by Shayne Morrow, Alberni Valley Times
In a report to the provincial Health Ministry, the B.C. Care Providers Association has suggested re-inventing senior care practices that were once standard in the Alberni Valley.
BCCPA delivered a set of recommendations to Health Minister Kevin Falcon last week, ranging from changes in how care rates are calculated, to the use of private care beds to free up acute care beds filled by seniors waiting for publicly funded beds.
"We had a pretty good response from minister Falcon when we presented it to him last week," BCCPA spokesman David Hurford said Monday.
Hurford said there really isn't a cohesive formula for funding senior care in the province. It's a grab-bag of per-diem payments ranging from $140 to $240 per day, depending on the level of care required and who's delivering it. There are private homes, non-profit homes (like Fir Park/Echo Village) and homes run by the various health authorities.
"Health authorities have complete discretion on contracts. Too often, they pay their own facilities a little more," Hurford said. The problem is, facilities cannot provide lesser care if they are being paid less money, he added.
There is the question of the breakdown on care costs, between the actual health services being provided and the accommodation.
"We believe funding from the ministry should be focused first and foremost on patient care, that's what the health ministry is there for," Hurford said. Patients are required to pay the balance of their stay, over and above what the ministry provides, based on personal income. Hurford noted that low-income seniors are eligible for funding for housing supports through programs including B.C. Housing. If care costs were better delineated, those seniors could receive a portion of their accommodation cost through non-ministry sources and that would leave a greater balance of ministry money to be dedicated to their actual care costs.
"But you can't do that without full transparency," Hurford said. "The ministry is not providing per-diem figures or full cost figures. And health authority facilities are subsidized by the taxpayer for ancillary costs like legal expenses."
But there appears to be agreement that using empty private beds to house seniors waiting for publicly-funded care beds makes a great deal of sense. Those private beds would cost the province about $200 to $250 a day on an emergency basis, compared to about $1,400 a day for an acute care bed.
"Estimates are that about 12% of acute care beds contain seniors waiting for continuing care beds," Hurford said.
Fir Park/Echo Village executive director Barbara Stevenson said that's an option that Home and Community Care, now a branch of the Vancouver Island Health Authority, used to have.
"We have five private care beds that are not funded by the government," Stevenson said. "Prior to VIHA, Community Care was able to purchase those beds. They were used as a transition to public beds."
Before VIHA was created, local health boards had a great deal of flexibility, Stevenson said. The new body assumed greater authority over all health decisions, at the expense of regional autonomy. It's ironic that this once-local solution is now being proposed as a global solution, but Stevenson said it only makes sense for the province to tap into this unused capacity, when it benefits the financial picture on both sides.
In our case, the community has built and supported these facilities, and the city and regional district have supported us through tax breaks and making property available," Stevenson said. "We need to break even and cover our costs."
Stevenson noted that care providers in different communities have widely different fixed costs for their facilities, making one-size-fits-all funding formulas inappropriate.
"What we are suggesting to the province is that the model used for assisted living should be used for continuing care, factoring in fixed infrastructure overhead," she said.
"Where the health authority ought to be able to monitor is the health delivery costs."
Hurford said BCCPA advocates far greater use of home support than is being delivered currently.
"It's what the patients want. It's what the families want," he said. "It's the way to go, and most people would expect to see an expansion, yet, what we're seeing is a slight contraction in service levels."
Part of that stems from historically low pay rates and high turnover of personnel, Hurford said. BCCPA is now supporting local governments in promoting new bylaws to allow laneway housing and "nanny suites" in Lower Mainland municipalities to encourage more on-site home care, he said. And there is a role for the federal government, by developing tax incentives to upgrade homes and existing care facilities to provide home support for a growing sector of the Canadian population.
"We think senior care is something ripe for the federal government to be looking at. Senior care can be an important economic driver in small communities," Hurford said. "We also think the federal government should be putting more training money into senior care."
