Untangling the spin about long-term care in BC

April 11, 2005

In recent months the provincial government has acknowledged that it has not delivered the 5,000 new long-term residential care beds promised during the last election. But it continues to claim success in its overall approach to restructuring BC’s continuing care services, even if falling short on the beds promise. We are told that there are plans for thousands of new beds, and that we need not worry because although the population of seniors is growing, they are healthier than ever before.

This would be well and good if it weren’t for the reality facing thousands of seniors and people with disabilities who depend on BC’s continuing care system. That reality is a system in steady decline, and in a significant degree of chaos. This is the result of a long-standing lack of investment by successive provincial governments, and of deep cuts and reductions in access made since 2001.

Continuing care refers to the continuum of programs designed to maintain or improve the health and functioning of frail seniors and people with disabilities. These services are delivered outside of hospitals and doctors’ offices. They include home care (nursing), home support, assisted living, residential care and other community-based services.

During the 2001 provincial election campaign, the current government promised to address pressures in the hospital system by building 5,000 new long-term residential care beds by 2006. After the election it shifted gears and began talking about “de-institutionalizing” senior’s care and moving to a new assisted living housing model, while still promising to create 5000 new beds.

In reality, since 2001 the government has closed 2,529 residential care beds, and has created only 1,065 assisted living spaces. This leaves BC with more than 1,400 fewer beds than there were in 2001.

The government claims these numbers are wrong and that it has built thousands of new beds. However, these figures were carefully gathered over many months, are current as of December 2004, and were verified by the health authorities themselves.

So why the discrepancy in the numbers? First, the government is counting renovated beds as new beds. If you trade in your car for a newer model, you still only have one car. Second, the government is counting seniors’ housing where some meals or cleaning are provided, but no actual care. This is not part of continuing care, and will not help frail seniors with more significant care needs.

The government also points to the thousands of new beds it promises to build over the coming years. The problem is that most of these will be assisted living spaces, not residential care. Residential care includes 24-hour nursing supervision and can accommodate the needs of the very frail elderly. Assisted living, on the other hand, provides a very limited number of services to seniors who can still direct their own care. .

This shift in focus to assisted living is one of the problems with the government’s approach to restructuring. The assumption is that assisted living can be used as a less costly substitute for residential care. Assisted living is a good option for those seniors who can live semi-independently, but it is not appropriate for an elderly person with, for example, dementia, or significant mobility challenges.

It is a contradiction for the government to claim it is creating more opportunities for people to remain independent and at the same time reduce access to home health care services, which help seniors stay in their own homes. Access to these services in BC has fallen to 30 percent below the national average, and is second lowest in Canada.

Lack of adequate continuing care services means seniors and their families are forced to pay for care privately or provide it themselves. Those who can’t afford to pay or who don’t have families to support them often simply go without until they are admitted to a hospital emergency ward in crisis. This is precisely what is happening across the province, and the result is increased wait times and backups for everyone requiring acute care — as several health authorities now acknowledge.

Exactly how much this is costing the health care system remains unknown. We do know that housing seniors in acute care beds costs many times more than it does to house them in residential care. We also know that while health care spending is up, access to acute care, residential care and home health services has declined since 2001.

The government’s restructuring of continuing care services has caused undue suffering for some of the most frail and vulnerable members of our society and increased wait times for everyone requiring hospital services. It is time to go back to the drawing board.

Marcy Cohen is the lead author of the study Continuing Care Renewal or Retreat: BC Residential and Home Health Care Restructuring 2001-2004, released recently by the CCPA.