Access to care for B.C. seniors shrinking as their numbers grow

B.C. seniors’ access to home and community care has declined drastically in the past decade and must be improved or seniors will overwhelm our hospital system, warns a new Canadian Centre for Policy Alternatives report.

The study, Caring for B.C.’s Aging Population: Improving Health Care for All, released Wednesday, ties deficits in seniors’ home and community health care to chronic, expensive hospital overcrowding and long wait lists.

This article was published by The Province on July 11th 2012.  To see this article and other related articles on The Province’s website, please click here

“A decade of underfunding and restructuring has led to a home and community care system that is fragmented, confusing to navigate, and unable to meet seniors’ needs,” the report states.

“Seniors often have to wait until they are in crisis and are admitted to hospital before they can access residential care services,” and “hospitals are increasingly the route through which seniors gain access to both residential and home health services” — an expensive, inefficient route.

Across B.C., as the number of seniors over 75 increased 28 per cent from 2001 to 2010, their access to residential care dropped 21 per cent and access to home support fell 30 per cent, with steep declines regionally, notably in Vancouver Coastal and Northern Health, the report says.

That’s due in part to slower funding growth — B.C.’s per-capita health spending has fallen to the second-lowest among provinces in 2011 from second-highest in 2001 — and also tighter eligibility criteria. (These reductions have been offset by a 14-per-cent increase in availability of community rehabilitation, while access to home nursing fell minimally by three per cent.)

Overall, access to home and community care in the province has fallen 14 per cent over the past decade, according to the report, which calculated its figures by comparing the volume of services to the number of seniors over 75.

That shortfall, said report author Marcy Cohen, an adjunct professor at Simon Fraser University and CCPA researcher, has serious consequences.

“We see [seniors] end up in crisis in emergency rooms. We see them end up being hospitalized for conditions that could have been dealt with in the community. The use of hospital beds is the most expensive part of the system, and there’s less room for people who need those acute-care beds.”

The report also found more patients languishing in acute-care beds. Between 2005 and 2011, there was a 35.5-per-cent rise in the number of B.C. hospital beds occupied by “alternate level of care” patients who no longer require acute care but remain there for lack of somewhere to go, costing the system thousands.

The CCPA stresses it costs $825 to $1,968 per day for an acute-care bed versus $200 a day on average for a residential-care bed.

Providence Health Care vice-president of seniors care and clinical support services David Thomson says he believes hospitals and health authorities are improving and integrating seniors care.

At St. Paul’s and Mount St. Joseph’s hospitals, he said, the average length of stay for a patient over 70 is 10 days, slightly longer than for younger groups, while Providence’s “alternate level of care” rate is low at seven per cent.

“People tend not to wait too long for residential-care placement in Vancouver,” Thompson said. “I think we do a good job, from a systems perspective.”

To help achieve this, they hold daily discharge rounds and designate geriatric transition nurses to check on discharged patients.

Others in the sector tell a different story.

New Westminster Seniors Services Society executive director Kara-Leigh Jameson says for two years they’ve been holding outreach seminars with hospitals, health authorities and related sectors trying to teach them better ways to discharge seniors so they can get the services they need. But they have a hard time scheduling sessions: many say they’re too busy.

As a result, seniors are falling through the cracks.

“We get a lot of clients who get into the hospital and there are no places for them to continue on to,” said Jameson, whose group helps 2,000 seniors get home supports.

“They are stuck in acute care on a waiting list for public residential care. They are scared and there’s a sense of, ‘There’s nowhere for me to go,’ but also, ‘I don’t want to go because residential care is a scary place and they don’t come out.’”

Sue McIntosh of the White Rock Come Share Society agrees almost all seniors want to remain at home as they age. But they also need help navigating the health system.

“They need a way of connecting to the services so they are not constantly frustrated,” she said.

Her group used to have outreach workers walk seniors through health-care decisions and arranging services. But their funding was cut four years ago. Programs like that need to be restored to make home and community care work, McIntosh stressed.

Some in the seniors services sector were aware shifting seniors care from hospitals would off-load responsibility on families.

“Every strategy to relieve pressure on the health-care system ends up pointing back to the families to be that solution, so what kinds of support are we building for them as we work to relieve pressure?” said Barb MacLean, executive director of the Victoria-based Family Caregivers’ Network Society.

To remedy the care crunch, the CCPA recommends the government create interdisciplinary health teams available 24/7 to manage cases, add programs to help seniors manage their own care, increase social supports for seniors, and make more health care data publicly available.”

“Provincial leadership, resources, and infrastructure,” the CCPA stressed, “are required if real progress is to be made.”

As the former chair of the Premier’s Council on Aging and Seniors’ Issues, Dr. Patricia Baird applauded the report.

“Clearly, with our population aging and so many people living to quite advanced ages, it’s really important that we help people stay in their homes as long as possible,” she said, noting that helps cut costs to society of hospitalizing or institutionalizing seniors.

“To me, it’s a bit of a no-brainer. We need to be spending more on helping to keep people in their homes.”

However, Baird said society’s focus should be evenly divided on both medical and non-medical support. While some seniors require medical services related to health and illness, others simply require help completing day-to-day tasks such as buying groceries or making trips to the library.

“The non-medical side — something is happening there,” Baird said, citing various community programs established to help seniors stay active and mobile. “But as far as I’m aware, there’s been no increase for the medical home services … we need to focus on both.”

According to Baird, one in four individuals will be over the age of 65 within the next 15 to 20 years — pointing to a demographic that is quickly growing.

“We need to, as a society, realize that we’re getting older and we need to deal with it. We need to provide services for independents and also medical support services,” Baird said.

The Ministry of Health would not respond to specific questions on the report, citing a need to review a full copy and its methodology, but in a statement to The Province the government defended its efforts on seniors’ health care.

“We can say we have made significant progress to improve care and services for seniors over the past 10 years, increasing the amount we spend on home and community care from $940 million from 2001 to over $2.5 billion — an increase of 60 per cent. This has helped us reduce the average wait time for access to residential care from up to one year in 2001 to less than 90 days in 2009/10.”

The report is funded in part by the United Way of the Lower Mainland, VanCity, the Hospital Employees’ Union and the B.C. Government and Service Employees’ Union.

©  The Province