February 24th 2012: A report recently published by the B.C. Ombudsman says that government needs to do more to care for seniors. On the whole the report is highly critical of what the provincial government has failed to do for older British Columbians.
Findings reveal many facilities don’t even have minimum standards of care. It is also choc-full of stories about terrible conditions in residential homes such as unacceptable sanitary surroundings and residents agreeing to go to bed at 4 o’clock in the afternoon because of staff shortages.
During a 2008 tour of provincial residential facilities, B.C. Ombudsman Kim Carter encountered a lot of very unhappy seniors. As a result she issued a news release calling on anyone with concerns about seniors’ care to contact her office. They received so many complaints from across the province that she decided to undertake a huge systemic investigation – the largest her office has ever seen.
The investigation was in part motivated by the fact that seniors in care facilities faced certain barriers to raising their concerns and did not all have loved ones to provide advocacy and support on their behalf.
Ms. Carter has finally released her report on seniors’ care in the province of B.C. Spanning over 450 pages and having taken the better part of four years to investigate and publish. The focus of the report is on three types of health services for seniors that fall under Home and Community Care Services: home support, assisted living and residential care. Delivering these services falls under the responsibility of five regional health authorities. These authorities are: the Ministry of Health, the Ministry of Housing, the Fraser Health, Interior Health, Northern Health, Vancouver Coastal and Vancouver Island Health authorities – all were involved in the investigation.
The Ombudsman’s Report, explains that while there is legislation that regulates the provision of services, much of the actual operation is guided by policy. Each year, over 50,000 B.C. seniors and their families are impacted by home and community care services.
This report is “The Best of Care 2 – Volumes One and Two”, it is a follow up to “The Best of Care (Part 1)” – published in 2009. The initial report had focused on three residential care issues – residents’ rights, public information, and the role of resident and family councils.
Here are some of the most important recommendations made in Part 2 of the report (a more detailed list is available at the end of this article):
- A clear, province-wide policy on when the Mental Health Act can be used to involuntarily admit seniors to mental health facilities and residential care facilities and that the authorities stop charging seniors that are involuntarily detained in such facilities;
- An internet venue from which seniors can navigate the home and community care system;
- Consistent reporting and tracking of elder abuse and neglect;
- The protection from retaliatory action for seniors who complain in good faith about the home and community care services they receive;
- Objective and enforceable standards of care for home support services. This would include legally binding minimum requirements for assisted-living residences on staffing, residents’ rights, food safety and nutrition, emergencies and record management;
- Ensuring equal treatment, benefits and protection of seniors in residential care by establishing one legislative framework that applies to all residential care facilities instead of the two that currently exist;
- Enhancing dementia and end-of-life care services in residential care;
- Helping seniors stay in their homes by assessing the adequacy of current support programs and analyzing the benefits and costs of expanding those services.
It is important to note that the Ombudsman’s mandate is not to make health reform policy proposals but to assess the administrative actions of provincial authorities with the goal of ensuring they deal with people and deliver services in a fair and equitable manner. The results of the Ombudsman’s investigation is a report that makes 143 findings and 176 recommendations. Issues investigated include access to services, adequacy of information, standards of care, complaints processes, and monitoring and enforcement. At the highest level, the recommendations are about accessibility and are designed to improve support, protection, and choice.
Provincial Response – New Action Care Plan
The province has responded to the Ombudsman’s report by introducing a New Action Care Plan that promises the following:
- Ensuring concerns and complaints are responded to and resolved in a timely manner through the establishment of the Office of the Seniors’ Advocate, and a separate toll-free phone line for seniors and families to launch June 2012.
- Improved access to information for seniors and their families so they can make better care choices. This includes online access to facility reports, easier access to assessments of seniors’ health needs and information on policies around eligibility, charges and hardship waivers – all by September 2012.
- Piloting a new risk assessment tool for residential facilities to provide a more accurate indication of potential risks to quality and safety, as well as establishing enforcement processes that ensure compliance.
- Protection and safety of seniors through the development of a provincial elder abuse prevention, identification and response plan by December 2012, which will include consultations with key stakeholders starting in February 2012.
- Meeting the support needs of seniors in their community so they age in place by expanding non-medical home support from five communities to up to 65 communities over three years, initiating opportunities for new housing and care options, providing province-wide, after-hours access to palliative tele-nursing beginning April 2012 and better integration beginning April 2012 of primary and community care for seniors.
If implemented in keeping with projected timelines, these new initiatives sound like great first steps. Such comprehensive reports as these, however, only highlight the extent to which we need national dialogue and leadership on healthcare issues. Ms. Carter touches on this need in her report, saying that the larger picture needs to be considered– even if it falls beyond the scope of her investigation:
“Administrative fairness operates within a wider context. During the course of our investigation into home and community care issues, it became evident that context includes questions about whether the changes in service delivery models for seniors care made since 1984 should be considered during any review of the Canada Health Act; whether a conversation with seniors and others about the type of services needed, their costs and how these costs are paid, would be timely and produce positive change; whether there is a rationale for the difference in support in British Columbia provides to vulnerable children and their families (a Ministry and a provincial-level representative) and vulnerable seniors and their families; and whether the current home and community service delivery model which is a mix of private and public agencies delivering home and community care services under contract to the health authorities is the most effective model.”
Key Recommendations from the Ombudsman’s Report
Home and Community Care
· Provide clear information to seniors and their families and track key home and community care data and report it publicly in annual home and community care report (R) 1 to 5, 9 to 11 and 19.
· Support seniors and families in navigating the home and community care system (R) 22
· Protect seniors through consistent standards for training, registration, and criminal records checks for all care aides and community health workers (R) 23 to 26
· Protect seniors through consistent reporting and tracking of abuse and neglect (R) 27 to 32
· Protect those who complain in good faith about home and community care services from any adverse consequences for doing so (R) 33
· Assist seniors to continue to live at home by assessing the adequacy of current home support programs and analysing the benefits and costs of expansion (R) 34
· Ensure equal treatment by developing consistent and adequate time allotments for home support activities (R) 35
· Support seniors by establishing a set time frame within which seniors requiring home support will receive services (R) 36 to 38
· Enhance home support by including continuity of care as an underlying principle (R) 40
· Ensure objective and enforceable standards of care for home support services (R)
· Ensure the Office of the Assisted Living Registrar ceases to contract with the Health Employers Association for staff (R) 51 (For more information on this recommendation – please visit our article on the subject by clicking here)
· Ensure fair and equal treatment by ensuring immediately that no seniors are charged extra for services and benefits that are included in the assessed client rate (R) 53
· Ensure there is a legal foundation for any expansion of services and a concurrent increase in the monitoring and enforcement powers of the registrar (R) 54 to 56
· Support Seniors by establishing a timeframe within which seniors requiring assisted living will receive service (R) 63 to 65
· Protect seniors by establishing a clear, consistent and fair process for assessing whether they are still able to live in assisted living (R) 59 to 61, 67
· Ensure objective and enforceable standards of care for assisted living (R) 69
· Provide legally enforceable tenancy rights to assisted living residents (R) 82 to 84
· Enhance protection of seniors by establishing a single, accessible process to respond to all complaints about assisted living (R) 75 to 81
· Enhance protection of seniors by improving reporting of serious incidents (R) 85 to 87
· Establish an active inspection, monitoring and enforcement program (R) 88 and 89
· Ensure equal treatment, benefits and protection of seniors in residential care by establishing one legislative framework that applies to all residential care facilities (R) 94 to 96
· Provide choice and offer flexibility in moving into residential care (R) 100, 117, 119 and 120 · Act transparently by providing seniors and their families with the information they need to make decisions about
placement (R) 102 to 107
· Enhance the transparency of the admissions process by establishing a standard admissions agreement and by bringing Part 3 of the Health Care (Consent) and Care Facility (Admission) Act into force (R) 86-87
· Ensure fair treatment by not charging seniors involuntarily detained in residential care under the Mental Health Act fees (R) 130 to 132
· Ensure objective and enforceable standards of care for seniors in residential care (R) 133 and 134 · Establish consistent rules on the use of restraints (R) 135 to 137
· Ensure there are clear legal requirements that apply to obtaining consent for the administration of medication (R) 139 to 141 and 154
· Establish specific staffing standards for residential care facilities (R) 142 to 143
· Enhance dementia and end-of-life care services in residential care (R) 145 to 147
· Provide a simple and responsive complaints process (R) 148 and 149
· Improve the reporting of incidents, inspections, monitoring and enforcement practices (R) 152, 153, 156 to 167
· Establish more transparent and flexible processes for moves between facilities and moves on closure of facilities (R) 168 to 176 quality of life for all B.C. seniors and help them remain independent for as long as possible.”
To download a full copy of the report:
Update – September 2012
Following the report there was a lot of talk but there seems to have been very little in the way of concrete actions taken since the release. In early September Christy Clark unveiled her new cabinet and after a shuffle – Ralph Sultan is the newly minted minister for seniors. Recently, Sultan hinted via his MLA website that we might soon see some action on the seniors file in the form of the long awaited independent seniors’ advocate. The Health Ministry has described the mandate of the would be advocate as “to ensure a more accessible, transparent and accountable approach to seniors’ care.” In theory, the advocate would have the power to make government inaction on the seniors file very uncomfortable. There are many pressing issues to be addressed and according to the New 2011 census data, BC is the only province west of the Maritimes to have more seniors than youths under 15.