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Volume Ten, Number Three   May 2005

Now near the bottom

Long-term care and home health services in BC on steady decline

Province-wide audit provides clear picture of cuts since 2001, documents lost beds

CPPNews --   Access to long-term care and home health services for BC seniors has decreased significantly over the past three years, in spite of rising pressures from an aging population and cuts to the acute care system. The level of services in BC has fallen far below the Canadian average, and is now near the bottom compared to other provinces. Cuts have also been much deeper in some health authorities than others, leading to growing regional inequities in the availability of care.
These are the central findings of Continuing Care Renewal or Retreat: BC Residential and Home Health Care Restructuring 2001-2004, released by the Canadian Centre for Policy Alternatives. The study documents the actual changes in the number of beds and services available to seniors and people with disabilities, using information gathered from the health authorities and the provincial and federal governments during a detailed province-wide audit.
The study finds that:
There has been a net decrease of 1,464 long-term care beds since 2001— even after accounting for new assisted living units. Between 2001 and December 2004, BC cut 2,529 residential care beds and added only 1,065 assisted living units to the system.
Home support (personal care) has also been cut since 2001. Relative to the population of BC seniors aged 75 and over, there has been a 13 percent decline as of 2003 in home support hours, and a 21 percent decline in number of clients. Home care (professional nursing) hours and clients declined by 8 percent.
Along with New Brunswick, BC now has the lowest level of access to residential care beds in Canada for seniors aged 75 and over, falling 13 percent below the national average. The number of clients served by BC’s home health care services (as a share of the population aged 75 and over) has fallen to 30 percent below the national average.
Cuts to continuing care were made at the same time as more than 1,200 hospital beds were closed, and while BC’s population is aging.
The cuts have created significant inequality in access to services between the health regions. Seniors living in the Vancouver Coastal or Northern Health Authority have far ‘better’, though still inadequate, access to residential care than people living in the Fraser, Vancouver Island or Interior Health Authorities. The cuts to acute care and home health services have also been much deeper in some regions than others.
“There has been a great deal of confusion about cuts to residential care. The bottom line is that there has been a significant net loss of beds,” says Marcy Cohen, lead author of the study, a research associate with the CCPA and a researcher with the Hospital Employees’ Union.

 “It is an impossible situation for most seniors,” says Joyce Jones of the BC Seniors’ Network. “The shortage of services is forcing seniors and their families to pay for care privately or provide care 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.”

“The lack of home support and residential care services has a cascade effect,” says Melanie Lekovic, an emergency room nurse in the Fraser Health Authority. “Seniors with no place to go end up in the emergency wards or in hospital beds, which increases the wait times and back ups for everyone requiring acute care services.”

This situation is quantified in a recent Capital Regional District (Victoria and area) report showing that there are now, on average, 162 elderly people who should be in residential care waiting in hospital each month. “Housing seniors in acute care in the Capital Regional District alone is costing between $2 million and $4 million more per year than it would to house them in residential care,” says Cohen.

 “Many seniors are now fearful about the future,” says Jones. “They are afraid publicly-subsidized care won’t be available to them when they need it. And they can’t afford to pay for it privately.” The study’s authors conducted a province-wide survey of corporate residential care and assisted living facilities in BC. They found that in residential care, fees range from an average of $44,000 per year to a high of $67,000. Assisted living fees range from an average of $38,000 per year to a high of $52,000.

The vast majority of continuing care clients are ‘unattached’ women aged 70 and over, three quarters of whom had incomes of $25,000 or less in 2000.

Since 2001, the provincial government has put an additional $2.4 billion into health care and regional health authority budgets increased by 21 percent between 2000/01 and 2003/04. However, the province has stopped tracking health authorities’ expenditures on continuing care services. As a result, it is impossible to determine how and where the health authorities have allocated the increased funding from the province or from the reduced expenditures on residential care.

“This report shows that cuts to continuing care may in fact be increasing overall health expenditures,” says Cohen. “The lack of accountability is unacceptable.” The study’s authors are calling on the government to immediately set up an external review of continuing care services, including a public consultation process and an audit of health authority budgets by independent experts.


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