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The Office of the Ombudsperson as a Catalyst for Systemic Change – November 17, 2012

The Office of the Ombudsperson as a Catalyst for Systemic Change – November 17, 2012. Kim Carter Ombudsperson , Province of British Columbia Carly Hyman Manager, Systemic Investigations. Systemic Change for Seniors.

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The Office of the Ombudsperson as a Catalyst for Systemic Change – November 17, 2012

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  1. The Office of the Ombudsperson as a Catalyst for Systemic Change – November 17, 2012 Kim Carter Ombudsperson, Province of British Columbia Carly Hyman Manager, Systemic Investigations Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  2. Systemic Change for Seniors “I agree with the ombudsperson when she observes that the ministry and health authorities do not have an adequate program in place to ensure seniors and families are informed of availability of home and community care services, and the opportunity to have their eligibility for subsidized services assessed.” “[The report] is, as I have mentioned, extremely detailed and it has, I can assure you, informed our direction in setting an action plan and highlighted the need to move forward.” B.C. Minister of Health, February 2012 Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  3. CONTENTS • The Role of the Ombudsperson in B.C. • Our Work in Context • Office Structure • Jurisdiction • Investigations • The Office of the Ombudsperson and Seniors • Ombudsperson Systemic Reports on Seniors Care • Public/Stakeholder Response • Community and Media Interest • Examples of Systemic Change • Residents’ Bill of Rights • Sponsored Immigrants • Hospital Act vs. Community Care and Assisted Living Act • Fees under the Mental Health Act • Assisted Living Tenancies • Consent to Treatment • Questions Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  4. Role of the Ombudsperson’s Office • Receive complaints about administrative (not political) actions, omissions, policies and procedures from individuals or groups • By public authorities • That unfairly impact upon an individual in British Columbia • Can self-initiate investigations Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  5. Our Work in Context • B.C. population: 4.5 million • Authorities: 2,000 + • Public servants: 30,000 + • Crown corporation employees: 20,000 + • Local government, health and education employees: 150,000 + Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  6. Office Structure - 34 dedicated staff Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  7. Jurisdiction • Provincial ministries • Provincial boards and corporations (ie Workers’ Compensation) • Provincial Crown corporations (ie BC Hydro) • Local governments • Health authorities and hospitals • School boards and schools • Colleges and universities • Various Pension Boards of Trustees • Miscellaneous authorities (including self-regulating professions) Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  8. Investigations • Individual Complaint • Complaint Assessment • Information • Referrals • Early Resolution • Investigations • Systemic Investigations Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  9. The Office of the Ombudsperson and Seniors • Wide range of individual investigations involving seniors including • Ministry of Health: Pharmacare, Medical Services Plan • Insurance Corporation of BC and the Office of the Superintendent of Motor Vehicles • Regional health authorities: hospitals, home and community care services, assisted living and residential care • Public Guardian and Trustee • BC Housing Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  10. The Best of Care (Part 1) • Issues Investigated: • Rights for seniors in residential care • Access to information about residential care • Role of resident and family councils Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  11. On Short Notice • Vancouver Island Health Authority • Cowichan Lodge – Duncan • Closure of Residential Care Facility • Complaints from Residents, Families, Staff • Issues • Information • Seeking Exemption • Decision Maker • Consideration of Individual Circumstances • 6 Findings • 6 Recommendations • Recommendations Accepted except about Decision Maker Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  12. Honouring Commitments • Fraser Health • Newton Regency – Surrey • Ceasing Funding of Beds and Requiring Moves Contrary to Written Commitment • Three Complainants (out of 37 affected) • Issues • Consideration of Commitment • Adequacy of Notice • Planning and Flexibility • Advising of Temporary Status • Following Legislative Requirements for Notice/Exemption • 7 Findings • 9 Recommendations • All Accepted Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  13. The Best of Care (Part 2) • Investigation of home and community care issues, home support, assisted living and residential care including • Adequacy of information • Access to services • Standards of care • Complaint processes • Monitoring and enforcement • Facility closures • 143 Findings 176 Recommendations to the Ministry of Health, Ministry Responsible for Housing, and five regional health authorities Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  14. Public/Stakeholder Response “The B.C. Ombudsperson’s report represents an historic opportunity to address serious problems in our home and community care system, and to strengthen the services and supports that can help B.C.’s growing population of seniors to age in place, and to die with dignity.” Canadian Centre for Policy Alternatives, B.C. Health Coalition, Vancouver Cross-Cultural Seniors Network “By providing a roadmap to improve the quality, efficiency and transparency of the public system for families and front-line care providers, [the] report represents a turning point for seniors care in B.C.” B.C. Care Providers Association Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  15. Public/Stakeholder Response (2) "There has never been an investigation of this magnitude in this province. [The] recommendations are concrete and we urge the government and health authorities to take action to make significant changes to the way seniors receive care in B.C." B.C. Government and Services Employees’ Union president Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  16. Public and Media Interest Related to Seniors’ Report Release Intensity measured over 8 days: February 14 to 22, 2012 • 60 plus TV, radio broadcast and print articles related to the Seniors report • A 242% increase in visits to www.bcombudsperson.ca • 1,250 plus electronic downloads of the reports • Significant increase in ‘visits via social referral’ to our website To date over 35 presentations made through out B.C. The Best of Care (Part 2) reprint Original OrderReprint 2,000 Overview 2,500 Overview 500 Full Report 500 Full Report Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  17. Examples of Systemic Change • Residents’ Bill of Rights • Sponsored Immigrants • Hospital Act vs. Community Care and Assisted Living Act • Fees under the Mental Health Act • Assisted Living Tenancies • Consent to Treatment Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  18. The Residents’ Bill of Rights • Issue: • Questions about level of care seniors entitled to receive in residential care • Seniors and families reluctant to raise concerns • Recommendation: • the Ministry of Health set out in law rights of seniors in all residential care facilities and require that rights be posted in a prominent place in all facilities - The Best of Care (Part 1) • Status: • Enacted in December 2009 as a part of the Health Statutes (Residents' Bill of Rights) Amendment Act, 2009 Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  19. Sponsored Immigrants • Issues: • Fees charged to sponsored immigrants for home and community care services • Whether fees charged to sponsored immigrants were in excess of the rates prescribed Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  20. Sponsored Immigrants • Sonya’s Story • Sonya sponsored her father to come to Canada in 2001 and signed an undertaking to be responsible for him for 10 years. In 2007, he developed Alzheimer’s disease and entered residential care, where he was charged the highest daily rate ($71). Sonya thought he should be charged the lowest daily rate ($23) given his after-tax income, but when she asked the health authority, they told her that all sponsored immigrants were charged the highest rate. Furthermore, she was told that her father was ineligible for a hardship waiver because practice was to include the income of the resident, the resident’s spouse and the sponsor in determining eligibility for hardship. Sonya was concerned that her father was being treated differently from other seniors who required residential care. Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  21. Sponsored Immigrants • Conclusion: • Ministry of Health did not have authority to use a different process to determine the rates that sponsored immigrants had to pay for home and community care services • Status: • Ministry removed the distinction between residents and sponsored immigrants in April 2011. Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  22. Hospital Act vs. CCALA • Issues: • Two legislative schemes govern residential care in BC • Many differences between facilities under the Hospital Act and facilities under the CCALA • Seniors and families may not know which legislation a facility is subject to • Seniors are expected to take the first available residential care bed and do not choose which facility they enter • New facilities and beds continue to be created under both Acts Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  23. Hospital Act vs. CCALA • Conclusion: • Ministry’s decision to maintain two separate legislative frameworks has resulted in unfair differences in the care and services that seniors receive and the fees they pay • Recommendation: • Ministry harmonize framework by January 1, 2013 • Status: • Ministry committed to putting plan in place by January 1, 2013 to standardize benefits and protections Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  24. Fees Under the Mental Health Act • Issues: • All health authorities charge fees to seniors who have been involuntarily admitted to a mental health facility or psychiatric unit and then put on extended leave and transferred to residential care facility • Patients involuntarily admitted to a mental health facility or psychiatric unit are not charged fees Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  25. Fees Under the Mental Health Act • Murray and Joan’s Story • Murray and Joan had been married for 50 years when Joan, who suffered from dementia, was removed from their house, involuntarily admitted to a mental health facility, and transferred to a residential care facility. Murray thought it was unfair to hold Joan in the residential care facility against her will, impose treatment on her and charge her for being there. He came to our office to complain. • At the time that Joan was admitted, she and Murray had been living in a makeshift suite in the home of one of their daughters. After being discharged from hospital, Joan received a visit from VIHA’s Elderly Outreach Service (EOS). The EOS team assessed the suite as unsafe and believed she should move into residential care. Joan did not have the capacity to consent to this move, and Murray, though not her legal representative, disagreed with the EOS’s plan. VIHA’s EOS doctor certified Joan under the Mental Health Act and admitted her to a mental health facility. Then, with the authorization of a second doctor, she was promptly put on extended leave and sent to a residential care facility. After VIHA transferred Joan to the residential care facility, it charged her residential care fees for those services.

  26. Fees Under the Mental Health Act • Conclusions: • Unfair to involuntarily detain seniors, subject them to treatment and charge them fees for the detention • Unfair to charge a person who would otherwise not be charged just because they have been transferred to another facility • Absence of clear legislative authority to charge fees Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  27. Fees Under the Mental Health Act • Recommendations: • Health authorities stop charging fees • Ministry of Health develop a clear policy on when it is appropriate to detain seniors under the Mental Health Act in residential care • Ministry of Health develop a process for seniors who have paid fees for residential care while being detained to apply to be reimbursed • Status: • Under review by the Ministry of Health Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  28. Assisted Living Tenancies • Issues: • Assisted living residences are not covered by the Residential Tenancy Act • No formal process to resolve tenancy disputes • Province has attempted to address the problem for over a decade. • Conclusion: • Ministry Responsible for Housing has not ensured that assisted living residents benefit from equal or greater legal protect than other less vulnerable tenants Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  29. Assisted Living Tenancies • Recommendations: • Ministry protect assisted living residents by bringing into force unproclaimed sections of the Residential Tenancy Act or by developing another legally binding process to provide equal or great protection by January 1, 2013 • Ministry of Health in consultation with Ministry Responsible for Housing consider whether to expand the jurisdiction of the OALR to deal with tenancy related assisted living disputes • Status: • Ministry Responsible for Housing advised that province intends to repeal the provisions of the Tenancy Statutes Amendment Act relating to assisted living once the Ministry of Health has established a program • Under review by the Ministry of Health Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  30. Consent to Treatment • Issues: • With the exception of emergencies, informed consent must be obtained before any health care treatment is administered in residential care facility • Seniors are presumed to be capable of providing consent • If health care providers determines senior is not able to give consent, he or she must seek substitute consent from someone with legal authority to consent on the senior’s behalf • no legal requirement for health care providers in British Columbia to document consent Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

  31. Consent to Treatment • Conclusion: • Health care providers who administer treatment and prescribe medications to residents in residential care are not required to document • that they’ve considered whether a person in care is capable of providing consent • who provided informed consent • when it was provided • how it was provided • the duration of the consent • Recommendation: • Ministry of Health establish legal requirements to document consent • Status: • Under review by the Ministry of Health

  32. Questions? CONTACT US: 1-800-567-3247 www.bcombudsperson.ca 947 Fort Street, Victoria PO BOX 9039 STN PROV GOVT VICTORIA, BC V8W 9A5 Office of the B.C. Ombudsperson, Elder Law Conference, Nov 17, 2012

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