Healthy Aging - Alberta · healthy aging and to meet the needs of an aging population, we need to take a fundamentally different direction for the future. We need a “paradigm shift”

Healthy Aging:New Directions for Care

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Long TLong TLong TLong TLong Term Care Reviewerm Care Reviewerm Care Reviewerm Care Reviewerm Care Review:::::FFFFFinal Report of the Pinal Report of the Pinal Report of the Pinal Report of the Pinal Report of the Policy Advisorolicy Advisorolicy Advisorolicy Advisorolicy Advisory Committeey Committeey Committeey Committeey CommitteeHEALTH AND WELLNESS

November 1999November 1999November 1999November 1999November 1999

For additional copies of this document, or for furtherinformation about the Long Term Care Review, contact:

Comunications BranchAlberta Health and Wellness22nd floor, 10025 Jasper AvenueEdmonton, Alberta T5J 2N3Phone: (780) 427-7164Fax: (780) 427-1171

ISBN 0-7785-0218-X

For more information on the Long Term Care Review,visit Alberta Health and Wellness’ Internet site at:http://wwwhttp://wwwhttp://wwwhttp://wwwhttp://www.health.gov.health.gov.health.gov.health.gov.health.gov.ab.ca/key/keylong.html.ab.ca/key/keylong.html.ab.ca/key/keylong.html.ab.ca/key/keylong.html.ab.ca/key/keylong.html

This icon shows two hands reaching out in a gesture of support and caring.Not only does this gesture represent our concern for each other, but it alsorepresents a handshake and therefore commitment. The white space betweenthe hands forms an “H” in reference to the title of this publication, Healthy Aging.

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Letter from the Chair

On behalf of the Policy Advisory Committee on Long Term Care, I am pleased toprovide our report and recommendations for the future.

At the outset, I want to thank literally hundreds of people who contributed directly tothe outcomes of this review – seniors, health care providers, health authorities, expertsboth here and around the world, interested Albertans, and members of a number ofdifferent committees and government departments.

It has been a privilege for me to work with an outstanding Committee – people whohave a strong commitment to improving seniors’ health and continuing care in theprovince, people who sacrificed a considerable amount of personal time over the pasttwo years to help shape new directions for the future.

From our work over the past two years, we have learned a great deal. Albertans caredeeply about their health system and they want continuing care services to be therewhen they need them. Hundreds of family physicians, specialists, nurses, healthproviders, pharmacists, therapists and a host of other health care providers worktirelessly, day after day, to meet the needs of Albertans, especially older people.Regional health authorities continue to lead the way in trying new approaches todeliver the services their community members need and expect. Albertans are trulyfortunate to have such a high level of dedicated people working to meet their healthcare needs.

Looking ahead to the future, we believe that the status quo is not an option. Doingmore of the same will not provide the kind of future we want or need. To promotehealthy aging and to meet the needs of an aging population, we need to take afundamentally different direction for the future. We need a “paradigm shift” in theway Alberta society and the health system responds to and addresses the needs of anew generation of older people.

Report of the PReport of the PReport of the PReport of the PReport of the Policy Advisorolicy Advisorolicy Advisorolicy Advisorolicy Advisory Committeey Committeey Committeey Committeey Committee22222

Carl Bond Evelyn Buckley

Mary Engelmann Jean Graham

Dr. Peter N. McCracken Paulette Patterson

Doug Schindeler Michael Senych

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Taken together, our recommendations describe a very different future for continuing care inthe province. They build on the many successes and strengths in today’s health system, andaddress both the immediate pressures and the need for new directions for the future. Weencourage government and all Albertans to consider our recommendations carefully and tobegin now to prepare for a new generation of older people.

Sincerely,

David BrodaChair, Long Term CarePolicy Advisory CommitteeMLA, Redwater

Karen KryczkaVice-Chair, Long Term CarePolicy Advisory CommitteeMLA, Calgary West


Why review long term carein Alberta?

PPPPPurpose of the reviewurpose of the reviewurpose of the reviewurpose of the reviewurpose of the reviewAcross Canada, Alberta is known as a leader in continuingcare. Health authorities, long term care centres, physicians,nurses and a host of health care providers have worked hardto recognize and respond to the needs of older people andpeople of all ages who need long term care.

At the same time, if we look ahead, we know that a numberof factors will affect continuing care in the future. Alberta’spopulation is growing in numbers – more people are comingto the province and many seniors are also choosing to returnto Alberta because of the range of programs and servicesavailable. We’re also aging. Today, 9.8% of Alberta’spopulation is over 65 years of age. By 2016, that numberis expected to grow to 14.5%, and by 2031, roughly one infour Albertans will be over 65.

Think about what Alberta will be like when there aremore grandparents than grandchildren! Clearly, there areimplications not only for the future of our health systemand continuing care in particular, but also for families,communities and our society as a whole.

2016 will be here before we know it. It’s important to lookahead and anticipate what Alberta’s continuing care systemwill look like in 2016 or sooner, consider what needs andexpectations Albertans will have, and think about how thesystem should be organized to meet those needs. By decidingnow what we want in the future, we can begin to take thenecessary steps now to achieve the future we want.

In November 1997, Health Minister Halvar Jonson initiateda comprehensive, two-year review of long term care servicesin the province. The purpose was to consult with Albertans,review trends and alternatives, consider the impact of anaging population, and develop a comprehensive direction formoving Alberta’s continuing care system into a newmillenium.


As the Minister describes it …

Simply put, our long-term care system needs to be readyto accommodate the baby boomers when they enter thesystem. We need to be able to provide more accessible andequitable long term care services to Albertans who needthem. We need to ensure consistency of long term careservices throughout the regional health authorities. Weneed to work to ensure that the choice of services that willbe demanded by clients will be available. In short, we needto ensure that our long term care system is able to meetthe future needs of Albertans in the new millenium.

A Long Term Care Policy Advisory Committee wasestablished to guide the review, provide advice on specificissues and develop recommendations for the future.

For the past two years, the Committee has listened toliterally hundreds of people – seniors, physicians, nurses,experts, regional health authorities, people who work directlywith seniors or in continuing care, and interested Albertans.Through its work, the Committee has learned a great dealabout Alberta’s continuing care system. We have learned thatpeople care deeply about health. They want their parents andgrandparents to get the kind of compassionate care andrespect they deserve. And they want the same kind of careand respect to be available when they become seniorsthemselves.

We learned that, across the province, people are taking thelead in developing and implementing innovative approachesto continuing care. Family physicians, specialists, nurses anda whole range of health care providers are working hard tomeet the needs of older people in their communities. Regionalhealth authorities, operators of long term care centres, andthe private and voluntary sectors are working together inmany locations to provide leading edge facilities and a flexiblerange of programs and services to meet the changing needs ofseniors. The CHOICE program in Edmonton, specialAlzheimer’s care centres in Edmonton and Calgary, assisted

“Family physicians,specialists, nurses and a

whole range of health careproviders are working hardto meet the needs of older

people in theircommunities. “

Policy Advisory Committee


Family pspecialiwhole rprovideto meetpeople commun

Regionaauthorilong terthe privsectors togetheto provifacilitierange oand serchangin

living programs in places like Spruce Grove, Stony Plain andMorinville, and care housing projects in places like Dayslandand Taber are just a few examples.

We also learned people’s views about a number of issues andlistened to their ideas about how those issues can and shouldbe addressed.

Alberta has long been known as a leader in continuing care inCanada. We now have a real opportunity to build on thestrengths of today’s system and look ahead to a very differentfuture. The Committee’s report and recommendations areintended to build on our tradition of embracing new ideas andnew approaches, and combining that with the commitment ofpeople already in the system to meet the needs of seniors intheir community.

Most important, the Committee hopes that its report andrecommendations describe an innovative new future forcontinuing care in the province, one that meets the needsof an aging Alberta population.

“Regional healthauthorities, operators oflong term care centres, andthe private and voluntarysectors are workingtogether in many locationsto provide leading edgefacilities and a flexiblerange of programs andservices to meetthe changing needsof seniors.”



Planning for the futurePlanning for the futurePlanning for the futurePlanning for the futurePlanning for the future

The Long Term Care Policy Advisory Committee’s mandatewas to:

Provide advice and recommendations to the Minister ofHealth and Wellness on:• Home care• Drug strategies• Health related support programs and policies• Accommodation policiesConsult with consumers, regional health authorities andstakeholder groups in the development of recommendationsDevelop a comprehensive health services approach towardmeeting the needs of an aging population over the next10 – 25 yearsProvide advice on any other issues relating to the need toplan for and respond to the impact of the aging populationon the health system.

“Think about the fact thatthere will be moregrandparents than

grandchildren. In 50 years,about the lifetime of abuilding, seniors could

compose between a fifthand a quarter of the

population. They willaffect the culture (more

early bird dinner specialsat restaurants than barsthat close late), patterns

of consumption (moreDepends than Huggies),

and achievements inwell-being (quality of lifeat the end of life, not only

in the early years).”

Dr. Satya Brink, Special Advisor,

Human Resources

Development Canada


David Broda, Chair, Long Term CarePolicy Advisory Committee

MLA, RedwaterMember, Standing Policy Committee,

Health and Safe CommunitiesMember, Natural Heritage Act Review

CommitteeMember, Standing Committee Law

and RegulationsPast member, Centennial MLA Committee

Karen Kryczka, Vice-Chair, Long Term CarePolicy Advisory Committee

MLA, Calgary WestChair, Steering Committee for the

Government-Wide Study on theImpact of the Aging Population

Chair, Seniors’ Advisory Councilfor Alberta

Carl BondPresident,

Alberta Long Term Care Association

Evelyn BuckleyChair, Board of Trustees,

Bethany Care Society, CalgaryMember, Mental Health Review Panel

Mary EngelmannPast President, Alberta Association

of Gerontology

Jean GrahamChair, David Thompson Regional Health

AuthorityChair, Provincial Health Authorities of

AlbertaChair, Canadian Health Care Association

Members of the Committee are:

Dr. Peter N. McCrackenProfessor of Medicine, University of AlbertaPast Divisional Director, Geriatric

Medicine, University of AlbertaPast President, Canadian Society for

Geriatric Medicine

Paulette PattersonPublic representativeBusiness woman and former manager

of a senior citizens lodgeChair, Human Resources and

Employment Appeal Panel, Grande Prairie

Doug SchindelerRetired health care executiveMember, Chinook Regional Health

Authority

Michael SenychMayor, Village of ThorhildChair, Thorhild Seniors’ FoundationFormer MLA

The Committee also received ongoingadvice and assistance from Dr. DarrylRolfson, a Geriatrician with the CapitalHealth Authority. Ongoing supportthroughout the review was provided bykey staff of Alberta Health and Wellnessincluding Ron Dyck, Vivien Lai and CarrollThorowsky, as well as members of the JointAlberta Health-Regional Health AuthorityCommittee.

In addition to the Long Term Care Review, the provincial government also has initiateda Government-Wide Study of the Impact of the Aging Population on government programsand services. The Policy Advisory Committee maintained close links with that study and,in several places in this report, issues have been identified for follow up by thegovernment-wide study.


Outline of the Committee’s reportOutline of the Committee’s reportOutline of the Committee’s reportOutline of the Committee’s reportOutline of the Committee’s report

It is difficult to summarize two years of work, countlessstudies and pages of information, and the excellent advicereceived from hundreds of people, both experts and interestedAlbertans. For that reason, the Committee has organized itsfindings and recommendations into a package of threedocuments.

Part One provides an overview and highlights of theCommittee’s new vision for continuing care and meeting theneeds of an aging population in the province. It includes keyrecommendations both for addressing immediate pressingneeds and for implementing new directions for the future.

Part T wo summarizes the process used by the Committeeand the major findings from the various submissions, trendsacross Canada and around the world, the views of Albertansand various experts, and a study of alternative scenarios forthe future.

Part Three describes, in more detail, the Committee’srecommendations on short term solutions, new directionsfor the future of continuing care and healthy aging, andspecific recommendations for addressing issues andimplementing a new, and very different, continuing caresystem in the future.

Along with this package, the Committee strongly encouragespeople to review three additional documents:

Summary of Consultations with Public,November 1998 to March 1999Summary of Consultations with Experts,January to March 1999Future Scenarios: Continuing Care Service Needsin Alberta, November 1999.


Listening and learning –A look at views, trends and issues

A key part of the Committee’s work was to seek the viewsof Albertans and experts in gerontology, geriatrics and thecontinuing care field, as well as to look at trends incontinuing care across Canada and around the world.

Highlights of the various views and trends include thefollowing:

Around the world, there is an increasing focus on peopleremaining in their homes as long as possible. Combinedwith that, there is a corresponding decline in the numberof people living in long term care centres or other forms ofinstitutions.

Health, social services and housing services are beingde-linked or “unbundled.” This allows people to makechoices about the kind of services they need regardlessof where they live.

More funding is going directly to individuals and movingwith them wherever they live. This also reflects a growingemphasis on people making their own choices.

There is an increasing array of community service providersin both the public and private sectors. The private sector isplaying an increasing role in providing housing alternativesso people can “age in place.”


The following are the key views we heard from Albertansthrough public consultations.

Albertans are passionate about their health system andthey know their values.Keeping people healthy is the first step.Many aspects of acute care services for older people needimprovement.Community support and care services need to be enhanced.More flexible housing options need to be developed.Continuing care facilities will be managing more complexconditions in the future.Multiple financial and funding approaches are suggested.The role of the private sector is a special issue.Drug utilization is a major concern.The physician’s role needs to be addressed.Technology holds high potential.Ethical issues are gaining prominence.Aboriginal members have special needs.Mental health issues need more attention.Quality of care, standards and regulations needto be addressed.

Through the various consultations, the Committee learnedabout a number of innovative new programs and servicesbeing developed across the province. At the same time,seniors, experts and people working directly in healthidentified a number of issues and provided their ideas onhow those issues should be addressed. Highlights of whatwe heard include the following:

Acute care hospitals and medical services need to be betterorganized to meet the complex, multiple health problems ofolder people, especially those who are frail.There is a shortage of people trained to work with olderpeople. That includes a shortage of geriatricians, registerednurses and nurse practitioners with a specialization ingeratrics, and people who are trained to address theincreasingly complex health needs of people who live inlong term care centres.


Strategies are needed to identify older people at risk, preventhospitalization unless it is necessary, carefully plan followup care when people are discharged from hospital, andprovide other options for addressing seniors’ health needs.To allow older people to maintain their independence aslong as possible, home care services need to be expandedand more housing options are needed, especially in ruralcommunities, so people don’t need to move into long termcare centres.Services for older people with complex and chronic healthproblems need to be coordinated, with physicians, nurses,health care providers and others working together to meettheir needs.There are some inconsistencies in access to continuing careprograms and services across the province.Informal caregivers – family and friends – need supportin caring for aging family members.Current rates of accommodation charges in long term carecentres need to be reviewed.In an immediate sense, there are shortages of spaces in longterm care centres to meet current needs, a backlog of peoplewaiting in hospitals, and a shortage of home care services.


Addressing two challenges

The primary focus of the Committee’s report andrecommendations is on describing a fundamentally newand different approach to continuing care in the future. Westrongly believe that the status quo is not an option for anumber of different reasons – most importantly, because itwill not meet the needs of a new generation of agingAlbertans.

At the same time, there are immediate concerns that need tobe addressed.

Taken together, the Committee’s recommendations aredesigned to address these two challenges – the challengeof meeting short term needs and the challenge of movingforward with a fundamentally new direction for continuingcare.

“The status quo is not anoption for a number of

reasons – most importantly,because it will not meet theneeds of a new generation

of aging Albertans.”



Setting new directions

A new visionA new visionA new visionA new visionA new vision

The Committee believes that a fundamentally new directionis needed for continuing care in the province. That newdirection begins with a new vision for aging in the 21stcentury.

Our vision for aging in the 21st century is a society where allAlbertans:

Are treated with respect and dignityHave access to information which allows them to makeresponsible choices regarding their health and well-beingCan achieve quality living, supported by relatives, friendsand community networks, and by responsive services andsettings.

Meeting the future needs of an aging population requiresmore than just expanding services. It requires a new focus onhealthy aging. It demands that people have choices in the carethey receive and where they receive it.

Guiding principlesGuiding principlesGuiding principlesGuiding principlesGuiding principles

Consistent with the vision, the following guiding principleswill help the health system respond to an aging population.

Wellness and prevention

Support healthy aging for all Albertans.Emphasize promotion of health and prevention of illness,injury and disease.Help Albertans to cope effectively with chronic conditionsand function to the best of their abilities.

“Whatever you do, do notwork under the assumptionthat all you need to do isdo the same thing, onlymore and faster. Throughthese careful deliberations,take the opportunity todevelop a new model thatworks for Alberta well intothe next century.”

Dr. Satya Brink, Special Advisor,

Human Resources Development

Canada


Client centered

Endeavor to understand and meet client and family needs,work in partnership with clients, and ensure client choicewhere possible.Acknowledge the client’s right to dignity andself-determination.Have reasonable access to a variety of affordable servicesand have their needs met in a flexible, timely andresponsive manner.Respect the client’s right to privacy of space and person.Recognize and respond to the physical, psychological,spiritual and social aspects of health.

Information

Provide clients with access to information required to makeinformed choices and decisions regarding care and services.Ensure confidentiality of personal information, however,allow appropriate sharing of information to support thehighest quality of services and best possible outcomes.

Individual and shared responsibility

Encourage independence by assisting Albertans to reachtheir greatest potential, recognizing that clients andfamilies have the primary responsibility for their ownhealth.Recognize the concept of interdependence and facilitatecollaboration between Albertans, community andgovernment.

“Aging is not a disease tobe treated, but a state of

living and being.”

Alberta Association of

Registered Nurses


Effectiveness and efficiency

Make decisions based, as much as possible, on the valuesof the consumer, on evidence provided through research,evaluation and technology assessment, and availableresources.

Intersectoral approach

Recognize that, by working together, Albertans,government, regional and provincial authorities,non-government organizations, and the voluntary andprivate sectors all have an active role in contributing tothe health of Albertans.

The Committee’s vision for aging for Albertans in the21st century is shown in the attached figure.

“The direction will be verydifferent from today. It willreflect a fundamental shift,putting the needs of theindividual first and givingpeople choices in where andhow their assessed needsare met.”




What is continuing care like today? What will continuing care be likein the future?

How will continuing care be different in the future?How will continuing care be different in the future?How will continuing care be different in the future?How will continuing care be different in the future?How will continuing care be different in the future?

The direction will be very different from today. It will reflect a fundamental shift, putting theneeds of the individual first, and giving people choices in where and how their assessed needsare met.

Perhaps the best way to describe the new direction is to contrast it to the current situation incontinuing care.

People have few choices – they can stay athome if they can get the help they need, orthey can move into long term care centres.Other options like supportive housingarrangements are just starting to develop.

Home will be the first choice, and peoplewill have the support they need so theycan remain independent as long aspossible. Home care services will beincreased dramatically.

Supportive housing will expand andpeople will have many different optionsfor the kinds of services available.

People with complex and chronic healthneeds will live in continuing care centres.Instead of this being a common option, itwill be accessed only when a person’sneeds can’t be met at home or insupportive housing.

There are few programs to help peoplestay healthy and well. The emphasis is ontreating people when they are sick.

There will be a lifelong focus on effectivestrategies to stay healthy and well. Theresult will be healthier people, peoplewho are able to live independently andstay active, healthy and well for much oftheir lives.



People who need services have to go towhere the services are provided. Servicesare attached to the place they are providedand aren’t tailored to meet individual’sneeds.

The focus will be on bringing services topeople not bringing people to services.

Services will be “unbundled” – people willbe able to tailor packages of services tomeet their assessed needs and allow themto age in place.

Services for older people are notwell-coordinated. It is confusing, andsometimes frustrating, for people tonavigate the system and find out how toaccess the kinds of services they need.Often the services provided by the healthsystem and individuals with continuingcare needs are like “two ships passing inthe night.”

The “Coordination, Assessment andReferral for Entry to Services” (CARES)process will provide coordinated access tothe full range of continuing care services.Once people’s needs are assessed, casemanagers will arrange for appropriateservices regardless of whether the personlives at home, in supportive livingarrangements, or in a continuing carecentre.

New primary health care models willensure that teams of health professionalsand others are working together to meetthe needs of older people – whether that’smedical treatment, identifying people atrisk, providing therapy, nutrition advice,or arranging transportation to essentialservices.

Concerted efforts will be made tointegrate and coordinate services to frailolder people with complex health careneeds.



Many of the current long term carecentres are old and out of date for today’sneeds. Too many people are living inrooms with up to four people.

A new generation of continuing carecentres will be developed to meetchanging needs. Roughly 600 new bedswill be added by the year 2003 in orderto meet expected needs.

All existing four bed rooms will be phasedout over the next five years.

Continuing care centres will be sites forfacility-based long term care as well aspalliative care, sub-acute care, respite care,care for people with Alzheimer’s disease,wellness and community care programs.They will continue to meet the needs ofAlbertans of all ages who need continuingcare.

Family doctors, nurses and other healthcare professionals have worked hard tomeet the needs of older people withcomplex, chronic health needs. However,most have very little training in geriatricmedicine. They are not well prepared toaddress the complex and chronic healthneeds of frail elderly people.

There aren’t enough well trained healthcare providers to meet the needs of anaging population and provide essentialservices in long term care centres.

Specialized, mandatory programscombined with ongoing inservice trainingand education programs will ensure thatmore health care professionals andnon-professionals have the expertise todeal with an aging population.

A new provincial Network of Excellencein seniors’ health and geriatric care willensure that health care providers haveaccess to the latest ideas and research onnew ways of addressing the needs of anaging population. The programs andservices will be coordinated with theneeds of the providers and the expertise ofuniversities.



Strategies will be in place to attract andretain a sufficient supply of geriatricians,nurse specialists, and continuing carefront line workers.

Informal caregivers – family and friends –carry much of the responsibility forlooking after aging parents and relatives.While steps are being taken to recognizetheir role and provide support, there isincreasing stress on these people as theyjuggle responsibilities and try to providethe care people need.

Informal care givers will be recognized aspart of the team of people providing careand support for a particular individual.

Day programs and respite programs willbe widely available to give informalcaregivers a break when they need it.

This new direction for continuing care represents a fundamental departure from today’ssituation. We believe it is the right direction for Alberta – a direction that reflects thechanging expectations and needs of a new generation of aging Albertans, and a directionthat will result in better care – better coordinated care – for an aging population.


Taking action

AAAAAddressing immediate issuesddressing immediate issuesddressing immediate issuesddressing immediate issuesddressing immediate issues

The health system today is under mounting pressure to meetthe demands for continuing care services. There is a shortageof spaces in long term care centres. The waiting lists forcontinuing care are long and many people are waiting inexpensive acute care beds. Home care resources arestretched, particularly as more people are being dischargedearly from hospitals and need care at home with theirrecovery. Currently, a number of spaces in long term carecentres are outdated and inadequate, with up to four peoplein a single room.

These issues need to be addressed. At the same time, theCommittee believes that short term actions taken now shouldbe consistent with a longer term vision of what we want toachieve in continuing care. There is no point in taking stepstoday, such as building a large supply of continuing care beds,if, in future, those beds are likely to stand empty as peoplechoose other options, including staying in their own homes.What is needed is an effective bridge – short term solutionsthat address immediate problems but also support a longerterm vision of new directions in continuing care.

“We believe it is the rightdirection for Alberta – adirection that reflects thechanging expectations andneeds of a new generationof aging Albertans, and adirection that will result inbetter care – bettercoordinated care – for anaging population.”



The Committee recommends that:

Additional funding should be provided to addressthe current pressing needs in continuing care.

• The first priority should be to increase support forhome care services so that more people can receivethe care they need at home rather than in facilities.

• Steps should be taken to expand home care servicesavailable in supportive housing arrangements suchas expanding services available in lodges especiallyin rural communities, making use of subsidizedapartments for seniors’ housing, and expandinghealth services in coordination with home care.

• Additional funding should be directed to increasingthe number of qualified front line staff available toaddress the increasing acuity of people in long termcare centres.

• For people with complex and chronic healthproblems, additional funding should be providedto regional health authorities to allow them to lookat all possibilities for using existing space and bedsin the region, including re-opening closed beds.Although these beds are located primarily in acutecare centres, they could be used on a short termbasis to accommodate people with higher healthneeds. There should be minimal disruption to peoplewho are already living in long term care centres.

• For people with less serious health problems,the priority should be on expanding home andcommunity care, providing respite care for informalcaregivers, and expanding supportive livingarrangements.

“What is needed is aneffective bridge – short

term solutions that addressimmediate problems but

also support a longer termvision of new directions in

continuing care.”



In the short term, additional funding is needed to addresscurrent pressures in continuing care. The Committee doesnot have sufficient information to recommend specific targetsfor additional funding to meet the immediate needs. Wesuggest that regional health authorities be asked to identifythe immediate needs in their region. We recommend thatadditional funding should be targeted to meet the mostpressing needs in the province, rather than providing anacross the board increase in funding for all regional healthauthorities.

In the longer term, the Committee envisions a continuingcare system where fewer people will need care in long termcare centres. More people will be able to remain in theirhomes or in supportive living arrangements while long termcare centres will serve only people with complex and chronichealth needs. While the Committee recommends thatadditional spaces will be required over the next five years,we urge caution in “over-building” long term care facilities ifpeople’s needs can better be met in other, more appropriateand less costly alternatives.

For that reason, the Committee suggests that the first priorityshould be to expand home care services and ensure that thoseadditional resources are used to meet the needs of people withlong term home care needs. Steps also should be taken toincrease home care services available in supportive housingarrangements. A second priority should be to increase thenumber of qualified front line staff available to work in longterm care centres.

At the same time, the Committee understands that there isa backlog of people who need to be cared for in long termcare centres. Finding more appropriate spaces to care for thesepeople would free up acute care beds in hospitals for peoplewho have acute illnesses. In addition, acute care beds are notan appropriate environment for people with long term healthcare needs.


Therefore, the Committee recommends that every effort bemade to make use of existing spaces and beds. This maymean re-opening wings in hospitals or re-opening beds thathave been closed for financial reasons. As a bridging strategy,the existing spaces could be converted to continuing care bedson a short term basis. The cost would be less than buildingnew spaces. And it would provide an immediate solution,whereas building new spaces will take time.

Over the next three years, the Committee suggests thatplans be in place to open an additional 600 beds in long termcare centres to accommodate projected needs. However,these additional beds will take time to build and will not besufficient to meet the current needs unless immediate stepsare also taken to expand home care services and supportiveliving arrangements.

“… there needs to be aprovince-wide capitalproject strategy which

recognizes the ongoingneeds for upgrading,

replacement anddevelopment of a number

of models for facility-basedcontinuing care.”

From public consultations


Implementing new directionsImplementing new directionsImplementing new directionsImplementing new directionsImplementing new directionsfor the futurefor the futurefor the futurefor the futurefor the future

Part Three of the Committee’s report provides acomprehensive package of recommendations designed toimplement the new directions for continuing care.

The recommendations are based on a future scenario where:

Three streams are in place – a home living stream,a supportive living stream, and a facility-based stream.

Staying independent and in their own homesis the first choice for the majority of aging Albertans.

Supportive housing arrangements expand considerablyacross the province and allow more people to stay inflexible arrangements with increasing levels of servicesprovided to meet their needs.

Continuing care centres are an option for people withcomplex and chronic health needs. In the short term, thereis a need to increase the number of spaces in continuingcare centres. In the future, the actual number of peopleliving in continuing care centres will not decline becauseAlberta’s population is growing and there will be more olderpeople. However, with expanded options to stay in theirown homes, the percentage of the population who lives incontinuing care centres is expected to decline by 2016.

“Unless there is adequatehome care available andappropriate supportivehousing options for peopleto “age in place,” theprovince will be faced withmounting pressures to buildan estimated additional8,900 costly long term carebeds, even if this is not themost appropriate option forthe aging population.”



It is important to note, at the outset, that the Committee’srecommendations depend very much on a significant increasein home care services and supportive housing arrangements.Unless there is adequate home care available and appropriatesupportive housing options for people to “age in place,” theprovince will be faced with mounting pressures to build anestimated additional 8,900 costly long term care beds by2016, even if this is not the most appropriate option for theaging population. (Source: Future Scenarios: Continuing CareService Needs in Alberta, November, 1999. See figures onpage 27 for more information.)

The Committee is confident that, with proper planning, thevision we have outlined can be achieved. It reflects whatmany Albertans said they want to see for the future. However,it will take time for this vision to unfold. A step by stepapproach, rather than an abrupt change, is important. Albertasociety needs to understand and support this new direction inorder for it to happen. Strategies to communicate with thepublic about new directions and expectations for continuingcare and healthy aging are needed. The dramatic changes inthe care of older people envisioned by the Committee cannothappen “with the flick of a light switch.”

“Each person must betreated as a person and

not as a bed. We would notaccept school systems

speaking of the number ofchairs they are teaching.”

From public consultations



Key recommendations of the Committeeinclude the following:

Establish healthy aging as a priority for government,including a greater emphasis on promoting healthylifestyles, preventing illness and injury, andempowering and engaging seniors.

Adopt primary health care models for providinghealth services for older people, so services are wellcoordinated, teams of health professionals worktogether to meet people’s needs, and there areeffective and well managed plans in place.

Introduce a new coordinated access process to assessneeds and ensure appropriate referrals to the fullrange of continuing care services, whether thoseservices are provided at home, in supportive livingarrangements or in continuing care centres.

Shift the focus so that the first priority is for peopleto remain in their homes and other types of supportiveliving arrangements. Expand home care servicessubstantially.

Encourage the private and voluntary sectors to expandthe range of supportive living options available acrossthe province. Expand supportive housing to includelight and medium care cases, people with milddementias, and young people with disabilities. Setprovince-wide standards for supportive housingdevelopments.

Establish a new generation of continuing care centresdesigned to meet the needs of a selective populationof frail older people. Begin phasing out all four bedstandard rooms. Increase the number of beds byapproximately 600 over the next three years to meetthe backlog of needs but, at the same time, increase


supportive housing alternatives and home care to takethe pressure off continuing care facilities and acutecare hospitals.

“Unbundle” health care services, other services suchas personal care and food services, and housingarrangements. Give people a choice in the specificpackage of services they need to meet their assessedneeds wherever possible. Bring services to peoplerather than requiring them to move into facilities ortravel to where services are provided.

Re-organize the delivery of acute care services forolder people. Introduce a comprehensive casemanagement strategy for meeting the needs of olderpeople with complex, multiple health problems.Ensure that there is effective discharge planning.Enhance geriatric services and access to geriatricassessment services, especially in rural communities.

Take steps to increase the number of qualifiedprofessionals and health care providers working witholder people. Establish designated, stand-alonepositions for training in geriatric medicine at Alberta’smedical schools. Increase the number of nursespecialists in geriatrics. Increase the number oftrained people available to work in the communityand in continuing care centres.

Expand geriatric education and training for healthcare professionals and other health care workers. Setnew standards for skills and competencies for peopleworking in continuing care centres. Establish a newprovincial Network of Excellence in seniors’ healthand geriatric care.

“The province is blessedwith resources to allow youto get the job done.”

Dr. Ken Rockwood, Professor of

Medicine, Dalhousie University


Continue to provide professional health services incontinuing care centres at no cost to the individual.Increase the current cost recovery charges to moreaccurately reflect both housing costs and people’sability to pay. Set minimum and maximum levels forcharges, and have appropriate subsidies in place forthose who need them.

Continue to provide professional home care servicesat no cost to the individual. Introduce consistentcharges for the personal care component of homecare services such as homemaking services andassistance with the tasks of daily living. Base thecharges on the actual average cost and set maximumand minimum charges based on income.

Use the additional revenues generated from new costrecovery policies to support improvements in servicesfor people in continuing care centres, expand homecare services, and renovate and upgrade existingcontinuing care facilities.

Implement new programs to support acute care drugsfor people who are receiving care at home or insupportive housing. Convene a conference on the useand effectiveness of drugs for seniors as a catalyst todevelop new strategies on drug utilization for anaging population. Involve physicians and pharmacistsin developing strategies for managing and monitoringseniors’ drug use.

Introduce a new Continuing Care Act to ensure thereare consistent standards, appropriate monitoring, andclear responsibilities for the different organizationsinvolved in continuing care.

“The aging of thepopulation will not haveas dire consequences for

the health system as someforecast. Nonetheless, it is

important that theprovince increases thepace of innovation to

ensure that primary healthcare is strengthened.

Without primary healthcare, the province’s elderlywill suffer needless healthproblems and there will beincreasing pressure on the

province’s institutionalsystem.”

Dr. Michael Rachlis, private

consultant, Toronto, Ontario


Next steps

The Committee would like to thank everyone whoparticipated in the review of long term care in the provinceand helped us set a new direction for the future. Literallyhundreds of Albertans, including seniors, health careproviders, health authorities, experts and organizations tooktime to consider today’s issues and offer their ideas for thefuture. Their advice was instrumental in shaping the viewsof the Committee as it set about the task of developingrecommendations.

We have learned a great deal about Alberta’s health systemand the people who work in the system day after day to meetpeople’s health needs. The quality of care people receivetoday depends directly on the dedication and commitmentof outstanding family physicians, specialists, nurses, regionalhealth authorities, families, volunteers and a whole range ofpeople who work in home care, in long term care centres,in hospitals and in other community programs. Ourrecommendations are intended to build on and support theimportant work these people do.

We believe that a combined focus on healthy aging, newdirections for care and different housing options will providethe kind of balanced and forward looking approach Albertaneeds to prepare for the next generation of older people.


Success will follow if …

deliberate steps are taken to implement the packageof recommendations included in this reportthose in the health system are able to manage careeffectively and make the best use of available resources,programs, services and facilitiessufficient resources – people and money – are in placethere is a spirit of cooperation among people workingin the health systemAlbertans embrace a new vision for healthy aging andcontinuing care and take steps to make that vision areality.

We encourage the government and all Albertans to actquickly – in collaboration with physicians, nurses, healthcare providers, and health authorities – in setting a newcourse for the future of seniors’ health and continuing carein the province.

Healthy Aging - Alberta · healthy aging and to meet the needs of an aging population, we need to take a fundamentally different direction for the future. We need a “paradigm shift”

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