Mary

I went with no electricity and no natural gas. I’m just getting, I guess, better at doing without.

Paul

As I got 65, I thought, jeez, I got pensions, I’ll be fine. It didn’t work that way. I have no money after I pay my rent to have fun.

Anne

You don’t really like to show your face because it’s embarrassing. You’re struggling every month to get by and having difficulty in paying your bills or eating.

Avis Favaro

Those are the voices of Canadian seniors who are struggling to age with dignity, with data showing that 1 in 5 live at the poverty line, with rent and housing eating up their meager incomes and pension, and home care that doesn’t reach seniors in rural communities. Ninety-one percent of our elders say they want to live at home, but the support isn’t always there, leaving our stressed health system to fill this gap.

On this episode, we’ll talk to Dr. Samir Sinha, a geriatric specialist at the Sinai Health System and an advisor to Canada’s National Institute on Ageing, on how to design a society that will care for our elders in a dignified and cost-effective way.

Samir Sinha

We need to actually say, look, okay, we are now a super-aged nation as of 2026, defined as 1 in 5 of us being 65. And actually, other countries have gotten it right, so let’s start doing what other countries have been doing for years, because better late than never.

Avis Favaro

Welcome to the Canadian Institute for Health Information Podcast. I’m Avis Favaro, the host of this conversation.

A note: the opinions expressed here aren’t necessarily those of CIHI, but this is an open discussion about aging with dignity in Canada and why, despite decades of warning about an aging population, our country seems wholly unprepared.

And joining us now from Toronto, Dr. Samir Sinha. Thank you for joining us.

Samir Sinha

Thanks for having me, Avis.

Avis Favaro

So we’re talking about aging with dignity. And I guess one of the first things is, how do you define aging with dignity?

Samir Sinha

Yeah. So when you think about aging—and the most important question we ask each and every one of our patients, and it really is, what matters most to you. And often it’s about wanting to stay healthy and independent in one’s home for as long as possible. And we’re not doing that. That’s when you start realizing that we’re not actually treating our older people with the respect and the supports that they deserve.

Avis Favaro

What would you score Canada in 2026 in terms of delivering dignity of care?

Samir Sinha

You know, I—

Avis Favaro

You made a face there.

Samir Sinha

Yeah. No. I wouldn’t give us an F, by any means, but I would say maybe a C. I think that we have made some progress as a society in terms of investing more in home and community care services, for example, to help people stay in their own homes for as long as possible.

But when you compare us to countries like Denmark and some of the other Nordic countries, they’re spending twice of their GDP spend that we are on providing long-term care that will support and enable older people to stay in their own homes.

Those countries also don’t have the massive phenomenon that we hear about on the news all the time, the overcrowded emergency departments, hospitals that are over capacity, mainly because when we don’t actually have the right types of care, we actually end up having an inefficient, overburdened system.

So countries like Denmark, where they actually have a very robust home and community care system, they don’t actually have people living in their hospitals. In fact, their modern-day hospitals are being built at a fraction of the size of their current hospitals because they can do more to support people in their own homes.

Avis Favaro

So that brings me to the survey that the National Institute on Ageing did looking at seniors. And it was pretty distressing that the number of people who are optimistic about aging dropped. What does it signal to you that fewer people are optimistic about aging?

Samir Sinha

Yeah. This is the biggest year-over-year drop that we actually saw. So to see a drop of five points, the survey was done in June of 2025, and how everybody in Canada was feeling a few months into a new U.S. presidency, our economic stability, I think that’s why I think a lot of people lost their confidence to age well. And it makes sense because we have to remember that unlike, say, younger people who might say, right, okay, maybe I can take on an extra job, for a lot of older people, they don’t necessarily have those same options ahead of them.

Avis Favaro

Your survey also found that 1 in 5 are facing poverty-level standards. I found that hard to believe. But I ended up speaking to a number of seniors across Canada and in my own neighbourhood, and what I was surprised and really distressed was the amount of hidden poverty.

We’re going to hear from Mary, who lives in rural Alberta. That’s not her real name because she doesn’t want anyone to know that at 74, with a lot of health issues, she has a secret.

So do you find that certain months, whatever your income is as a senior, doesn’t quite last?

Mary

Oh, that’s every month. Like right now, the pension comes in on Wednesday. A friend went to the store and picked me up some milk and cat food and stuff like that. So I’m out and there’s nothing left. I mean, I’m just getting, I guess, better at doing without. Like all right, I got one roll of toilet paper and that’ll be fine. And I’ve got a power bill that’s not paid. And consequently, the power company has put me on a limiter, which means I can’t do too much here that uses electricity. If I turned on my oven, all the power would go out, and it goes out for 15 minutes and then comes on again.

Avis Favaro

So they’re restricting your power use.

Mary

Yes. Yes. Yeah. And I can’t use my toaster and my microwave at the same time.

Avis Favaro

Oh, dear.

Mary

I’ve still got to find, between now and April, a couple of thousand dollars to pay off this power bill, because come—

Avis Favaro

Otherwise, what might happen?

Mary

Oh, they’ll turn it off. The only reason it’s not turned off completely now is because the law is you can’t turn it off from the 15th of October to, I think, sometime in April.

Avis Favaro

Have you gone other periods without any electricity?

Mary

Oh, yes.

Avis Favaro

Seriously. Like when?

Mary

Well, like last summer for a while, I went with no electricity and no natural gas. Well, the natural gas was really only for hot water. But yeah. It was a pain in the butt. You know?

Avis Favaro

When you hear stories like that, what’s your reaction?

Samir Sinha

No. Mary’s story is the story of many other older Canadians because officially, we have our low-income measures or our official poverty rate, for example. Mary, like many older Canadians who might cobble together their CPP, their Old Age Security, it’s about $2,000 a month. So okay, $24,000 a year. That just puts you at Canada’s poverty line. Right? But now when you think about food costs, if you think about—

Avis Favaro

Inflation. Inflation.

Samir Sinha

—renting, mortgages, a lot of older people are now retiring with a mortgage still on the books. But we noted in our survey that about 20% of older Canadians are retiring with only about $5,000 in savings.

Avis Favaro

That’s scary. That’s scary.

Samir Sinha

So okay. The government can say, Mary’s getting $2,000 a month; she’s just fine. But we know that Mary isn’t fine. That’s what we want to highlight here is that income adequacy is a really important aspect because you noted that, well, they can’t turn her power off during the winter; we don’t want her to freeze to death. But we know that with climate change right now, these summers in Alberta and everywhere else, they’re getting hotter and hotter, and air conditioning now is seen as a lifesaving tool. And then if Mary can’t live healthy and well in the community, you know where she ends up living? In our hospital emergency departments.

Avis Favaro

A few of these people that I spoke to talked about going to food banks. So there was one, Anne and her husband. She’s 62. Lots of health problems and chronic pain from a spinal condition. Her husband’s 65. They live in a rural community north of Toronto. And again, they don’t tell people. They heat their house with wood, and they go to a food bank.

When you go to the food banks, how does that affect your mental well-being?

Anne

Oh, it’s embarrassing. And the community that we’re near is very small, so you don’t really like to show your face because it’s embarrassing. At this age, we shouldn’t have to do that. But I mean, you’re struggling every month to get by and having difficulty in paying your bills or eating, and it just plays on your mental health because you’re obviously going to become depressed and it’s not nice.

Avis Favaro

I guess I want to challenge you on humiliating. You’re not alone.

Anne

I know. I know. It’s very hard. And I think that the government should not be taxing the incomes after your retirement age and living on the pensions as we do. You’ve worked your whole life. And I think it should be tax-free. We shouldn’t live in a society like this. We’re a wealthy country and we should be living better than what we are.

Avis Favaro

So, Doctor, I’m wondering, why is this level of senior poverty allowed in a wealthy country like Canada?

Samir Sinha

Well, there’s a lot of things that we unfortunately allow when kind of ageism is a societal issue. You’re clearly seeing it in the people that you’re talking with. Because when people can’t age independent and healthy in their own communities for as long as possible, it ends up actually costing us all more as a society. These are folks, for example, who end up in their local emergency departments. These are people who end up not being able to stay independent in their own homes and they now need to move into a long-term care home, for example.

And we don’t realize that actually, those things end up raising all of our costs for healthcare and other things more so than ever before. And so that’s why that we’re encouraging people to save, to make the right financial choices so that they can actually have income adequacy and financial security later in life.

Avis Favaro

The other thing that I found is—and it ties into what you’re saying—is that a number of them actually feel guilty and regret because they weren’t able to save money. For example, Paul, he’s 77.

Paul

I thought as I got 65, I thought, jeez, I got pensions, I’ll be fine. It didn’t work that way. I had, in my younger days, RRSPs, home ownership plans. I spent it all because I was relying on pensions. It didn’t work out. I made a huge mistake.

My rent has gone up $350 in the last three years. But it’s the food we’re getting killed on. Food has gone up drastically. I have no money left on my pension. I have no money after I pay my rent to have fun. And I miss that.

Avis Favaro

Do we need to do more to help people plan? Because I think one of the surveys say 81% of Canadians want to age at home or in some kind of a home setting. Very few are planning for it.

Samir Sinha

Well, a lot of people don’t realize that when we created our retirement income system in Canada, it was on the premise that we have something called the Canada Pension Plan. We have Old Age Security, but we also require people to be saving for their retirement and also have a workplace pension plan.

The challenge is, on those latter two, more Canadians than ever before don’t have access to a workplace pension plan. And many people haven’t realized how much they need to save or even have the ability to save towards their retirement overall.

Avis Favaro

What’s the biggest barrier, as far as you see it, in allowing more Canadians to age at home, to find a way that’s cheaper than having society build more long-term care?

Samir Sinha

One of the things we’ve looked at, how people actually organize their own physical house to actually make sure that they could actually age appropriately in these settings easily. And renovations can cost a lot of money.

So, I remember with my current housing purchase, instead of going for something that was multi-story, I’m in a single-story setup and all my door widths are actually 36 inches wide so that I can make sure that if I’m ever in a wheelchair or using a walker, I can get through to any part of my residence.

Avis Favaro

I haven’t thought about that. My husband and I are both over 65 and I hadn’t even thought about that.

Samir Sinha

Well, that’s the benefit of being a geriatrician. But the other aspect is, is that some people also say, well, look, I’ve got children; they’ll look after me. The reality is, is that between now and 2050, there’s going to be 30% fewer available family caregivers than there currently are today, partly because we’re having smaller families. Often, many people tell me that I’ve got two wonderful children, but they live on other sides of the world, for example.

And so the reality is, is that more and more of us are going to need the support of others so that we can stay independent in our own homes, we’ll receive care, and it often is much less expensive for us to organize kind of home and community care services at a societal level.

And like the Danes and others, they’ve realized that it’s much less expensive to care for aging societal members in their own homes where they often want to be than in expensive institutional settings or even acute-care settings where currently 15% of our beds in our hospitals are occupied by people who don’t need to be there.

Avis Favaro

But what I find interesting is that we’ve done stories and we’ve done interviews for decades on the tsunami of seniors coming our way. And it seems like it’s a surprise when the data has been pointing to this for a long time.

Samir Sinha

Well, Avis, let me pick up on that. Right? Because you just used the term tsunami. Tsunamis, by definition, happen without warning. They’re a complete surprise. But as you know and as I know, this is actually not a surprise. We’ve known what our demographics would be. We know that this year is the year Canada becomes a super-aged nation, defined as 1 in 5 of us being 65 or better, as I like to say. And within 5 years, when the baby boomers start turning 85 years of age, that’s in 2031, from then on, about 1 in 4 Canadians will be 65 and better. So I actually challenge people to not use the term tsunami.

Avis Favaro

Okay. I know. My question is, where is the advance planning? Healthcare, in my opinion, is a long-term industry. Planning, you’ve got to think ahead.

Samir Sinha

Absolutely. And why have we gotten it so bad. Right? Why haven’t we figured it out?

Our politicians live on a four-year cycle at best, for example. Right? And I remember early days when I was advising the Minister of Health in Ontario to develop Ontario’s first Senior Strategy, one of our chats, they reminded me what the number-one job of a minister of health is.

Avis Favaro

Which is? Which is?

Samir Sinha

Not actually to steward the healthcare system; it’s to get reelected. And so when all of a sudden you’re living on a political life cycle, it’s no longer thinking about the long-term consequences and the long-term planning. It’s more about what will get us votes and what will happen. All of a sudden, we’re getting our priorities wrong.

And I think that’s why we need to really, as a society, realize that we’re not heading currently in the right direction. We need to actually say, look, okay, we are now a super-aged nation as of 2026. This is only our future. And actually, other countries have gotten it right, so let’s start doing what other countries have been doing for years because better late than never.

Avis Favaro

Maybe what we need to do is make this a federal mandate that there has to be long-term planning when it comes certainly to this part of dealing with our aging society.

Samir Sinha

Well, it’s a tricky situation because, don’t forget, our federal politicians also live, if they’re lucky, on four-year life cycles as well.

But to your point, what Australia actually did, believe it or not, 10 years ago, was they actually transferred responsibility for all long-term care services from their states and territories to their federal government. So they have one national system so that every Australian now knows what their lifetime contributions towards their long-term care services will be, what they can expect from the state, how much money they need to save, and what they will be eligible for.

Avis Favaro

So let me just move forward. A lot of seniors, especially those with intensive problems or of low income, end up in long-term care. But the CIHI survey found that the majority of people don’t want to go to long-term care. They actually see it as something they dread.

Are we focusing too much on long-term care? And should we be focusing more on home care?

Samir Sinha

The reality is, is that with what we witnessed during the pandemic, we understand that in Canada, we have chose to grossly underfund the provision of long-term care services, whether that be care in a care home versus home and community care. The entire system is underfunded, half of what other countries are spending that have much stronger systems.

Avis Favaro

Is it still underfunded?

Samir Sinha

Absolutely. And Canada is an average spender in terms of long-term care services. So you can appreciate why people don’t want to end up in a long-term care home. They saw what happened during the pandemic. You don’t need any more reminders from that perspective.

Avis Favaro

In fact, in the survey, they called it warehouse where you go to die. That’s one of the phrases they use.

So there haven’t been any significant improvements in long-term care since the pandemic, despite everything that happened.

Samir Sinha

I was tapped by the government to help develop the new national long-term care standards that are now kind of being used to accredit 72% of Canadian long-term care homes. These are the standards that said we need to actually be providing at least four hours of care a day, which three provinces are now moving towards that.

The other challenges that CIHI notes—it does an annual report, and it notes that 1 in 10 people entering a long-term care home wouldn’t need to be there because there should be sufficient home and community care services available. Just so I just give you the math, a day of waiting in hospital to go to a long-term care home is about $800 a day. A day living in a long-term care home is about $200 a day. A day as a long-term care-eligible individual, getting home care in your own home, is about $100 a day.

So you don’t have to be a mathematician to realize that we can deliver care more effectively and at a lesser overall expense by caring for people in their own homes than in institutional settings.

Avis Favaro

One of the saddest things that I think I heard was listening to some of the folks talk about medically assisted death or MAID as being an option they were thinking about because they just can’t see living a life in poverty and low income. And that, for me, is sort of the ultimate sign that we are failing in providing dignity in aging.

Samir Sinha

It absolutely is, Avis. I’m involved in a Charter challenge right now against the federal government because, not that I’m against MAID, but we know that there are so many older Canadians, for example, who, while MAID is fully covered, we don’t make adequate home and community care services, long-term care services available. And so there are too many people who say, you know what, if you can’t allow me to live in my own home with basic supports so that I can age with dignity, well, I just want to—what’s the point?

When you’re not giving people a choice, that’s not fair. And I think that right now, we’re actually discriminating against older people in particular because they’re the ones for whom these are the services that they most often need but are struggling to get, especially those who are living in more rural and remote parts of our country.

Avis Favaro

What is your hope with this Charter challenge?

Samir Sinha

My hope is that the government is forced to say, right, so we should be adequately funding home and community care services, long-term care services, and palliative services.

We’ve got great examples of what a system designed to meet the needs of an aging population is, because I like to say that compared to 1965 when we created Medicare, when the average Canadian was 27 years of age and most of us didn’t live beyond our 60s, I like to say that the patients have changed, but the system hasn’t. And it’s high time that we actually made sure the system caught up with the patients and the individuals that we have living in Canada today.

Avis Favaro

Dr. Sinha, thank you so much. I feel unsettled after our conversation.

Samir Sinha

Yeah. But I mean, it’s one of those sorts of things that, again, I feel unsettled every day. And it shouldn’t be a struggle for so many Canadians that you’ve talked to, to be able to live with dignity and respect.

Avis Favaro

A note: CIHI is working on new ways of measuring senior services, like long-term care and personal support workers, to get a clearer picture of the demands and the gaps across the country. It’s all part of a special initiative on aging with dignity, including more data, podcasts, webinars, and web stories.

All the information is on cihi.ca, C-I-H-I dot C-A, and on our social media channels, including LinkedIn, Instagram, Facebook, and YouTube.

I’m Avis Favaro. I want to thank you for listening and I hope you’ll join us for future podcasts.

Published on the Canadian Institute for Health Information website