The report was completed by Howe Group Public Sector Consultants and supported with funding from the Canada/BC labour market partnership. It reflects feedback from contracted care providers, employee representatives, health authorities and BCCPA.

BCCPA CEO Ed Helfrich said, "In addition to helping address labour challenges associated with our aging population, this report supports recommendations of the BC Ombudsperson and elements of the Ministry's response which call for innovative approaches to the delivery of home support services."

Context

• 60% of home care employers anticipate retaining community healthcare workers (CHWs) will become a bigger challenge - particularly casual employees
• an unstable work environment will ultimately impact the ability to provide safe and high quality care for BC's aging population
• employers are struggling to provide home support services under the current block funding model as reporting requirements and client expectations increase
• while fundamental differences exist among key stakeholders, the lever for change remains the high importance all placed on improving the scheduling situation of CHWs to directly impact retention
• scheduling is a significant challenge to the sustainability of this workforce
• more than ever there is a need for openness to collaboration and innovation

Challenges

• home support lacks a positive profile and not currently seen as a 'career of choice'
• the current home care funding model is perceived to be at odds with performance requirements
• case manager messaging is incongruent with scheduling requirements
• peak client hours and sector financial needs do not accommodate regular schedules
• scheduling is a complex art and science that schedulers need to be equipped to manage
• lack of systematic approach to evaluating the effectiveness of scheduling pilot projects

Recommendations

• commitment needed from employers, unions and public sector to a co-investment of time and financial resources
• develop and deliver a comprehensive home scheduler training curriculum
• lead a home care summit this Fall with partners to create a more prominent voice for home support
• provide an account of findings and systemic challenges to health authorities, Health Employers Association of BC and the Community Bargaining Association

Funding from the Canada/BC Labour Market Agreement will be allocated to implement these recommendations. A formal announcement will be made in the coming weeks.

BCCPA has been representing non-profit, privately-owned and denominational seniors assisted living, residential care and home support providers across the province for 34 years. Our members care for more than 12,000 vulnerable seniors each day and employ over 10,000 health care professions and staff.

The BC Care Provider Association's annual conference and general meeting are highlights of the year. In addition to being a great way to share best practices and discuss current seniors care trends, the Conference is a fun opportunity to renew friendships and network with new contacts. A great event is being planned to celebrate our 35th Anniversary and we look forward to seeing you there. To register and get more information, click here.

This year's event in Whistler will be the last convention before next year's provincial election. In this light we are pleased to have confirmed that Health Minister Michael de Jong, the BC Ombudsperson and the Opposition Seniors Critic will be attending. In addition to speaking directly to care providers and industry leaders, they are looking forward to hearing from you.

• Vancouver Island - $300/bed
• Interior Health - $1100/bed
• Vancouver Coastal Health - $385/bed
• Fraser Health - $300/bed

"Home is where the heart is. We know that seniors, like everyone else, are happiest in their homes," said Premier Christy Clark in a news release outlining the initiative. "That's why our government introduced the seniors' home renovation tax credit, to help seniors stay independent, healthy and in their homes."

The refundable credit will be worth up to $1,000 each year, and it will be available to seniors or family members sharing their home, regardless of whether they own or rent.

The tax credit will also help to protect and create jobs by supporting the home renovation industry.

The maximum credit will be $1,000 annually, calculated as 10 per cent of eligible expenditures. The credit will be available to individuals who incur eligible expenditures on or after April 1, 2012. The credit can be claimed by seniors, whether they own their home or rent, and by individuals who share a home with a senior relative.

Legislation will be introduced later this spring, at which time a detailed list of eligible expenses will be available. Eligible expenditures will include things like: upgrades to improve accessibility, including handrails, grab bars, walk-in bathtubs and wheel-in showers, wheelchair ramps, lifts and elevators, motion-activated lighting and certain renovations to allow a first-floor occupancy or secondary suite for a senior relative (e.g., adding a bedroom/bathroom to the main floor so a senior can have access without having to use the stairs, eligible renovations must be "disability" related).

Some expenditures that will be excluded from eligibility include general maintenance, including roof repairs, windows, flooring, insulation and painting, devices, such as equipment for medical monitoring and home security, smoke alarms, appliances and services, including home care, housekeeping and gardening.

For more information, see www.sbr.gov.bc.ca/individuals/Income_Taxes/Personal_Income_Tax/tax_credits/seniors_home_reno.htm.

Families with aging relatives on limited incomes can take a number if they want to put them into a care facility. Nanaimo has a glut of beds for people with the money to pay, but for those without savings or a good pension, publicly funded beds are limited.

Patients must be assessed for placement in a publicly funded residential care facility, but such housing is in such short supply family members might not want to put off having the assessment done as soon as possible.

Seniors who are hospitalized often get care faster, but leaving it that long puts stress on the patient, family members and the healthcare system.

Each situation is different but there is no question senior care is more accessible to those with cash.

"There's a lot of high-end care homes or adult housing where they provide meals that are not full because people can't afford them," said Ruth Matson, senior peer coordinator with Nanaimo Family Life Association, a non-profit organization

The society served 147 senior clients last year, many for depression, often due to the anxiety of having to move or downsize. Clients come from all walks of life, and include those on limited income and homeless seniors.

"A lot of people between 60 and 65 fall between the cracks because they're not eligible for full pension and for lifestyle reasons usually aren't employable, so it's very difficult," Matson said.

When they need residential care housing they usually have to wait, "if you're lucky, two months."

In a worst-case scenario, the senior won't get placed at all, meaning family members, usually a spouse, care for them until they die. "You have an absolutely burnt-out caregiver and family, after the person has passed away, trying to put the other person's life back together."

Assessments for care are done by the Vancouver Island Health Authority, with residential care placement prioritized according to need.

Those unable to care for themselves and living at home, or at risk of wandering away, getting lost or injured due to dementia are placed into residential care faster. On average, placement is within 30 to 45 days.

"Certainly an individual who is in hospital who requires residential services and can go home to wait is a priority for us," said Caitlin Davies, VIHA home and community care access manager

It can take longer for those assessed as less urgent, or non-urgent to be placed. Many want to stay at home and whenever possible, that is the preferred form of care.

Otherwise, they join the queue of those waiting for beds.

"Obviously availability of residential care beds depends on someone passing away," Davies said.

There are 5,160 beds across VIHA. The total wait list is currently 708, of which 259 are in the central Island, defined as north of the Malahat to Bowser and west to Tofino. The turnover rate is approximately 35 to 40 beds per week Island-wide.

Meanwhile many new beds, built to serve an anticipated wave of retiring Canadian boomers, sit empty and unused.

"Today if you look at Nanaimo, it is one area where we have a tremendous amount of new supply in the last two or two-and-a-half years and that new supply has not been absorbed," said Amir Hermani, chief of operations of Berwick Retirement Communities, which operates Berwick on the Lake.

"It came right on the back of that economic change, the global recession, when seniors took massive hits to their pensions and a lot of seniors said: 'You know what, I'm going to stay home.' Hence we have vacancies."

Yet, subsidized beds are "almost nonexistent," a situation Amir calls a travesty for those on limited incomes. "They need help but can not afford to go into the community that provides help. Those spaces are packed."

With the population ageing, the problem can only get worse across B.C.

"Within five years, not only will we have maximized what's available, we will need to double that," said Kara-Leigh Jameson, executive director of the Seniors Services Society, a not-for-profit organization that serves Lower Mainland seniors.

"The biggest population is going to be turning 65 and we can't even house who we currently have. We know what is going to hit us and we have no capacity to be able to serve them."

RESIDENTIAL CARE BEDS

Nanaimo

126: Dufferin Place (VIHA)

82: Kiwanis House (Nanaimo District Senior Citizens Housing Development Society)

75: Kiwanis Village Lodge (NDSCHDS)

135: Malaspina Gardens (Chartwell REIT)

132: Nanaimo Seniors Village (Nanaimo Seniors Village LLP)

90: Nanaimo Traveller's Lodge (Nanaimo Traveller's Lodge Society)

110: Wexford Creek (Good Samaritan Canada)

26: Woodgrove Manor (Woodgrove Manor Ltd.) become a favourite wedding spot.

Parksville

75: Arrowsmith Lodge (Arrowsmith Rest Home Society)

30: Cokely Manor (Arrowsmith Rest Home Society)

200: Stanford Place (Ahmon Group-Stanford Holdings Inc)

75: Trillium Lodge (VIHA)

SOURCE: VANCOUVER ISLAND HEALTH AUTHORITY

Grand Forks' Boundary Hospital is one of 36 rural communities to receive financial assistance of up to $200,000 from the Ministry of Health.

In July 2011, the province announced that $10 million would be available for rural communities across British Columbia.

Communities can receive up to $200,000 a year for rural, fee-for-service physicians who will ensure reliable public access to emergency services.

According to a press release, "The funding can be used to hire additional physicians, incentives for working on weekends, holidays or night shifts and health authority-approved equipment purchases."

BCCPA focuses on senior and health care in rural communities.

"(The funding) recognizes that rural communities have some particular challenges with regards to health care," Hurford said.

"A lot of people talk about two-tier health care as private-pay versus public, but I think the real two-tier health care is rural versus urban.

"There are a lot of inequities in rural communities and I think the federal funding will be a step in the right direction to help close the gap."

Physicians and the regional health authority will develop community-specific plans once funding is received.

Dr. Robert Sebastian, a general practitioner at Boundary Hospital, who helped with Grand Forks' proposal, stated, "(The funding) is mainly focused on the recruitment and retention of new doctors."

The funds are also aimed at maintaining medical emergency services and to keep it open 24/7, Sebastian pointed out.

"We're looking for full-service general practitioners, in other words, doctors that will do everything, including office and special skills and work the emergency ward," he explained. "We're hoping it will attract new and younger physicians and to keep our manpower at sustainable hours."

According to Sebastian, the funding started because, though it hasn't been an issue in Grand Forks, there have been emergency departments that have been closed or the hours were curtailed.

"Princeton, Creston, Clearwater and Nakusp are four communities that come to mind right away; they're just not able to fully staff the emergency department," Sebastian said.

"Funding is always an issue in small towns."

There are 52 communities that are eligible to apply.

Trail's Kootenay Boundary Regional Hospital and Oliver/Osoyoos' South Okanagan General Hospital are two other communities that have received funding.

http://www.grandforksgazette.ca/news/140892983.html?mobile=true

While some of the provinces around the country give contracted health care providers extra funding to compensate for leap year, it's not the case in BC for non-profit or privately operated facilities contracted to provide care, says David Hurford, a spokesperson for the BC Seniors Care Providers Association.

"In Williams Lake you have a couple of contractors there that are providing publicly funded services for the health authorities. They do not get funded for that extra day of the year. They are doing it for nothing," Hurford says, adding it's care for a day that contractors are providing for a day at no cost.

Hurford did say that the Vancouver Coastal Health Authority provided leap year funding, but others had not.

"We're making the case that it's a gift that the providers are giving and to make sure that contribution is being recognized. These providers are working hard in the community every day," Hurford says.

Instead of calling on the government to fund leap year funding, the BCCPA is asking the government to respond to the recent BC Ombudsperson Kim Carter's recommendations to improve the province's senior care system.

"In the report she highlighted a number of funding inequities that exist within the seniors health care system right now. This is one of those funding inequities, but there are larger ones that she's pointed to that we're following up on with the government," Hurford says.

Health Minister Mike de Jong says two things come to mind regarding the association's press release.

"First of all, my understanding of most contracts, and there are some variations and that's something that we need to work on -- but most of the contracts provide funding to X number of beds over the course of the year, generally 365 days.

What will happen during the course of that year, however, when a resident leaves or is transferred there will be a few days, not many but a few days in the year where the bed is empty."

The contract does not provide for reimbursement of those days, de Jong suggests. "So over the course of four years, it all kind of comes out in the wash."

Focusing on the Ombudperson's recommendations, Hurford says she has identified realities the BCCPA has been raising for years.

Some of those points include long waiting lists for seniors in hospitals waiting for placement into residential care beds, insufficient funding to achieve provincial staffing levels at most residential care facilities, and user fees collected from seniors have not been fully returned to facilities for enhanced staffing as promised.

De Jong, however, says when the government announced residential care rate adjustments in 2009, it said all additional revenue would be invested back into residential care.

Of the $45 million invested so far into increased staffing levels, staff education and equipment at facilities across the province, more than $35 million has gone to contracted care providers, he adds.

http://www.wltribune.com/news/141955183.html

"Today, employers will absorb an additional $3 million in costs to provide publicly funded care for our most vulnerable BC seniors," said BC Care Providers Association (BCCPA) CEO Ed Helfrich. "While most provinces account for cost increases associated with providing care for an extra day on leap years, BC care providers are expected to provide the service without funding."

• Hundreds of seniors are waiting too long in B.C. hospitals for placement into residential care beds - and it is having a negative impact on their health.
• Sufficient funding has not been provided to achieve provincial staffing levels at most residential care facilities in BC
• Health Authorities services cost more than the same complex residential care services delivered by contracted non-profit, denominational and privately-owned providers.
• Historic funding anomalies need to be addressed and a consistent model should be established that considers the needs of seniors, actual costs, taxes and capital expenses.
• New user fees the province has collected from seniors over the past two years have not been fully returned to facilities for enhanced staffing as promised.

"The Ombudsperson has flagged several funding and staffing concerns in the BC seniors care sector," concluded BCCPA President Mary McDougall. "By providing a roadmap to improve the quality, efficiency and transparency of the public system for families and front-line care providers, Kim Carter's report represents a turning point for seniors care in B.C."

"The $3 million gift of care being made by sector employers across the province today is a demonstration that BC care providers want to play a positive role to quickly make the changes being proposed to improve the quality, efficiency and sustainability of our seniors care system," concluded Mr. Helfrich.

+ + +

See news item: "Extra day = extra cost for some senior care facilities"

As he presented the 2012 Budget, BC Finance Minister Kevin Falcon said, "We've pioneered patient-focused funding to ensure the system focuses first, not on institutional needs, but on the needs of the patient...We will continue to seek out efficiencies and administrative savings to maintain health outcomes while limiting - to the extent possible - the cost pressure on taxpayers." He concluded, "The final element of this new budget and fiscal plan is a reaffirmed commitment to finding and eliminating silent job killers - unnecessary regulations."

-30-

By Richard Chu

The market for private independent and assisted-living seniors residences continues to struggle with a surplus of facilities after years of development prior to the global financial crisis. (See "Market glut dampens retirement development sector" - BIV issue 1056; January 19-25, 2010.)

While some in the industry hope demographic trends will strengthen demand, some suggest changes to B.C.'s subsidized seniors housing program would help balance the market and help solve the government's future funding challenges.

Is the market for private seniors retirement homes still over-supplied?

Yes, most of the markets in B.C. are over-built for private-pay, independent and assisted living [units] right now. There were developers that didn't do their homework and thought demographics were going to cure all their ills, and it really doesn't for many, many years.

That appears to contrast with the lack of supply in subsidized seniors housing

On the subsidized housing side, it's going to continue to be a challenged marketplace where demand is going to outstrip supply. The government can only afford to subsidize so many units, but when you look at the projections for growth in the seniors housing population, demand is a question that needs to be addressed. The cost for provision for subsidized units is very substantive, and I don't know how we as a society are going to manage it unless there is some rationalization of the cost and the user-pay component.

What are some ways to deal with the cost?

I'm on the board of the BC Care Providers Association, and we have many ideas about how those costs can be rationalized. One issue that we have advocated for is to change the standard accommodation in subsidized residential care. In Alberta and Ontario, for example, the standard is semi-private accommodation. In B.C., the standard is a private room. The cost of building and servicing a private room is substantially higher than for a semi-private room. It costs in excess of $200,000 per bed to build a private room and about $140,000 for a semi-private room. So there is a $60,000 capital saving per bed. That's a big burden for taxpayers to pay to make sure that everyone that wants subsidized housing [gets] a private room.

Does this affect the private-pay seniors housing market?

Yes. When you look at the fact that the standard for a government-subsidized unit is a private room, there really isn't an appetite or desire to pay privately for accommodation. As far as the demand for private-pay accommodation on the skilled nursing side, it's very shallow because of that. There's a certain entitlement mentality for residential care.

Are there any benefits to clients for having semi-private rooms?

There are all kinds of benefits. My grandmother lived in a residential care facility and she requested a semi-private room so she could be with her friend. For her, the benefit was companionship. Many seniors would prefer a semi-private room, but they just aren't being built anymore. The licensing guidelines are now that 95% of your beds need to be private rooms, even if you aren't subsidized.

What's preventing changes to reduce the costs associated with subsidized seniors housing?

To change the requirement to semi-private accommodation might be unpopular. In other provinces, to get a private room, there's an extra fee, just like if you go to a hospital. But [in B.C.], if you want a private room in a residential care facility, you don't pay extra.

The seniors' care report released last week by B.C.'s Ombudsperson has made the clearest case yet that the challenges of our aging society are no longer falling at the feet of future leaders. They are here today.

By providing a roadmap to improve the quality, efficiency and transparency of the public system for families and front-line care providers, Kim Carter's report represents a turning point for seniors care in B.C.

Among other things, the Ombudsperson's investigation confirms realities B.C. care providers have been raising for years.

• Hundreds of seniors are waiting too long in B.C. hospitals for placement into residential care beds - and it is having a negative impact on their health.
• Health authorities are not meeting the maximum community care wait time or residential care staffing tar-gets they have set.
• Health Authorities pay themselves more to provide the same complex residential care services than contracted providers.
• Historic funding anomalies need to be addressed and a consistent model should be established that considers the needs of seniors, actual costs, taxes and capital expenses.
• New user fees the province has collected from seniors over the past two years have not returned to facilities for enhanced staffing as promised.

The Seniors Care Action Plan released by the B.C. Health Minister last week demonstrates the government is taking the issue seriously and interested in the concerns care providers have been raising - particularly as it relates to ongoing staff training, transparency and inefficiencies in the current system.

However, the new Ministry Action Plan steers clear of specific solutions that can only be addressed through the government's budget process.

The Ombudsperson's Report con-firms more long-term care beds are needed to meet growing demand. In contrast, she points out that as a percentage of their overall funding, health authorities' spending on residential care has actually decreased from 19 per cent in 2003 to 16.3 per cent in 2010. The total number of subsidized residential beds also decreased. There were 1,748 fewer in 2011 than 2006.

The Ombudsperson confirms the average wait time for seniors' residential care in the Fraser Health Authority has doubled since 2008. In the B.C. Interior, the average wait is more than two months - surpassed only by Vancouver Island where seniors wait an average of three months for long-term care.

The Alzheimer Society of Canada estimates that over the next 30 years the demand for long-term care for dementia patients will increase by over 10 times the 2008 demand. The number of British Columbians with dementia is expected to increase by 47 per cent over the next 15 years. Where will they be cared for?

The Interior Health Authority is in the process of constructing over 500 new residential care beds. What is the government's plan for new facilities in Metro Vancouver, the Fraser Valley and Vancouver Island? Will funding finally be allocated to achieve the ministry's long-established 2013 staffing targets? Will this week's budget answer these questions?

A Fraser Health survey of 3,000 families with loved ones in residential care concluded that over 90 per cent were satisfied with the quality of direct care, nursing and administration services they were receiving.

However, the Ombudsperson has exposed a system that is on the verge of becoming as frail as the seniors it serves. Can high-quality seniors care be sustained for the incoming wave of seniors?

The Ombudsperson's report con-firms the answer is no - as long as the status quo prevails. It will be incumbent on all parties to ensure that the necessary changes are implemented quickly.

Ed Helfrich is CEO of the B.C. Care Providers Association.

Posted in Vancouver Sun: http://www.vancouversun.com/health/Have+reached+turning+point+seniors+care/6183655/story.html