Transcript An Uncertain Future for Seniors

An Uncertain Future for Seniors
BC’s Restructuring of Home & Community Health Care, 2001-2008
Briefing Notes • April 15, 2009
research • analysis • solutions
Background
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CCPA-SFU Economic Security Project
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CCPA assesses provincial government record on seniors’ care
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Without Foundation: How Medicare is Undermined by Gaps and Privatization in Community and
Continuing Care (published November 2000)
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Continuing Care Renewal or Retreat: BC Residential & Home Health Care Restructuring 2001-2004
(published April 2005)
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Today: An Uncertain Future for Seniors - only publicly available, comprehensive accounting of longterm care beds in BC
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Aging population
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# seniors aged 85+ increased 43% since 2001, # aged 75-84 up 15%
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Home and community health care more important than ever
An Uncertain Future for Seniors, Briefing notes, page 2
What is home & community health care?
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In-home and residential services for seniors and people with chronic
conditions, disabilities, mental illness
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Uncertain Future study focuses on seniors’ care
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Dignity, independence, prevention, cost-effective
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Types of services:
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Home support (personal care such as bathing, help with medications)
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Home care (home nursing and community rehabilitation)
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Assisted living (for people with low to moderate levels of disability)
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Residential care (24-hour nursing, for people with complex needs)
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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 3
The 5,000-bed commitment
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2001: Will build 5,000 new, non-profit residential care beds by 2006
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Later shifted promise to 5,000 residential care, assisted living & supportive housing beds
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Omitted reference to non-profit
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“Extended” deadline to 2008
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Ministry of Health Services, Sept 08: claims 5,000-bed target exceeded
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CCPA research: 3,589 net new beds between 2001 and 2008
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Compared Ministry of Health Services bed numbers to numbers obtained by FOI from each health
authority
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Discrepancies tracked facility-by-facility
An Uncertain Future for Seniors, Briefing notes, page 4
The beds equation
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4,393 new
assisted living beds
–
804 fewer
residential care beds
=
3,589 net new
“long-term care” beds
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Province fell short of 5,000 bed commitment by 1,411 beds
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All new capacity = assisted living
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Assisted living not an adequate substitute for residential care
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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
Why the discrepancy?
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Over-counting and inaccurate reporting by Ministry
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Counted beds that are not at all equivalent to residential care
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Supportive housing units, short-term convalescent care, group homes, housing for people with
developmental disabilities, independent living units, mental health facilities
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Correct numbers verified through facility and other websites & by phoning
facilities
An Uncertain Future for Seniors, Briefing notes, page 6
Reduced access to residential care
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Access, or ‘bed rate’ = beds per 1,000 seniors aged 75+
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Residential care (excluding assisted living)
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Access dropped 20.5% since 2001
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2001: BC just above average compared to other provinces
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2008: Second lowest after New Brunswick
Even when combine assisted living and residential care bed #s
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Access dropped 6.2% since 2001
An Uncertain Future for Seniors, Briefing notes, page 7
Reduced access to most home-based services
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Home support
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Number of clients dropped 17%
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Access (clients per 1,000 seniors aged 75+) dropped 30%
Home nursing
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Number clients increased 6%
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Access (clients per 1,000 seniors aged 75+) dropped 11%
Community rehabilitation
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Only service with increased access, up 24%
An Uncertain Future for Seniors, Briefing notes, page 8
Shift to high-needs clients
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Eligibility for residential and home based-services restricted to those with
higher needs
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Staffing & training in residential care not increased to reflect higher needs
clients
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Residential care patients more likely to end up in hospital
Lower needs clients don’t have access
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Prevention and early intervention undermined
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Must rely on family, pay privately, or go without care
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More likely to end up in expensive hospital beds
# deaths in residential care up 60%
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Not negligence - access restricted to more frail seniors - more likely to be at end-of-life stages when
admitted
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Residential care facilities not funded to provide palliative care
An Uncertain Future for Seniors, Briefing notes, page 9
Impact on acute care system
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Inappropriate use of hospitals
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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
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Province refers to this as “Alternate Level of Care”
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In 3 health authorities: increase in inappropriate use hospital beds.
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In 2 health authorities: decrease - but these two HAs changed how they count
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No consistent reporting requirements for health authorities
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BC’s numbers high compared to other provinces
“First available bed policy”
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To move frail seniors out of hospital more quickly, they must accept the first available bed
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Shifts the priority for placement from those waiting in the community to those in hospital
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Without access, seniors’ health deteriorates…more likely to end up in hospital
An Uncertain Future for Seniors, Briefing notes, page 10
Shift to for-profit delivery
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Provincial policy changes favour private facilities
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Increase in private residential care facilities
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20.5% increase in for-profit facilities since 2000
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12.9% decrease in non-profit and health authority facilities
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Evidence: For-profit delivery means lower quality of care
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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
Symptom of deeper problems
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Reduced access, system in serious decline
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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
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BC went from 2nd to 6th in per capita health spending
No plan, lack of coordination and leadership
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Home and community care system = $2 billion annual budget
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No strategic plan
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Lack of coordination, leadership
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Lack of transparency, consistency in reporting to public
An Uncertain Future for Seniors, Briefing notes, page 12
Growing chorus
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Study supports concerns raised by others about deteriorating state of system
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BC Auditor General
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BC Ombudsman investigation into systemic problems in seniors’ care
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BC Medical Association
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BC Care Providers Association
An Uncertain Future for Seniors, Briefing notes, page 13
Top recommendations
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Full public consultation process
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Development comprehensive strategic plan
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Commitment to increase access to care
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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
Specific recommendations
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Increase residential care beds
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At minimum: restore 2001 levels as share health care funding
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Brings residential care budget up by $94.5 million (equivalent 1,500 new beds)
Fully fund current operating costs of residential care
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At minimum: 3.2 hours care per resident per day
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Develop provincial standard of core services for palliative care
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Invest $100 million additional in home support to fund team-based delivery,
improve recruitment/retention, increase services by 15%
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Finance delivery of new residential care beds by non-profits and/or health
authorities
An Uncertain Future for Seniors, Briefing notes, page 15
Existing innovations = key to long-term success
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Examples of successful innovations in seniors care exist
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Some have proven successful in reducing use of expensive emergency &
hospital services
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Ex: Integration of Primary Care Services in Residential Care in Prince George
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Ex: Netcare in Chilliwack
Others show the health benefits of improved coordination & early intervention
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Ex: VIHA case managers working with family physicians
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Ex: Northern Health frail elderly collaborative
Given aging population - implementing these innovations province-wide is key
to health care sustainability
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Provincial leadership needed to scale up
An Uncertain Future for Seniors, Briefing notes, page 16