Alberta’s Continuing Care System Organization and Priorities Presentation to BC Care Provider’s Conference Tyler James, Executive Director Continuing Care Alberta Health May 6, 2013

Continuing Care System Governance Alberta Health Services (AHS) created as single health authority on April 1, Alberta Health, accountable to the Minister of Health sets directional policy, legislation, regulations and standards, and provides funding to AHS for the delivery of continuing care health services. AHS is accountable to the Minister of Health, and is responsible for developing and implementing operational policies, delivering continuing care health services, and assessing and placing continuing care clients.

Continuing Care System System and Standards Continuing Care Health Service Standards –Apply to all publicly-funded continuing care health services. –Currently under review; revisions expected to focus on areas of risk and quality of life. Supportive Living and Long-Term Care Accommodation Standards –Apply to all supportive living and long-term care accommodations. –Last updated April Home LivingDesignated Supportive Living (DSL) Long-Term Care (LTC) 95,975 Unique Clients7,985 DSL Spaces*14,565 LTC Spaces* Cumulative total to December 31, 2012 Point-in-time information as of March 31, 2013 Point-in-time information as of March 31, 2013

Continuing Care System Capacity Planning Capacity Planning –Provincial Capacity Planning Model –Commitment to add 1,000 continuing care spaces per year between 2010 and Affordable Supportive Living Initiative (ASLI) –Capital funding provided to operators to support the development of affordable supportive living spaces in the province. –Since 1999, almost $600 million in funding has been provided to develop, renovate or renew approximately 10,000 supportive living spaces. –Work in collaboration with AHS to increased the continuing care capacity in priority areas of the province.

Continuing Care System Policy Priorities Shift to the Community 90% of Albertans want to live in their own homes during their senior years; 59% of individuals over 95 years of age still live at home. –Growth in Home Care Home Care Redesign and Directional Policy Development –Supportive Living Capacity Growth Quality and Innovation –Policy Review –Standards –Innovation Grants –Information Resources

Continuing Care System Policy Priorities Accommodation Charges –Long-Term Care Maximum Accommodation Charge increased in January Private Room Rate: $58.70/day (~$ /month) Semi-Private Room Rate: $50.80/day (~$ /month) Standard Room Rate: $48.15/day (~$ /month) Business Model review –Alberta recognises increasing pressures related to cost on the accommodation and the health side –Upcoming work will look at the funding/revenue and expense issues review options to develop a model that is more sustainable.

AHS Seniors Health The Right Care in the Right Place Presentation to Members of BC Care Providers Association By David O’Brien SVP, Primary and Community Care, AHS May 6 th, 2013

8 Familiar Challenges with the Numbers Number of older adults in Alberta will grow from 375,000 to 880,000 by 2030 As cognitive impairment is associated with age, the number of individuals living with dementia will also grow Of concern – Alberta has the highest proportion of early onset dementia – 17% (e.g. 1,693 individuals under 65 with a primary diagnosis of dementia were seen by physicians in 2008)

9 Familiar Challenges with Public Expectations Higher levels of education and income Greater interest in being partners in their own health – autonomy and choice Expect a higher level and quality of services Younger, disabled adults want to stay in community Older adults want to stay in community or as close to home as possible

10 Principle Driven Service Delivery Client based care Coordinated and trained case manager staff – increasing integration within community Acting from a position of wellness and independence; enhancing individual and community capacity – Caregiver respite; education – Common Home Care services – Adult day programs – Self managed care funding – Testing technology

11 Principle Driven Service Delivery Aging Closest to Home – Aging in Place 90% of Albertans want to live in their own homes during their senior years - 59% of individuals over 95 years of age still live at home Increase the services provided through home care – Increase number of clients by 3,000/year for 3 years – Increase the variety of home care services – Provide for assessed extra-ordinary funding

12 Principle Driven Service Delivery Right Care – Right Place – Shift to Community Provide home care, and continue to support individuals who are unable to remain in their own home in living options close to home Increasing the range of congregate living options Increasing supports within current environments, such as lodges, to accommodate unscheduled health needs Increase the number of living options – Add 5,000 new spaces over 5 years – Align living option with right mix of staffing – Provide added care option for episodic care

13 Community Health and Pre-Hospital Supports (CHAPS) Right patient to the right place at the right time to be cared for by the right practitioner CHAPS is an EMS referral program Connects patients to community and home based services Helps patients stay at home longer and stay healthier with additional home services Connect more patients to community services Reduce calls to EMS  Reduce Emergency Department presentations  Reduce acute care admissions

14 ED To Home (E2H) Connects Seniors visiting the ED with services in the community, ensuring access to the right care in the right place Currently there are 13 EDs across Alberta with E2H program in-place The E2H program is a model of integration between Community and Acute Care 5,003 additional Home Care referrals generated, enhancing client knowledge of Home Care and increased communication among service providers

15 Destination Home Represents philosophical shift in how Health System currently responds to seniors with complex needs, and those at risk for admission to supportive living, long- term care and/or ED/acute care Mirrors similar approaches in other provinces (Home is Best in BC and Home First in Ontario) Transfers to congregate living settings will not be considered until all community-based options have been exhausted. Moving to a residential care facility is a life-changing decision that optimally should be made from home.

16 Path to Home Is an AHS discharge model to effectively and consistently discharge patients in a standardized method from in-patient beds Coordinates teams within Acute and Transition care, enabling completion of activities required prior to discharge in a timely manner, to allow return to home with appropriate community supports Model developed on 5 best practices: – Anticipated date of discharge upon admission – Estimated day and time of departure – Readiness for discharge – Complex discharge targeting – flagged and proactive on admission to acute care – Right time to diagnostics and timeliness of reports

17 Home Care Redesign 3-year plan to address provincial inconsistencies around –Home Care Service Guidelines (hours of care available): developed and implemented across AB –Integration of Home Care with Community & Primary Care supports –Types of services provided –Rates of pay for Home Care services –Service effectiveness and quality outcomes

18 Responding to the Needs Patient Care Based Funding – Case Mix Indexing Started with Long Term Care Facilities; then Supportive Living; then home care services Systematic equitable way of dividing available resources based on client needs Based in RAI assessments

19 Capacity Changes since 2010 Added >3,000 new beds All of them in Supportive Living Services designed for client need 24X7 Home Care in retirement homes/lodges Cost per client reduction Placement options increasing

20 Outcomes - Making Progress

21 Wait Time for Living Options

22 Seniors ED Utilization

23 Seniors ED Utilization

24 Questions?

Bruce West, Executive Director Alberta Continuing Care Association May 6, 2013

Represent the owners and operators of publicly funded long term care and supportive living facilities and the providers of publicly funded home care and home support services. 26 facility-based members operating over 11,000 beds/spaces in 110 facilities 26 home care and home support members providing over 5 million hours of care annually to over 40,000 clients Vision:The recognized voice for advancing excellence in continuing care Mission:We advance the continuing care system by: Advocating for effective public policy; Assisting members in networking, education and pursuit of best practices; Promoting a sustainable and innovative continuing care system; and Championing quality care and quality of life for individuals receiving continuing care. Values: As ACCA members our actions are guided by a commitment to excellence, professionalism, integrity and accountability.

 Health System Restructuring  Loss of corporate memory  Revisions to contracts and regional programs and policies  Changing roles and responsibilities  Communication and Consultation  Lack of consultation on policy and program development  Inconsistent and contradictory messages (Gov’t and AHS)  Operating Funding – Health and Accommodation  Continuing care underfunded  Regional funding and accountability differences  No acuity adjustments since 2005  Introduction of Activity Based Funding  No accommodation fee adjustment mechanism  Taxation inconsistencies

 Capital Funding  Capital funding available for supportive living but not LTC  No capital component (debt servicing or upgrading) in accommodation fees  Aging LTC Inventory  No action on 2008 strategy to replace 7,000 aging long term care beds by 2015  Standards and Monitoring  Regional accountability differences  Impact of standards on operating costs  Introduction of new health and accommodation standards  Multiple, uncoordinated inspections  Workforce  Labour shortages  Aging workforce  Higher expectations and standards  Injury and lost time rates

Challenge Industry Rating Trend Health System Restructuring B Communication and Consultation B Operating Funding – Health and Accommodation C Capital Funding B Aging LTC Inventory D Standards and Monitoring B Workforce B