Message to Health Minister: Enough with the numbers game - it's time to deal with serious problems in seniors' care

April 30, 2009

With an election on, it's no surprise that the provincial government is claiming success on everything from the environment to the economy. But one area where it hasn't earned bragging rights is seniors' care.

The home and community health care system that seniors and their families rely on is in serious decline, thanks to years of poorly planned restructuring and a failure to maintain (let alone enhance) access to key services as BC's population ages.

The most problematic area of all is long-term care - often referred to as residential care or nursing homes. Before its election in 2001, the government promised to build 5,000 new non-profit residential care beds within five years. Numbers obtained by Freedom of Information request from the province's health authorities show that there are actually fewer residential care beds today than there were in 2001 -- 804 fewer to be precise.

What the province has done is build 4,393 new assisted living units. Given that we have lost 804 residential care beds, this works out to 3,589 net new beds, all of which are assisted living. But that only makes sense if we assume residential care and assisted living are interchangeable. In reality they are very different.

Assisted living is for seniors who can live quite independently without 24-hour supervision. Residential care is appropriate for the frail elderly with 'total care' needs and includes 24-hour nursing supervision. Assisted living is an important part of a continuum of home and community health care services - but it is not a substitute for much-needed residential care beds.

When pressed by journalists last week, Health Minister George Abbott admitted the government has not built the promised residential care beds. However, he also claimed that our research - published earlier this month in a Canadian Centre for Policy Alternatives study - is not to be trusted.

This is a bizarre accusation to make. Our bed numbers were obtained from the health authorities and verified with individual facilities. The Ministry of Health Services, in contrast, reports much higher numbers because it counts beds that have nothing to do with long-term care for seniors - such as adult group homes, mental health facilities, supportive housing, etc. The mis-reporting of beds is something the Minister should be called on to explain.

This numbers game is a symptom of much deeper problems in our home and community health care system. The CCPA is not alone in drawing attention to these problems. The BC Medial Association, BC's Auditor General, and the BC Care Providers Association have all raised concerns recently about the deteriorating state of seniors' care.

Today, BC has the lowest access to residential care of any province other than New Brunswick (access means beds per 1,000 seniors 75 years and older). Access to home support has dropped since 2001 -- by a substantial 30% (these are personal care services provided in seniors' homes, such as help with bathing and medications). Access to home nursing also dropped, by 11%. Only access to community rehabilitation has seen an increase, up 24%.

The province's way of dealing with inadequate service levels has been to limit eligibility to those seniors with higher-level needs. As a result, the vital prevention and early intervention role of home and community health care is undermined.

The government's failure to maintain (let alone increase) access levels means many seniors have to rely on family members for care or simply go without. Too often, seniors living at home only get access to the residential and other community health services they need after being admitted to hospital. Being in hospital is hard on the frail elderly. It blocks beds that could be used by other patients who genuinely require acute care services. And it's extremely expensive.

The good news is that providing effective community-based health care to seniors is not an impossible challenge. Adequate funding is an important part of the solution, but so is better coordination of services.

A number of very successful and innovative programs are already in place in local communities across BC. These programs bring different care providers together to better coordinate, monitor and deliver care to the frail elderly. While these innovations hold much promise, they remain at the margins - isolated pockets of excellence in the midst of a home and community care system that is largely in decline. If they are to make a difference they will need to scaled up and introduced province-wide.

What we need in this election is not more hot air about bed numbers. We need leadership and a commitment to transparency, public consultation, good planning, and increased access to seniors' care.

Jeremy Tate is a former Director of Health Facilities Planning at the Capital Regional District in Victoria. Marcy Cohen is a research associate with the Canadian Centre for Policy Alternatives (CCPA). They co-authored the recent CCPA study
An Uncertain Future for Seniors: BC's Restructuring of Home and Community Health Care 2001-2008. Marcy Cohen is also an author of Innovations in Community Care: From Pilot Project to System Change. Both are available at