When Laura Tamblyn Watts’ senior mother fell and broke her arm, her mom was able to spend thousands on physiotherapy because she was covered under her teacher’s pension and the Ontario Health Insurance Plan, which funds physiotherapy for seniors in the province.
After taking a short break from her physiotherapy sessions, her mom returned to find that her recovery had seriously regressed.
“They said you’re gonna need to do [physiotherapy] for the rest of their life,” says Tamblyn Watts, chief executive officer of CanAge, a national seniors advocacy organization. “My mother is lucky because she lives in Ontario. But many people in her situation in different parts of the country would have different coverage experiences.”
As a burgeoning portion of Canada’s population become seniors, it will be increasingly important for them to access physiotherapy, experts say, both to maintain their own well-being and reduce demands on an overburdened health care system. But for the physiotherapy profession to play this role, barriers to access must be addressed.
“If we’re trying to save our acute care system, [reduce] hospital visits, [reduce] doctor visits, one of the most effective things we can do is make sure people maintain their physical wellbeing,” says Tamblyn Watts. “And physiotherapy is a critically important part of that.”
“But for most older people, they have a really hard time accessing it, affording it or continuing with [their care].”
Decondition quickly
As people age, they become more prone to chronic disease, like arthritis, heart disease and stroke, says Sally Blenkhorn, health services director with Nova Scotia Health, where her portfolio is senior rehabilitation and long-term care.
Seniors also “decondition very, very quickly,” says Tamblyn Watts, which can create cascading problems.
For example, “if [I stop moving my knee], I’m not moving out of bed and so I get bed sores. And then I’m not going to see my family and friends, so I have mental health and depressive impacts. And I can’t go to the grocery store and carry my groceries home, so my nutrition suffers.”
Allison Stene, president of the board of directors at the Canadian Physiotherapy Association, agrees. Seniors who don’t access physiotherapists often move more quickly into assisted living situations or end up having longer hospital stays, she says.
Physiotherapy can help mitigate the effects of aging and onset of disease, and thus plays an important role keeping seniors functional, independent and out of hospitals.
But physiotherapy is costly, particularly when extended sessions are required. In Ontario, the average hourly rate for a physiotherapy appointment is $135, according to the Ontario Physiotherapy Association. For seniors recovering from an injury, rehabilitation several times a week is not unusual.
Many seniors live on restricted budgets, Tamblyn Watts says. The median after-tax income for single seniors — who make up approximately one quarter of all seniors — was $31,400 in 2021. In 2021, six per cent of seniors lived in poverty, according to Statistics Canada.
Several provinces now fund out-of-hospital physiotherapy for seniors. In Ontario and Quebec, people aged 65 and older are eligible for publicly-funded physiotherapy with a doctor’s referral.
But this public coverage can have its limitations, according to Ryan Davey, co-founder and director of the physiotherapy clinic Toronto Physiotherapy.
A physiotherapist only receives a lump sum of $312 to treat a patients’ condition, according to the Ontario Ministry of Health. “Clinics are expected to budget their Episodes of Care, their visits and their overall funding appropriately and according to patients’ needs.”
This lump-sum approach can encourage clinics to quickly wrap-up treatment, Davey wrote in a blog post on Toronto Physiotherapy’s website: “OHIP funded clinics have a very strong financial incentive to end your care as quickly as possible, and to provide care as cheaply as possible.”
The other provinces and territories offer seniors limited or no out-of-hospital physiotherapy coverage. Alberta, British Columbia, Manitoba, Saskatchewan, Prince Edward Island and Nunavut provide limited coverage for patients with a doctor’s referral.
In Newfoundland and Labrador, New Brunswick, the Yukon and the Northwest Territories, physiotherapy is only covered when patients are admitted in a hospital. In Nova Scotia, anyone can access outpatient physiotherapy through their local hospital, but the government’s website says “there are often lengthy wait times to receive care.”
“Most physiotherapy is private pay in Canada,” says Tamblyn Watts. “Not all but most. And it is rare that full benefits will be covered for physiotherapy for older people unless they have some type of extremely good [pension plan].”
“I think there’s a very strong desire for physiotherapy to be covered as an included health benefit and not as a private benefit,” she added. “[T]here’s certainly advocacy around that, but you know, that’s a big policy change.”
Access ‘a challenge’
For many seniors, physically accessing physiotherapy appointments can also be a challenge.
This is particularly true for older people with comorbidities and those who may not drive, says Tamblyn Watts. “Remember, [these are people who], by their nature, are injured in some way.”
Exacerbating the access challenge is that a small minority of physiotherapists — just 10 per cent in 2020, according to the Canadian Institute for Health Information — work in rural centres, while roughly one quarter of seniors live in rural areas, according to 2021 Statistics Canada data.
“[E]nsuring that we can provide the service in those smaller more remote areas becomes a bit of a challenge,” says Blenkhorn.
“In some cases, [seniors] don’t get the care they need,” says Blenkhorn. “That’s something that we really try not to have happen, but it does sometimes happen if there isn’t availability of the service.”
Moving professionals closer to areas where there’s high demand or providing travel for seniors to get to appointments in urban centres are two solutions, Blenkhorn says. But “that’s not always possible or even reasonable” considering a senior’s health status and the availability of physiotherapists.
Blenkhorn said Nova Scotia is also looking to develop health teams in rural areas that would include physiotherapists, says Blenkhorn.
“There are pockets across the province that have dedicated seniors’ teams [that] really have a very specific focus on seniors.”
Team-based solutions
For Krissy Bell, CEO of the Canadian Physiotherapy Association, the issue is “bigger than just the solutions [physiotherapists] can’t provide because we’re not in a [physical] setting.”
“There is all this untapped potential for physiotherapy that can help in places where the healthcare system is really struggling right now,” she says.
Bell says there are opportunities for physiotherapists to provide “innovative, team-based solutions in primary-care, long-term care and home-care settings” to reduce burdens on physicians and reduce demand for pain management through drugs.
The association she represents is also advocating to have physiotherapists included in emergency rooms.
In a recent interview with Canadian Affairs, Dr. Alika Lafontaine, the outgoing president of the Canadian Medical Association, a national physicians association, advocated for an increased emphasis on team-based care in hospitals. Like Bell, he believes this approach is key to boosting physician retention and reducing doctor shortages.
The healthcare system’s failure to leverage physiotherapists “creates a bottleneck that we’re seeing at the physician’s door right now,” says Bell, “where [seniors] go back to their physician and go, ‘Hey, I need you to help me with this piece or I’m in this pain,’ where those conditions can be managed by the physiotherapist.”
Correction: A prior version of this article incorrectly said that Krissy Bell was the president of the Canadian Physiotherapy Association. She is the CEO.
