B.C.’s seniors advocate Isobel Mackenzie thinks rural residents in the province are not getting a fair shake when it comes to many services and opportunities.
It’s even worse, she says, for rural residents over the age of 65.
“Everybody’s a B.C. taxpayer, but everybody isn’t getting equal services and supports as they age, and that’s pretty clear,” Mackenzie told an audience at the Nelson Seniors Centre on Feb. 15.
On the eve of her retirement — she is the province’s first seniors advocate and has held the position for nine years — Mackenzie has just released a report entitled Resilient and Resourceful: Challenges Facing B.C. Seniors.
The report outlines issues facing rural seniors in health care, income, housing and transportation. It states that the province does not have a rural plan or strategy in any of those areas.
To give seniors the attention they deserve, she wants provincial government to create a ministry solely focused on rural issues.
Mackenzie said 86 per cent of the population of B.C. lives on four per cent of the land mass. In rural B.C., one in five people is a senior (age 65-plus), and in urban B.C., it’s one in four. She said the urban share of seniors is decreasing quickly because immigrants, most of whom are young or middle-aged, tend to choose to live in urban centres.
Housing and income
Mackenzie said the median income for rural seniors is $32,190 and for urban is $34,546. This is not a huge difference, she said, but it is more instructive to look at the wealth of both groups.
“The wealth is dramatically lower in rural areas,” she said. “The wealth of seniors is basically their home, their principal residence. And homes in rural B.C. are two thirds less than the value of urban homes ($450,000 vs. $1.5 million).”
Mackenzie said lower housing prices in rural areas would not help seniors.
“That only matters when you’re buying,” Mackenzie said. “Seniors aren’t buying. The issue is they have that much less wealth.”
Mackenzie said an urban homeowner can sell their house and buy a condo without government help.
“In rural B.C. the government is going to have to play a role because there’s nothing for people to buy.”
Eighty per cent of rural homeowners live in single detached homes. In urban areas, it’s 43 per cent.
Mackenzie said it is true that rents are lower in rural B.C., but that does not help when there is no place to rent. She said the waiting lists for subsidized rental housing (such as housing built by non-profits with the help of B.C. Housing) are much longer in rural B.C.
Mackenzie is recommending the province develop a rural seniors housing strategy that includes both renters and homeowners.
Hospitals and health care
Mackenzie said fewer rural seniors use the health-care system than urban seniors. She said 17 per cent of rural seniors do not have a family doctor, compared with 13 per cent of urban seniors.
Fifty-five per cent of emergency wards are located in the urban four per cent of the B.C. land base, leading to serious health transportation problems for rural residents. Of the 35 emergency wards located in rural B.C., none are trauma centres.
The rate of acute care beds per population is 70 per cent lower in rural areas.
Mackenzie said it’s only in the last few years she has been hearing about doctor sh0rtages in the cities. But in rural areas it’s an old story.
She said many rural people may be attached to a clinic, but that clinic might be open only once every few weeks and be far from home. Urban people have better access to walk-in clinics, Mackenzie said, whereas in many small communities these don’t exist.
Access to clinics and doctors is especially hard for seniors, for whom it is often a struggle to travel for medical appointments.
Seniors tend to be motivated to use the health-care system if they have a doctor who knows them, Mackenzie said.
“That’s less important for young people who have already Googled it and can explain (to the doctor) what’s wrong with them and already have a diagnosis.”
Mackenzie said it is difficult to encourage new health-care workers to move to rural areas. Most urban workers will not readily make that move, especially for a casual rural job, when you can get a full-time job in the city.
“When you look at the numbers, it is very clear (the workers) that are needed in rural B.C. are not going to come by convincing all the baristas to become care aides and the real estate agents to become nurses.”
Her report recommends that the government develop and implement a rural health human resource strategy.
Home support, assisted living, long term care
Mackenzie said the rate of home care per population is 24 per cent lower in rural areas. Rural seniors who receive home care get 19 per cent fewer hours and are therefore often discharged later from hospital.
Similar statistics apply to assisted living and long-term care, where rural seniors receive relatively lower service.
Mackenzie said that in the cities, unlike in rural areas, there are many private assisted living facilities. There needs to be government assistance to providing such services in rural areas, she said.
“You can sell your $1.5 million home in the city and be pretty confident that you can afford the $90,000 a year it’s going to cost you for you a private assisted living, and the government is very aware of that, and they’re very OK with that.
“The problem is not everybody lives in the city, and everybody who lives in the city doesn’t have a $1.5-million house to sell. And we’re treating everybody as though they do. And that’s part of the challenge.”
As for nursing homes, Mackenzie said we often over-estimate their population.
“Only 13 per cent of people over the age of 85 live in nursing homes. So overwhelmingly most seniors will not go to long-term care nursing homes. And so we need to make sure that we are supporting people to age in the community with dignity and with the supports they need.”
Mackenzie’s report recommends that the province develop and implement rural seniors home and community care strategy, and a long-term care and assisted living plan based on equity throughout the province.
She said there’s a question the province should be able to answer.
“What is the plan 10 years from now? Where are the long-term care beds going to be, and how many are there going to be, and when? They can’t answer that.”
Transportation
Emergency medical transportation for B.C. residents is now provided by the government’s Travel Assistance Program (TAP), and by Hope Air, a non-profit that provides non-emergency travel assistance.
Mackenzie said the challenges of the TAP program are that the approval process is too complicated, there is no reimbursement for travel already taken, and there is no reimbursement for travel in a private vehicle.
She said Hope Air — which is a registered charity — provides full cost coverage on flight, hotels and offers a meal per diem, but it is underutilized because it is so little known.
Stephanie Aldridge, Hope Air’s executive director, told the Nelson Star in an email that in the West Kootenay in 2023, the organization supported 168 patients and 83 escorts. This included 365 flights, 485 nights of accommodation, 118 taxi rides and 214 meal vouchers.
She said most of these flights were on commercial airlines, and a few were carried out by volunteer pilots with their own small planes flying out of small airports.
Mackenzie said that to serve rural seniors better the province should improve these programs, provide better co-ordination between them, and publicize them more.
In addition to emergency travel, public transportation itself is a problem for rural seniors. A member of the audience talked about the cost incurred by seniors in Nelson who have to make three trips per week at $60 per trip to the Trail hospital. They have to hire people to drive them because public transportation does not fit their dialysis schedules.
Mackenzie said the province should provide or fund public bus service between communities.
Her report recommends that the province develop and implement a provincial rural transportation strategy.
A new ministry
To make sure all these recommendations don’t fall on deaf urban ears, Mackenzie wants the province to create a ministry, or a minister of state for rural affairs.
While most MLAs have constituents who are seniors, she said, most do not have rural constituents. This new office would help to inform those MLAs, she said, while signalling to rural residents that “their voice will not get lost in the urban mass.”
She told her Nelson audience that rural seniors are remarkably resilient.
“I can’t help but be struck by how in rural B.C. people learn to help themselves and help each other. In the city, we turn to government for the services and supports. In rural B.C. they’re not there. And so you have to turn to each other and you have to turn inwards, and that creates some great, beautiful communities.”
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