Research analysis solutions An Uncertain Future for Seniors BC’s Restructuring of Home & Community Health Care, 2001-2008 Briefing Notes April 15, 2009.

research • analysis • solutions

An Uncertain Future for Seniors

BC’s Restructuring of Home & Community Health Care, 2001-2008

Briefing Notes • April 15, 2009

An Uncertain Future for Seniors, Briefing notes, page 2

Background

• CCPA-SFU Economic Security Project

• CCPA assesses provincial government record on seniors’

care

- Without Foundation: How Medicare is Undermined by Gaps and Privatization in

Community and Continuing Care (published November 2000)

- Continuing Care Renewal or Retreat: BC Residential & Home Health Care

Restructuring 2001-2004 (published April 2005)

- Today: An Uncertain Future for Seniors - only publicly available,

comprehensive accounting of long-term care beds in BC

• Aging population

- # seniors aged 85+ increased 43% since 2001, # aged 75-84 up 15%

- Home and community health care more important than ever

An Uncertain Future for Seniors, Briefing notes, page 3

What is home & community health care?

• In-home and residential services for seniors and people with chronic conditions, disabilities, mental illness

- Uncertain Future study focuses on seniors’ care

• Dignity, independence, prevention, cost-effective

• Types of services:- Home support (personal care such as bathing, help with medications)

- Home care (home nursing and community rehabilitation)

- Assisted living (for people with low to moderate levels of disability)

- Residential care (24-hour nursing, for people with complex needs)

- Palliative care (provided in hospital, residential care and at home), adult day care, supportive housing, and others

“long-term care”

These service should form a well-coordinated continuum of care, but today they are fragmented and inadequate

- Innovations study shows there are cost-effective solutions

An Uncertain Future for Seniors, Briefing notes, page 4

The 5,000-bed commitment

• 2001: Will build 5,000 new, non-profit residential care

beds by 2006

- Later shifted promise to 5,000 residential care, assisted living &

supportive housing beds

- Omitted reference to non-profit

- “Extended” deadline to 2008

• Ministry of Health Services, Sept 08: claims 5,000-bed

target exceeded

• CCPA research: 3,589 net new beds between 2001 and 2008

- Compared Ministry of Health Services bed numbers to numbers obtained by FOI

from each health authority

- Discrepancies tracked facility-by-facility

An Uncertain Future for Seniors, Briefing notes, page 5

The beds equation

4,393 new assisted living

beds

804 fewer residential care

beds

3,589 net new “long-term care”

beds+ – =

• Province fell short of 5,000 bed commitment by 1,411 beds

• All new capacity = assisted living

• Assisted living not an adequate substitute for residential care

• Using growth population over 75 as rough estimate of growing demand – target for

2008 should have been 6,815 new beds

An Uncertain Future for Seniors, Briefing notes, page 6

Why the discrepancy?

• Over-counting and inaccurate reporting by Ministry

• Counted beds that are not at all equivalent to residential

care

- Supportive housing units, short-term convalescent care, group homes, housing

for people with developmental disabilities, independent living units, mental

health facilities

• Correct numbers verified through facility and other

websites & by phoning facilities

An Uncertain Future for Seniors, Briefing notes, page 7

Reduced access to residential care

• Access, or ‘bed rate’ = beds per 1,000 seniors aged 75+

• Residential care (excluding assisted living)

- Access dropped 20.5% since 2001

- 2001: BC just above average compared to other provinces

- 2008: Second lowest after New Brunswick

• Even when combine assisted living and residential care bed

#s

- Access dropped 6.2% since 2001

An Uncertain Future for Seniors, Briefing notes, page 8

Reduced access to most home-based services

• Home support

- Number of clients dropped 17%

- Access (clients per 1,000 seniors aged 75+) dropped 30%

• Home nursing

- Number clients increased 6%

- Access (clients per 1,000 seniors aged 75+) dropped 11%

• Community rehabilitation

- Only service with increased access, up 24%

An Uncertain Future for Seniors, Briefing notes, page 9

Shift to high-needs clients

• Eligibility for residential and home based-services

restricted to those with higher needs

• Staffing & training in residential care not increased to

reflect higher needs clients

- Residential care patients more likely to end up in hospital

• Lower needs clients don’t have access

- Prevention and early intervention undermined

- Must rely on family, pay privately, or go without care

- More likely to end up in expensive hospital beds

• # deaths in residential care up 60%

- Not negligence - access restricted to more frail seniors - more likely to be

at end-of-life stages when admitted

- Residential care facilities not funded to provide palliative care

An Uncertain Future for Seniors, Briefing notes, page 10

Impact on acute care system

• Inappropriate use of hospitals

- Too many seniors waiting in hospital due to lack of access to residential & home

care

• Important to know how many seniors end up in hospital

inappropriately

- Province refers to this as “Alternate Level of Care”

- In 3 health authorities: increase in inappropriate use hospital beds.

- In 2 health authorities: decrease - but these two HAs changed how they count

- No consistent reporting requirements for health authorities

- BC’s numbers high compared to other provinces

• “First available bed policy”

- To move frail seniors out of hospital more quickly, they must accept the first

available bed

- Shifts the priority for placement from those waiting in the community to those in

hospital

- Without access, seniors’ health deteriorates…more likely to end up in hospital

An Uncertain Future for Seniors, Briefing notes, page 11

Shift to for-profit delivery

• Provincial policy changes favour private facilities

• Increase in private residential care facilities

- 20.5% increase in for-profit facilities since 2000

- 12.9% decrease in non-profit and health authority facilities

• Evidence: For-profit delivery means lower quality of care

• But both non-profit & for-profit contracted facilities not

getting enough funding to cover current costs

An Uncertain Future for Seniors, Briefing notes, page 12

Symptom of deeper problems

• Reduced access, system in serious decline

- Despite 37% increase in funding 2001-08 for home and community care

• Overall increases in health spending in BC since 2001 less

than any other province

- BC went from 2nd to 6th in per capita health spending

• No plan, lack of coordination and leadership

- Home and community care system = $2 billion annual budget

- No strategic plan

- Lack of coordination, leadership

- Lack of transparency, consistency in reporting to public

An Uncertain Future for Seniors, Briefing notes, page 13

Growing chorus

• Study supports concerns raised by others about

deteriorating state of system

• BC Auditor General

• BC Ombudsman investigation into systemic problems in

seniors’ care

• BC Medical Association

• BC Care Providers Association

An Uncertain Future for Seniors, Briefing notes, page 14

Top recommendations

• Full public consultation process

• Development comprehensive strategic plan

• Commitment to increase access to care

- Services increase with aging population

• Commitment to develop a more innovative & integrated

approach to service delivery

An Uncertain Future for Seniors, Briefing notes, page 15

Specific recommendations

• Increase residential care beds

- At minimum: restore 2001 levels as share health care funding

- Brings residential care budget up by $94.5 million (equivalent 1,500 new

beds)

• Fully fund current operating costs of residential care

- At minimum: 3.2 hours care per resident per day

• Develop provincial standard of core services for

palliative care

• Invest $100 million additional in home support to fund

team-based delivery, improve recruitment/retention,

increase services by 15%

• Finance delivery of new residential care beds by non-

profits and/or health authorities

An Uncertain Future for Seniors, Briefing notes, page 16

Existing innovations = key to long-term success

• Examples of successful innovations in seniors care exist

• Some have proven successful in reducing use of expensive

emergency & hospital services

- Ex: Integration of Primary Care Services in Residential Care in Prince

George

- Ex: Netcare in Chilliwack

• Others show the health benefits of improved coordination &

early intervention

- Ex: VIHA case managers working with family physicians

- Ex: Northern Health frail elderly collaborative

• Given aging population - implementing these innovations

province-wide is key to health care sustainability

- Provincial leadership needed to scale up