An Uncertain Future for Seniors

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

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 2

3. “long-term care” 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 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 3

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 4

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 5

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 6

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 7

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 8

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 9

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 10

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 11

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 12

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 13

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 14

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 15

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 An Uncertain Future for Seniors, Briefing notes, page 16