An updated guide published by the Office of the Seniors Advocate (OSA) in January shows that only 10 per cent of B.C. seniors in residential care are getting the 3.36 hours of staffing care per day recommended in provincial government guidelines. That is down from 18 per cent of seniors receiving 3.36 hours of daily care in 2015.
The guide—the 2017 British Columbia Residential Care Facilities Quick Facts Directory—was intended to be like a phone directory, says Seniors Advocate Isobel Mackenzie; a guide that provided key information in a standardized and concise format for 292 publicly funded licensed care facilities in the province. “People are more looking at it is a report,” says Mackenzie, noting that the new version shows there has been improvement in some areas, but a step back in others.
“There has been a decline in the misuse of anti-psychotic drugs, a decline in the number of complaints, and a decline in the number of reportable incidents, such as disease outbreaks, falls, and missing or wandering seniors.
“Where we also saw a decline was in the number of facilities that meet provincial staffing care guidelines of 3.36 hours per patient per day. An overall decrease of .6 per cent wasn’t where we were supposed to be.” (According to the report, residents at the Jackson House Long Term Care facility in Ashcroft each received 3.37 hours of funded direct care hours per day in 2016.)
Direct care providers include nurses, occupational and recreational therapists, nutritionists, care aides, and physiotherapists. Mackenzie feels that one way to improve staffing levels would be for people already employed at care facilities to move to full-time rather than part-time positions. “Probably 50 per cent of the workforce doesn’t work full-time.”
She notes that while more human resources are needed at care facilities, there is a greater shortage of staffing when it comes to people receiving care at home.
“Some people [in acute care or hospital beds] could be at home, but they might need a fairly high level of care if their challenge is cognitive, not physical. We can care for these people in the community if we organize home support correctly.”
Having a patient in an acute care or hospital bed costs between $1,200 and $1,800 per day. Mackenzie notes that a residential care bed is $200 per day, while four hours of daily home support costs between $120 and $140.
Fraser-Nicola MLA Jackie Tegart was part of the select standing committee on finance, which solicited feedback from people all around the province in fall 2016. “There was much more participation from groups advocating for seniors and senior care, as it’s very important to British Columbians.” The committee reported out to the Minister of Finance in November 2016, and the recommendations were taken into consideration when developing this year’s budget.
Four of the top five recommendations were specifically related to seniors’ care. “I know from talking to the ministry and the minister that they take the recommendations very seriously,” says Tegart, noting that the ministry has, in the past, responded to quite a number of recommendations from the OSA. “Within the ministry it’s a huge challenge: how to change from having people in acute care and hospital beds to getting them into residential care or back home.”
Coquitlam-Maillardville MLA Selina Robinson, the NDP’s spokesperson for seniors, is disappointed to find that the situation regarding daily care for seniors has got worse since the 2015 report. “From my perspective, the part of the story that’s important to tell is that a year ago it was shocking to find that the government was not funding to the minimum level [of care]. And it’s getting worse. The government has done nothing in a year.
“A caring government would act, say ‘This is terrible,’ do something. There is no plan. They’re not proactive, always reactive.”
She says that an NDP government under John Horgan would be proactive. “We would make sure we have home support services, to get people home as soon as possible and free up beds. There are ways to change the system.”
Robinson notes that publicly funded residential care facilities tend to have better coverage than private ones. “Private operators need to make a profit,” she says, adding that private operators frequently contract out and flip contracts, firing existing staff and then hiring new staff at lower wages. “It’s not good for the senior population. They are vulnerable, with complex care needs, and we need to look after them.”
The Hospital Employees’ Union (HEU) agrees, noting that private operators can contract out and flip contracts at will, laying off entire staff teams. The practice, says the HEU, destabilizes the continuity and quality of care seniors receive. The union would like to see new funds for residential care, as well as a determination of the level of staffing hours needed to deliver safe, quality care.
All involved agree that attracting more people to work in residential or home support care is key. Mackenzie says that nursing is a well-paid profession: “It’s definitely a family-supporting job.” She notes, however, that providing intimate care for someone is something a person has to want to do, and is not for everyone.
Tegart agrees that staffing is important. “When health authorities and the ministry look for solutions, a lot will be around staffing and quality of care. But there is the challenge of coordinating and finding staff. It shouldn’t be a political issue. How do we provide quality care to people who are the building blocks of our communities?”
Robinson says that there will, at least for a time, be a gap in staffing, but that a good place to start is with the people already there and who may not be working full-time hours. “That way you can act quickly. The government could have made a commitment to bring care up to the minimum standard. It’s all about choice. This government has chosen not to act on information we knew about a year ago. We have to do better; can do better.”
Tegart says it’s a huge issue. “How do we best provide care to our seniors? As a rural representative, however, I’m very cautious that we don’t take a cookie-cutter approach. What works in an urban setting doesn’t necessarily work in a rural setting. In our area we’re fortunate to have Better at Home, and the ministry is looking at different delivery models.”
For her part, Mackenzie says that the failure of 90 per cent of residential care homes to meet the minimum provincial guidelines is unfortunate. “We made progress in some areas, but not in this.
“I am hopeful that we will get a commitment from the government to get to 3.36 hours per day in a timely manner.”
The 2017 edition of the British Columbia Residential Care Facilities Quick Facts Directory can be viewed online at http://bit.ly/2klPkgC.