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Vancouver–A major study released today finds that BC’s home and community health care system is in serious decline — the result of reduced access to services and poorly planned restructuring.
An Uncertain Future for Seniors: BC’s Restructuring of Home and Community Health Care 2001-2008 builds on past CCPA studies. It provides detailed evidence related to concerns raised recently by the BC Auditor General, the BC Medical Association and the BC Care Providers Association about the deteriorating state of seniors’ care in BC.
Key findings include:
- The provincial government fell short of its 2001 promise to build 5,000 new residential care beds for seniors. Since 2001, 3,589 net new beds have been built – a shortfall of 1,411 beds. The study also provides bed numbers by health authority and municipality.
- All the new beds are assisted living units, which provide lower levels of service than residential care and are not an adequate substitute. (There were 804 fewer residential beds in 2008 than in 2001, but 4,393 new assisted living units were added, for a net new bed total of 3,589.)
- Bed numbers reported by the Ministry of Health Services did not match those obtained from the health authorities by Freedom of Information request. The 1,753-bed discrepancy resulted from over-counting and inaccurate reporting by the Ministry. The Ministry included ineligible beds in its totals, such as supportive housing units, short-term convalescent care, group homes, independent living units and mental health facilities.
- The original 5,000-bed target was for 2006. Using increases in the population aged 75 and older as a rough estimate of growing demand, the province should have built approximately 6,815 new beds by 2008. The number of seniors aged 85-plus grew by 43% since 2001, while the population between age 75 and 84 increased by 15%.
- Access to residential care dropped by 20.5% since 2001 (access = beds per 1,000 seniors aged 75-plus, excluding assisted living). BC has the lowest access to residential care beds in Canada, after New Brunswick.
- The number of home support clients dropped by 17% since 2001, and the rate of access (clients per 1,000 seniors aged 75+) dropped by 30%. The number of home nursing clients increased, but the rate of access dropped by 11%. Only community rehabilitation has seen an increase in access (up 24%).
- From 2001 to 2007 per capita health care spending increases were lower in BC than in any other province. While funding for home and community health care in BC increased by 37% since 2001, these increases have been inadequate given the rapidly aging population, and the increased reliance on home and community care compared to hospital services.
- The number of people dying each year in residential care increased by 60% between 2001 and 2006 — not because of negligence, but because eligibility has been restricted to seniors with more complex needs, meaning they were in worse health by the time they could enter residential facilities. However, most of these facilities are not funded to provide palliative services.
- Rather than maintain or increase access to residential and home-based care as the population ages, the province has restricted these services to seniors with more complex needs. The shift to high-needs clients undermines the prevention and early intervention functions of home and community health care. Seniors with lower needs are increasingly required to pay out-of-pocket, rely on family members, or go simply go without access to care.
“When seniors can’t get timely access to these services, they end up in more expensive hospital beds,” says Jeremy Tate, co-author of the study and former Director of Health Facilities Planning at the Capital Regional District in Victoria. “Being in hospital is hard on the frail elderly, and it blocks beds that could be used by other patients. It’s also extremely expensive.”
The CCPA study offers the only publicly-available, comprehensive accounting of long-term care beds in BC. “It’s important to set the record straight on bed numbers, but the government’s failure to deliver on its 5,000-bed promise is just a symptom of deeper problems,” says Marcy Cohen, study co-author, CCPA research associate, and Research Director at the Hospital Employees’ Union.
In 2007 the Auditor General asked the Ministry of Health Services to develop a strategic plan for home and community care by March of 2008. The Ministry hired the firm of Deloitte & Touche to prepare a plan, but it has still not been released to the public.
The study authors have forwarded the CCPA study to the Auditor General and expressed concern about the government’s failure to deliver effective planning and stewardship.
“There is no strategic plan for the home and community care system, despite the fact that BC spends about $2 billion per year on these services,” Jennifer Baumbusch, adjunct professor of nursing at UBC and study co-author. “We need transparency, public consultation, comprehensive strategic planning and commitment to increase access to care for seniors.”
A second study released today, Innovations in Community Care: From Pilot Project to System Change, looks at successful case studies around BC that, if scaled up, offer cost-effective solutions. By focusing on prevention and early intervention, they would significantly enhance the sustainability of BC’s overall health system.
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