $5.46 per day per senior (compared to $11.43 per day for inmates of the province’s prisons)

Recently, George Smitherman, Ontario’s Minister of Health, talked about trying out a new, substantially more absorbent diaper by wearing it for a day to “better understand the patient’s experience” before addressing concerns by the Ontario Federation of Labor (OFL), the union representing workers in long term care facilities. The OFL maintains that it does not have sufficient staffing to adequately care for seniors and the health minister’s response was to provide diapers with increased capacity that would not need changing as often.

It’s a small point, but it all adds up to what Ontario’s healthcare system’s priorities are. Given that the current population of Ontario is 12.1 million people of whom more people are over the age of 40 that under the age of 40, it doesn’t take a mathematical genius to determine that eldercare in the province is on a collision course with disaster.

I personally have been privy to the shabby care provided to Ontario’s elders, as a friend’s mother had a severe stroke and is left partially paralyzed and spending her last days in an Ontario long-term care facility. The nursing home has 127 residents and the staffing levels are a joke. During her first two weeks there my friend’s mother developed three bedsores, one of which is quite serious. Often times these sores are caused because the patient is not turned often enough in bed or the patient’s diapers are not changed with enough frequency. But then, if there are only 4 nurses looking after 127 patients, then the patients are bound to suffer.

As the population ages and more and more people will require long-term care these problems will become ever more prevalent. Public healthcare systems all over North America will have to establish priorities about what is or isn’t medically necessary. It would appear that sex reassignment surgery is a luxury that Ontario’s healthcare system can ill afford, so long as its nursing home residents do not receive minimally adequate care.

Written by Klaus Rohrich on Saturday, 30 January 2010

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