The only way BC has been able to respond effectively to the pandemic in long-term care is by taking measures that public health care advocates have been calling for many years such as enhanced employment standards. BC has taken an important first step in putting public solutions first in long-term care and assisted living by requiring that most staff work at only one facility, be paid the unionized industry standard, and committing to full-time hours for workers required to work at a single site. This is an important first step but not enough. We need to remove the for-profit motive from the seniors’ care system.
- Implementation of the Seniors Advocate recommendation to create a provincial association of family councils to ensure residents and their loved ones can be represented provincially.
Make private operators more accountable for the public funding they receive by:
- Establishing measures to ensure transparency towards both Health Authorities and the public on how much profit private operators are making, including clear accounting and Ministry of Health staff assigned to analyze and compare data across the province.
- Establishing measures to ensure transparency on how much funding operators are spending on food, recreation, mobility and direct care hours.
- Make wage-levelling across the sector permanent by requiring all facilities to pay public sector agreement wages.
- Phase out the additional government subsidy provided to private-for-profit facilities to provide standardized wages. Full-time employment is tied to continuity of care.
- Bring back long-term care jobs that were privatized by the BC Liberals, including long-term care aides, housekeeping, and dietary workers into the public sector.
- Ensure community health worker wages are kept comparable to LTC sector to support seniors ageing in place.
Invest in public and non-profit beds by:
- Developing an ambitious capital plan to support the design and building of new non-profit or public facilities that reduce the use of public-private partnerships. This should be significant enough to eliminate multi-bed rooms, update ageing facilities, and expand the total number of beds in the system to keep up with population growth.
- Revising Health Authorities’ Request For Proposals process to privilege small, local operators and non-profits in winning contracts.
- Invest in home care so older adults can age at home
The BCHC proposes that standards must be enforceable and legislated while meeting the following standards:
Improve Quality of LTC
- All homes must provide a safe, secure home-like environment for residents that meets their care needs.
- Support the cognitive, emotional, social and cultural well-being of residents.
- Increase staffing levels to provide sufficient staffing and an appropriate staff mix to meet the care needs of residents and support for the staff.
- Require a minimum care standard for daily hands-on care that provides for residents' care needs.
- For Indigenous peoples, the LTC program must respect the unique cultures of the communities.
Improve LTC Accountability
- Provide meaningful recourse for residents, substitute decision makers and staff when care needs are not met.
- Include the right for the public to appeal the awarding of LTC licenses.
- Track how the funding provided has been spent to improve quality, oversight and access to LTC
Take Profit Out of LTC
- Federal funding must provide funding for public and non-profit LTC, and support to expand public and non-profit LTC.
- The BC Health Coalition released The Place of Assisted Living in BC’s Seniors Care System: Assessing the Promise, Reality and Challenges report with the Canadian Centre for Policy Alternatives and the Hospital Employees’ Union.
- Assisted living was introduced in 2002 as a less institutional environment for seniors with less complex needs than long-term care. It offered the promise of greater independence and being able to live in a more home-like environment—which are important and highly valued by seniors. Drawing on interviews in different parts of the province with 28 care aides, Licensed Practical Nurses (LPNs), front-line managers, residents and family members, the study offers a preliminary assessment of the quality and appropriateness of assisted living services, the conditions for both residents and workers, and the legislative and regulatory frameworks that govern assisted living.
- The key findings portray symptoms of a crisis in our fragmented, under-regulated, and largely privatized system of home- and community-based health care. Read the report here.
Key finding from the report:
- Many seniors have care needs that are not met due to affordability challenges, particularly in private-pay units (where the senior or their family pay the full cost and are charged for each additional service beyond the basic minimum required). For example, LPNs and care aides reported residents using towels as adult diapers or for wound care, skipping meals not included in basic food packages, or wearing dirty clothing because laundry detergent was too expensive or residents could not afford to buy new clothes.
- A significant number of seniors in assisted living residences do not appear to qualify for assisted living under provincial legislation, which requires that residents are able to direct their own care and independently respond in case of an emergency. LPNs and care aides overwhelmingly reported struggling to meet the needs of residents with moderate to advanced dementia or significant mobility limitations – but who were nevertheless living on their own in both publicly-subsidized and private-pay assisted living.
- The assisted living model allows residents to make the choice to “live at risk” in order to remain independent, but it can easily become a way for operators to cope with or justify low staffing levels, and too often leaves residents in situations that border on neglect.
- In subsidized and especially private-pay assisted living, front-line staff reported being unable to do what they ethically know they should as a result of institutional constraints like low staffing levels, a lack of resources and the philosophy of allowing residents to “live at risk.”
- Front-line staff participating in this study reported a high rate of ER visits and hospital admissions of residents in assisted living, particularly due to falls.