Byline: Jeff Nagel - Surrey North Delta Leader
Residential care home operators are warning persistent underfunding will force them to turn away growing numbers of incoming patients with complex care needs.
The B.C. Care Providers Association (BCCPA) has unveiled new voluntary guidelines to help its members assess how much staff time a proposed new resident requires and then decide whether to accept the referral.
"A lot of facilities are already refusing admissions," said association spokesman David Hurford, who says patient safety is at stake.
"We do not want facilities accepting patients they can't care for," he said.
The association's new stance likely means significant numbers of the most challenging residents to care for may be refused admission, leaving them nowhere else to go but health authority-run residential care homes.
"The most complex cases will have a tough time finding placements," Hurford said.
The 130-member BCCPA represents about 35 per cent of care homes in the province, both non-profit and for-profit operators.
It contends the amount of money provided to handle the growing caseload of elderly patients with advanced requirements is inadequate.
The BCCPA contends that Fraser Health pays enough on average to provide 2.3 hours of direct care to each patient per day - significantly below the provincial average.
The association contends that needs to go up to between 2.8 and 3.2 hours per day for facilities to offer an acceptable level of care.
The health authority pays each facility in the form of a per diem rate that ranges from $110 to $230 per patient, per day.
Providers contend there's no apparent logic to the wildly varying rates, except that government-run homes often get paid near the top end of the scale while non-profit and private operators are expected to get by with much less.
They argue it amounts to a "race to the bottom" that pits price against quality.
The issue boiled over late last year when the non-profit Zion Park Manor care home in Surrey closed its doors, citing underfunding.
"We're at a point where we can no longer reduce staffing to make ends meet," said Christine Nidd, B.C. director of the Revera Inc., which runs long-term care homes in Maple Ridge, New Westminster, Vancouver and the North Shore.
If significant numbers of complex care residents end up back in health authority-run units, some may also back up into hospital acute care wards, potentially impacting on ER congestion as well.
The problem is no surprise to Fraser Health.
The health authority's 2007 service plan warned the budget it receives from Victoria left it unable to increase payments to care home operators to reflect rising costs of complex care.
"Providers may stop admission of these clients," the plan warned, adding "service disruptions may commence if adjustments are not sufficient to meet their needs."
Fraser Health has also contemplated increasing the extra payments charged to patients for residential care.
Health minister George Abbott could not be reached for comment.
But a ministry spokesperson said care home operators might be in breach of their contract if they turn away referred patients who are expensive to serve.
The spokesperson said the assessment tool being advanced by the care providers association is outdated and the guidelines are at odds with a newly unveiled internationally recognized system of assessing resident care needs.
The challenge of paying for elder care is expected to only get bigger in the years ahead as the population ages.
While in the past residential care homes handled many elderly patients in reasonably good health, most of them are now expected to stay in their homes as long as possible.
The trend means care homes increasingly get only the more complex patients.
A care home in Burquitlam, for example, that had five residents in wheelchairs a decade ago has 45 today.
