research analysis solutions An Uncertain Future for Seniors BC’s Restructuring of Home & Community Health Care, 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 (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 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 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