Recommendations for Improving Alberta's Seniors Care System
The Seniors Task Force of Public Interest Alberta has launched an advocacy campaign that highlights the privatization of seniors care.
We are gathering stories of Albertans' experiences with our continuing care system. Do you have a story to tell, or a solution to propose? Send these to SeniorsCareStories@pialberta.org. These stories will be used to advocate for a quality public seniors care system, and will not be shared publicly without the permission of the authors.
The Seniors Task Force is made up of representatives of many key seniors organizations and health professionals who work with seniors (click here for a list of Seniors Task Force members). They have set out the following five recommendations for improving Alberta's seniors care system.
We call on the Alberta government to implement the following five recommendations for improving Alberta's seniors care system:
1. Create viable and responsive public home care
Most seniors want to remain in their own homes and communities as long as possible, and government wants to minimize the number of institutionalized seniors and the accompanying cost.
However, countries such as Denmark and Sweden have shown that aging in place works only if help is provided to ageing seniors to assist with their nursing and medical needs and the tasks of home upkeep.
The underfunding of home care is also financially shortsighted because it is infinitely cheaper to provide very basic assistance to allow seniors to stay in their own homes than to have seniors in institutional care
2. Strengthen the Nursing Home Act - Don't circumvent it
The regulations under the Nursing Home Act provide the only guarantee of staffing levels in Alberta nursing homes. The Act specifies minimum hours of combined nursing and personal care per resident, per day, and that a registered or certified graduate nurse must provide 22% of that care.
For the past decade, the Alberta government has been using various means to circumvent these requirements:
- The government has paid numerous nursing homes to be down-graded to assisted living, thereby eliminating the need for qualified nursing staff.
- Nursing homes have actually been reclassified as auxiliary hospitals, again to eliminate the need for specific levels of qualified nursing staff.
- Finally, the proposal for a new Alberta Health Act would allow for the elimination of the Alberta Nursing Home Act.
Measures such as these have robbed vulnerable seniors of the skilled care they require and made them the principal target of government efforts to curtail its health care costs.
3. Build more long-term care facilities (nursing homes)
No one wants to end up in a nursing home, but it is the only feasible option for people with cognitive impairment, debilitating illnesses, or profound frailty.
The provincial government has not increased the number of long-term care beds to meet the needs of our growing seniors population. Sadly, the government's emphasis has been on building "continuing care" facilities, few of which are nursing homes. Most are various types of supportive or assisted living facilities where, in addition to room and board, residents are also charged for the medications, nursing and personal care they require.
In December 2008 the Health Minister froze the number of LTC beds in the province. Shortly after, in the fall of 2010, emergency room doctors predicated the "catastrophic collapse" of the ER system, largely because of the number of seniors occupying acute care beds awaiting LTC placement.
Rather than build the nursing home beds required, the government has been subsidizing the private sector to build and operate supportive or assited living facilities. While these facilities are fine if you are healthy and wealthy, these facilities do not have enough highly trained staff or expertise to provide the level of care required in a LTC facility.
Rather than pouring tax payers' money into corporations to own and operate seniors care facilities, the government should be investing in building public care facilities. Repeated promises to build 1,000 "continuing care" beds per year are meaningless when few if any of these are nursing home beds and we have current LTC waiting lists of 1,600 people.
4. Establish a Seniors Advocate as an Officer of the Legislature
The seniors care system is very confusing for many seniors and their families. There is no independent mechanism for people to explore systemic issues and work with the government to improve how we provide care.
A Seniors Advocate as an Officer of the Legislature (like the Ombudsman or the Auditor General) would be independent of government departments and could have three major impacts:
- Develop a listing of all component parts of the seniors care system and assess how effectively and cooperatively each is functioning.
- Identify gaps and overlaps in existing services and regularly report these to the legislature with recommendations for changes to legislation or regulations.
- Oversee a corps of trained elders to assist seniors in distress and help them access and navigate the seniors care system.
5. Make seniors care facilities more democratic
In the 1980s, the Alberta government mandated that every school in Alberta must form a school council that included the principal, staff and a community representative, but on which parents had the majority vote.
Seniors care facilities could benefit from similar patient/family councils. Most families feel they have no power to speak out to protect their loved ones. Seniors care facilities are micro-communities in which the residents are citizens, many of whom have little outside contact. As such, the residents and their families have a right to a say in how these communities are run.
The problems in seniors care facilities cannot all be solved by top-down, imposed solutions. Patient/family councils can more effectively address problems in particular facilities. Problems not solved this way could then be referred to the Seniors Advocate.
Alberta's seniors care system needs fixing
Over the past two decades, in an effort to reduce its healthcare costs, the Alberta government has been steadily disengaging itself from seniors care, leaving much of it to the private sector, which, in turn, has off-loaded much of its costs onto those who require the care.
This trend has now progressed to the point where the lack of adequate home care drives many seniors out of their own homes; where seniors are backing up hospitals because of the shortage of nursing home beds; and where many seniors who are cognitively impaired, disabled or profoundly frail now find themselves in facilities where they not only have to pay exorbitant fees for room and board, but also have to pay for the nursing and personal care they require.
Corporations are aware that, with the increasing population of seniors, there is an opportunity to make huge profits in providing seniors care. These corporations, along with the insurance industry, have been lobbying politicians and funding their election campaigns for years to make sure that government policy will continue to support the expansion of the private, for-profit seniors care industry.
Seniors are the same people who built Canada's Medicare system, who supported it with their taxes and healthcare premiums, and who assumed it would be there for them when they needed it. Understandably, seniors feel betrayed.
The Redford government has proposed a plan to remove the cap on long-term care fees and expand corporate seniors care. The following is an excerpt from a letter dated February 7,2012, from Minister of Seniors, George VanderBurg in which he reveals the government’s commitment to corporate care.
"There are currently over 1,500 Albertans awaiting space in continuing care, making it a priority for government to increase the number of spaces without delay. Premier Redford has expressed her commitment to creating the conditions that will lead to increased system capacity. One tool that government is considering to foster those conditions, where appropriate, is removing the limit or cap on the amount paid to long-term care facility operators for accommodation services. This may enable private industry to build greater capacity, meaning that seniors could choose from a wide variety of safe, comfortable accommodations that suit their unique needs. The possible benefits and implications of removing the cap are being reviewed”.
Read the full letter (PDF): Minister of Seniors Letter
The Seniors Task Force was involved in hosting the Beyond Acute Care conference, February 24 & 25, 2012. For details, visit the conference website: Beyond Acute Care Conference