The BC Continuing Care (CC) Story Canadian Health Coalition Conference on Continuing Care Marcy Cohen, BC Office of the Canadian Centre for Policy Alternatives

The Larger Context -- Why the focus on CC NOW? The number one recommendation from the Canadian Medical Association to federal government: a pan Canadian strategy for seniors care. WHY?  Reduced acute care in-hospital beds over the last 25 years  Today we have very high hospital occupancy rates compared to other OECD countries – in BC 105% occupancy compared to 76% OECD average.  Waits list for hospitals services can not be solved if the shortfall in CC system not addressed

Progress in Implementing a Comprehensive Public System of CC Stalled for 20+ years NOT new: Seen as the 2 nd stage of Medicare by Tommy Douglas, supported by BC’s Royal Commission in 1991 and by many research studies Continuing Care NOT covered under the five principles of the CHA Without legislated protection, it is very easy to for gov’t officials redefine eligibility and restrict access in response to a budget shortfall. Until very recently Continuing Care has not been recognized as a key component of primary health care reform (as it was in the Romanow Report)

Resident Care (RC)  In early 1970’s most “nursing homes” for-profit and union organizing efforts highlighted the issue of poor “working and caring” conditions in these facilities.  In late 1970’s the BC gov’t initiated provincial continuing care program, with one stop access, increased non-profit RC delivery and gradual improvements to pay and working conditions.  Building new RC slowed stopped in the mid 1990’s…since 2001, a 20% reduction in access to RC for seniors 75+ and increased for-profit provision.  Seniors in RC frailer, much more likely to suffer from dementia and to die in RC. BUT  Staffing levels and training not kept pace with higher needs of residents  Few RC facilities have team based primary care  More people now dying in RC, but palliative care program not available

Assisted Living (AL) and Supportive Housing (SH)  AL -- new level of care introduced in early 2000’s as a substitute for RC using $$ earmarked for housing. About 2/3 of AL are publicly subsidized (you pay no more than 70% of your income) and the remainder are entirely private pay.  Now serving higher needs seniors but staffing and standards inadequate  Missing in BC is an affordable supportive housing option – particularly important for low income senior women living alone

Home Support (HS)  Greatest access before the cuts in federal transfer payments in the mid 1990’s – since 2001, 30% reduction in access for seniors 75+  Shorter hospital stays, fewer residential care beds and new policies like the palliative home care program and “home first” dramatically increasing demand…but funding not kept pace. The result: Increased focus on nursing tasks, less support for seniors with limited needs, seniors who only need help with domestic tasks now not eligible for services from the HA, less social support, less continuity and less ability to monitor and report changes in clients health…to be the “eyes and ears” of the health system In BC the number of private agencies providing home support services has doubled since in the last 10 years…from 39 to 84.

Home Nursing and Rehab  Not the same dramatic reductions as in home support and residential care – actually an increase in rehab services  But because nursing clients are also more complex, less time available for nurses to support and work with Community Health Workers/Home Support Workers  Also an increased demand for case management as people in community become more complex and need more co- ordinated care

Other Continuing Care Priorities More support needed for the informal and formal care givers who are the backbone of our system of CC  Many seniors, particularly women, caring for loved one without adequate support and recognition from the health system – respite care at home, in RC, or in an adult day care centre  The care aides and community health workers who are the front line workers in RC and HS also need additional support and recognition – many work as casuals, have inadequate training and job security and work for very low pay, particularly in the for-profit sector…results in high turnover and poor continuity of care

Wishful Thinking in the Current Policy Environment In the current context of fiscal restraint and the perceived unwillingness of the public to pay more taxes there is a lot of wishful thinking going on when it comes to the role CC 1.Fallacy to think you can cut hospital services to pay for an expansion of CC. 2.Fallacy to think you no longer a need to spend money on residential care. 3.Fallacy to think “domestic” services can be hived off and provided by a separate non-health agency with no link back to the health system. 4.Problematic to pit the generations against each other in terms of whether services to children are more or less important than services to seniors.

Continuing Care Principles 1.CC must be understood as a key component of a comprehensive publicly funded system of primary health care 2.Seniors, people with disabilities and communities must have a voice in care decisions at the individual and health system level 3.Seniors and people with disabilities must have the services and supports required to live and die with dignity 4.The CC system must be designed to support seniors and people with disabilities to be as independent and socially connected as possible 5.Informal and formal care givers, who are play a key role in CC, must be appropriately resourced, recognized and compensated.

Despite all the wonders of modern medical technology, seniors share with all of us the raw and basic need for dignity and human connection. What I now understand is that this has to be the primary focus of how society looks after our elders and how we think about health care for seniors