Action Plan

Let's make BC the best place for seniors' care

BC Care Providers Association has prepared this positioning paper as a vision framework toward building the best care for seniors based on the four pillars of quality, transparency, standardization and innovation.

1. Quality inspires confidence, attracts the best and delivers results by ensuring outcomes that best meet the needs of seniors. People who are drawn to careers in healthcare are motivated by quality. In a future where attracting workers becomes a challenge, creating patient-centred, quality workplaces will be essential.
2. Transparency results in improved outcomes for seniors through information sharing and improved communication. A system that is open and accessible establishes trust and builds integrity while promoting improvements through comparative analysis and understanding.
3. Standardization ensures everyone is treated fairly and equally by creating a rational process that can be easily understood. Standardization is also linked to consistent quality which means better outcomes for seniors.
4. Innovation delivers value for money and prepares for the Silver Tsunami by encouraging new approaches to do more with less. As the rate of aging is expected to well exceed the growth in resources, we need to foster new thinking and plan now for appropriate services and models of delivery.

Pillar 1 - Quality

Quality inspires confidence, attracts the best and delivers positive results

A system built on quality principles generates upward momentum that continuously performs, evaluates and improves. The fundamentals of such a system include attracting and retaining the best people while providing them with the best tools possible to deliver the service. There is extensive local, national and international knowledge about the requirements to achieve quality in Residential Care settings: BC Care Providers and its members understand what is needed.

RECOMMENDATION

Foster public confidence and an environment of quality improvement by funding residential care, social support services and home support workers at a rate that respectfully recognizes employee skills and commitment. Specifically, fund the continuing care system for a minimum average of 3.2 hours (2.8 hours of direct care) per resident day at a daily rate of $125.

Today's service levels reflect yesterday's needs... and costs

Current service levels start as low as 2.0 hours of direct care (nursing and care aide time) and range up to 2.8 hours per resident per day. As the complexity of care continues to increase, residential care delivery is at risk and work environments are stressful. As work demands increase without added resources, care workers seek time saving processes, some of which include:

• Shortcuts to personal grooming and toileting practices
• Reductions in rehabilitation programs
• Reductions to activity programs (TV time instead of personal interactions)
• Increases in medications and restraints to manage particular behavior
• Procedures that compromise home-like environments in support of efficiency

With increased workload demands and compensation which does not reflect responsibility and pressures, the environment becomes unattractive. Staff become complacent and unhappy, the risk of burnout increases. Evidence includes:

• (HEABC) In 2007, the average sick time per healthcare worker was...
• (membership) At date of issue, the number of vacant direct care positions within the BC Care membership was...
• Daily, there are unfilled shifts which create short-staffing and increased workloads
• BC CARES, a province-wide enrolment campaign, is encouraging people to come work in a sector that, three years prior, had extensive applications for open positions.

BC Care Providers believe in supporting quality of life at every stage of life. A Residential Care system that recognizes the social experience of living, blended with the physical care needs of living, values the individual in a holistic way. And, by providing appropriate compensation to care workers, there is needed recognition of society's value to caring for our elderly.

BC Care Providers strive to deliver the best seniors' care

BC Care Providers advocates for quality residential and home support care. We refer to practical experience and best practices to establish parameters that can realistically deliver desired results. From all perspectives, 3.2 hours funded at a daily rate of $125 is a reasonable and achievable component for ensuring a quality system. By establishing this target, government responds to growing pressures while encouraging efficiency. The end result is a system that values our elderly citizens, respects caregiver contributions and demonstrates economic responsibility.

Pillar 2 - Transparency

Transparency results in improved outcomes for seniors

A system that is open and accessible establishes trust and builds integrity while promoting improvements through comparative analysis, information sharing and improved communication. Seniors and families benefit by knowing that the system is transparent and that there is consistency in the services offered and received across the Province.

RECOMMENDATION

Uphold transparency across the continuing care sector by ensuring the full disclosure of financial and non-financial measures (excluding items under FOIPPA) to all stakeholders within the Home & Community Care Sector. By embracing transparency and sharing information, government can promote a culture of best practices and consistent, quality service delivery.

The current system discourages sharing of information

The current system does not disclose meaningful information, which results in unexplained differences and poor outcomes for seniors despite sharing of best practices. The complexity of delivering care requires sharing both operational and financial information between all service providers to promote the best outcomes.

Prior to regionalization, contracted providers were funded by a model based on case mix and the three components of wage and benefits, capital costs and administrative and supply costs. Providers were able to easily calculate, understand and verify their level of funding and similarly compare performance outcomes.

Now with global funding at the discretion of each health authority to define and administer unexplained differences emerge between operators. Specifically, there are unexplained variations in funding and staffing levels. There are no formal measures to track services needs (i.e. acuity) which limits a provider's ability to explain differences or compare performance. There are operations run by health authorities for which no disclosure is available. The result: an inconsistent system at risk of service failure.

Further evidence:

• Consolidated sector information is not shared. As a result, contracted operators cannot evaluate performance, sharing knowledge and best practices.
• There is no disclosure of how the sector's $1.5 billion is spent, allocated and made relative to performance.
• Seniors' care is subsidized at rates ranging from $140-$195 per day (within and across health authorities) regardless of the consistent delivery of complex care services.
• There is no mechanism to compare costs, funding, services or performance outcomes. As both operator and funder, health authorities function in a conflicted state of interest, creating distrust throughout the sector.
• Lack of disclosure is interpreted as health authority funding their own operations more favorably than those of contracted service providers.

Lessons from other regions

There are some important lessons that can be learnt from other regions. To ensure fairness in funding across all sites, health authorities in Alberta (now disbanded) created an internal arms-length relationship between the health authority as a funding agent and the health authority as legal owner and operator of residential care facilities.

For example, Capital Health in Edmonton set up Capital Care as a separate legal entity with the mandate to operate all health authority owned facilities. This ethical approach also helped close the funding gap between private, non-profit and publicly-owned residential care facilities.

BC Care Providers strive to deliver the best seniors' care

BC Care Providers advocate for a system that best serves seniors. This can be achieved through transparency, where financial and non-financial information is shared between all stakeholders. Enabling operators to compare their performance regardless of ownership supports integrity and encourages best practices. Shared learning and opportunities for improvement become apparent which leads to better outcomes for seniors in care.

Pillar 3 - Standardization

Standardization ensures everyone is treated fairly and equally

A system that is standardized establishes predictability and harmony by ensuring all stakeholders know what to expect and why differences may exist. Seniors and families benefit by knowing there is consistency in services across the province and by having confidence knowing elder care is delivered within an equitable, standardized system.

RECOMMENDATION

Create a standard funding model for residential care services to seniors. Implement province-wide, across all health regions, to ensure consistent treatment of seniors and those who deliver services. A standard system requires agreement to define subsidized services and results in comparable outcomes.

Variations in subsidy payments result in varying care for seniors

Health care leaders cannot explain nor predict the varying amounts of subsidies paid for residential care. As a result, a senior in Quesnel may benefit from higher-funded care than a senior in Victoria or vice-versa.

Without a standardized system, members advise, variations increase as service gaps widen.

Vancouver Island Health has taken steps to create and implement a standardized funding model for residential care. The model is premised on base-line calculations which determine direct care hours and related funding allocations together with allocations for support services and accommodation costs. While the model still underfunds the housing and support services components, BC Care Providers applaud VIHA for creating a consistent calculation.

Further evidence is as follows:

• Direct care staffing levels in BC range from 2.0 to 2.8 hrs per resident per day yet service requirements and outcomes are expected to be consistent. In a 100-bed facility, the result is a staffing difference of up to 15 FTEs equal to 29,200 hrs of care.
• Recent tender calls for services have mandated a social model of care with priority placed on the ability to offer activities, recreation and rehabilitation. Service payments and reporting focus on direct care services with little recognition or support for social and recreational activities, thus compromising quality.
• Subsidy for accommodations ranges from $8.55 to $25 per resident per day with little or no reference to facility age, local marketplace factors, current construction costs or other valuation references.
• User fees are considered partial payment for accommodation and hospitality costs. The current range of user fee is $29.90 to $71.80 per resident per day.
• Based on industry valuation principles and benchmarks established by Canadian Mortgage & Housing Corporation, the range of costs for property is approximately $25 to $68 per resident per day.

BC Care Providers strive to deliver the best seniors' care

BC Care Providers advocate for a standardized system that best serves seniors and the public purse where all stakeholders understand the parameters and limitations for determining a subsidy calculation regardless of location. By using a funding model that fairly calculates fund allotment, government fosters integrity, promotes understanding and ensures consistency in care service delivery.

Pillar 4 - Innovation

Innovation promotes value, choice for current and future needs

A system that acknowledges the value of planning and preparing for tomorrow while responding to the challenges of today is both strategic and proactive. In light of today's need to reform residential health care in BC, it is imperative we show leadership and make time to create a future vision and explore new ideas, viable solutions. BC Care Providers welcome the opportunity to propose innovative change.

RECOMMENDATION

Explore an alternate service delivery model where care costs are separated from housing costs. Consider, too, how residential care and home support providers could play a more effective role in BC's care continuum.

Yesterday's solutions will not fit tomorrow's problems

The current system embraces yesterday's thinking where BC's seniors population represented less than 10% of the national demographic. As we near a seniors' population of more than 30% of Canada's population, the need for innovation and thought-leadership becomes mandatory. Already, the early pressures of growth are destabilizing current practices and causing systemic strain. It is well recognized that fundamental change is needed; BC Care Providers aim to contribute to a real solution.

Some examples:

• By separating care costs from housing and hospitality costs, government could form distinct funding 'envelopes'. This approach distinguishes overall costs of care from inflationary pressures associated with the cost of living and invites discussion on government's responsibility for funding housing and hospitality services.
• Review the process for subsidy calculation by blending private and public costs into an integrated program encouraging users to seamlessly move between the two.
• Empower consumer quality controls by altering the system to fund the person rather than the bed. This would impact service satisfaction and market demand by giving the user the power of choice.
• Expand the functionality and usefulness of residential care facilities by redefining providers' roles. Consider a service blend of pro-active prevention programs, home support services, short-term and long-term stays. Since facilities are staffed 24/7 with skilled nurses, care aides and administrators, facilities could become a natural site for housing community health services.

BC Care Providers strive to deliver the best seniors' care

BC Care Providers encourage creative solutions to address today's needs and the challenges that lie ahead. Seniors needs are changing and the aging of the population will put increased demands on the system. The time is now to craft a future vision that can unite and focus a diverse group of organizations who currently respond to the care and quality-of-life needs of seniors.