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Eldercare – on the Auction Block

The Alberta Association on Gerontology has reviewed the recent publication of the Consumers’ Association of Canada, Alberta Chapter entitled, “Eldercare – On the Auction Block”, which raises concerns about the long term care services in Alberta at the present time. While we do not support completely some of the points made in this report, there are some good points which we believe are valid. Our comments are outlined below.

Recommendation: Restore and expand universal public coverage for long term care supports, regardless of the setting.

Many older people today, who are reaching the point where they need some home care help, did not have a chance to make plans for paying for these services. Many home care services are not “medically” necessary but promote overall health and prevent deterioration (e.g. homemaking). There is a gap in services for those with a mild dementia who do not require the full services of a continuing care centre but who may need 24 hour supervision for safety reasons. The other major gap is in coverage for medical supplies and drugs that would be covered if the individual was in hospital or another health care institution. Seniors were assured that these services would be available without significant extra charge. This is in addition to the fact that they have lost many of the benefit programs that were available to seniors at the time they planned their retirement incomes. Consequently, many people do not have adequate income to pay the high costs of private home care services, and services offered through the regular home care program are no longer sufficient for some people. Expansion of home care services was a key recommendation of the government’s Broda report (Long Term Care Review).

It is important to assess the income of those individuals requiring continuing care in the community to determine whether they are still able to afford the services needed to maintain their independence. It is an important function of the Alberta Government to carefully monitor the costs of continuing care in the community as well as in long term care centres, so that real “choice” remains affordable to those seniors with minimal incomes.

We also now have situations where family members, usually the female members, have to leave their jobs, take part-time jobs or take leaves to provide care for an older member of the family. The report is correct in stating that these people are the poor of the future generation of retirees. They are not provided with adequate supports while they are caring for their older relatives, and they are losing valuable pensionable time and chances of advancement while they are out of the workforce.

One of the fundamental principles of the development of assisted living facilities is that these offered the promise of “choice” as an alternative to a system of institutional care. However, private pay assisted living facilities cater to seniors that are able to afford the services. There needs to be more of these types of facilities for low or average income seniors. Developers will need government assistance to be able to make their facilities affordable. A partnership between all levels of government, and private developers, is suggested. Some of these partnerships have started but government involvement is required to make the housing component affordable.

Recommendation: End the unbundling of services.

We support “unbundling” of services as this separates the services from the place where they are delivered. In other words, the services are not tied in with a specific location. When services are tied to a specific location, the individual has to move should his/her needs change. Unbundling ensures that people only get the services needed, which should save money in the long run.

While assessment to determine need does restrict choice, we believe that it also determines what the needs of the individual are and what services would be most appropriate. What perhaps is needed is a greater range of services, which can be provided in a variety of settings: home or supportive housing as well as long term care facilities, regardless of geographic location in this province. The Broda report also advocated expanding the range of supportive living options in the province. These should be available to those who need some help with maintaining their independence. At the present time, those with low incomes have very little choice. Even some of those with a moderate income are finding it difficult to afford real choice. This is an important consideration. Being able to make choices is crucial if older people are to age well. To summarize, there needs to be a greater range of services that are available to those with low incomes. At present, seniors with low incomes have very limited choices.

As the report points out, the home care program has financial constraints. Since it is increasingly serving people released early from active treatment hospitals, there are not enough funds to provide proper and needed assistance to those who have long term disabilities. Some home care recipients are informed that if they have family in the area, the family must do certain tasks. This does not take into account the fact that we now have two person wage earners in most families. Most families have limited free time to take on additional caregiving roles. Forcing families to do certain tasks without ascertaining whether they have the time to do so puts much stress on the family, contributing to their own health problems, and is almost certain to hamper economic productivity. There needs to be an increase in services such as respite programs to provide relief for families. This is a growing need.

The Minister of Alberta Seniors has stated several times that the person should not be brought to the service, but the service should be brought to the person in order to encourage “aging in place”. This is an excellent suggestion, and follows recommendations from the Broda report. While we recognize the difficulty in bringing this idea to full fruition, we would like to see greater emphasis placed on implementing a meaningful “aging in place” policy. We would like to see this approach extended to include those individuals that have chosen to live at home. At present, some services are brought to individuals living in assisted living facilities, but this does not offer “choice” to the low income senior. We believe that there needs to be subsidies available to low income seniors, to help them take advantage of assisted living facilities. There are also access barriers unique to rural areas that need to be specifically addressed.

Recommendation: License, regulate, and monitor supportive housing and Assisted Living settings.

Many supportive housing/assisted living projects for seniors are being developed in our province with the residents paying for their own housing costs. As noted above, the difficulty has been that many of these are not affordable for lower income seniors. In addition, in a number of the projects, residents have been paying for additional services not included in the basic charge. It is easy to see how charges for extra services, both in the community and in long term care, can gradually be increased so that it is hardly noticed if one increases each cost only a minimal amount. The Alberta Government needs to assure that we have well trained and diligent people monitoring this situation to ensure access to publicly funded services is not based on ability to pay.

We are also concerned about the proliferation of supportive housing/assisted living facilities without any standards available to determine what services should be provided at these facilities. Assisted living facilities are an excellent concept, however when people are looking for assisted living accommodation, they frequently do not have any clear understanding of additional service charges, nor do they have the energy or time to thoroughly investigate the situation. Many of them end up in a state of confusion and frustration. We support efforts of groups such as The Kerby Centre in Calgary and Society for the Retired and Semi-Retired in Edmonton, the Alberta Long Term Care Association, ASCHA and regional health authorities to provide what information they can on these settings. Setting province-wide standards for supportive housing developments was another recommendation of the Broda report.

Some assisted living facilities offer a number of services; others offer very little, and they charge such a variety of prices that people can become quite confused. Assisted living facilities should offer certain basic services which are required by everyone such as meal service and 24-hour on call help. They could vary with additional service options, but in order to be called supportive housing or an assisted living facility, they should be required to offer certain basic services as a part of the monthly rental charge. The Alberta Association on Gerontology understands that some work is now being done to try to bring some consistency and guidelines into this situation. We believe that this is essential and that the government should develop an effective way of licensing or regulating these facilities. The current unregulated scenario is really a “buyer beware” situation for seniors and their families. Government could assist by providing standard definitions of the services available and a standard spreadsheet type document that would indicate what amenities are available where using the standard definitions.

Thank you again for taking the initiative to prepare your report and recommendations.