Op-ed: Sustainability Through Innovation: Exploring Options to Strengthen BC’s Continuing Care Sector

By Michael Kary

With BC’s population rapidly ageing, now is the time to explore new solutions to meet the fiscal challenges we face, while also improving the overall quality of seniors’ care. Redesigning the existing health system with new care models and providing targeted investments that can improve care will be an integral part of this process. In particular, we need to explore alternative ways to sustain and innovate to create a health system so that it is less acute oriented and better designed to provide care for those with ongoing care needs, including the chronically ill and frail elderly.[i] In this regard, on May 16, 2016 the BC Care Providers Association (BCCPA) released two major White Papers that outline a number of potential options to improve the sustainability of the continuing care sector, as well as to foster innovation.[ii]

The first White Paper deals primarily with issues around funding and financing of continuing care in order to improve sustainability and enhance quality within the sector, including for care providers and seniors. While the second White Paper also touches on funding matters, it deals more with identifying innovative approaches, focusing on five key areas including exploring new care models for seniors, improving dementia care, effective use of technology, as well as enhancing the health, safety and well being of seniors.  Along with better meeting the needs of an ageing population, the approaches outlined in both White Papers highlight potential ways to reduce acute care congestion (including alternate level of care days) and emergency room visits, as well as providing better care in the community for the frail elderly, including seniors with chronic conditions and dementia.

The BCCPA, through its Emerging Issues and Policy Committee, has invested significant resources over the last year to research, draft and refine these White Papers, which outline various options for consideration. The White Papers also build on many of the key themes of the BCCPA Policy Paper released last year entitled Quality-Innovation-Collaboration: Strengthening Seniors Care Delivery in BC, which was a direct response to the policy papers released by the Ministry of Health in February 2015.[iii]

As outlined in detail in the Quality-Innovation-Collaboration paper (2015), the BCCPA advocates for a shift in funding from acute to home and community care. In particular, the BCCPA recommends a specific target for redirecting acute care expenditures – such as a minimum of 1% annually over a five-year period – to the continuing care sector.  While the White Papers build on many of the themes or recommendations in the earlier BCCPA paper, they also outline a number of key ideas and initiatives being undertaken in Canada and internationally to improve the sustainability of the continuing care sector and the quality of seniors’ care.  In particular, each paper outlines 16 specific options for consideration (see table 1 for overview of options).

Table 1: Overview of Options for Consideration from Sustainability and Innovation White Papers (Click here)

In the process of developing these White Papers, the BC Ministry of Health in April 2016 also announced it will be undertaking a review of staffing guidelines in government-funded long-term care homes for seniors, following an earlier report from the province’s Seniors Advocate.[iv] In particular, BC Heath Minister Terry Lake requested the Ministry undertake a review to examine how health authorities are funding seniors’ homes, including looking at the care hours provided for seniors with different types of ailments, such as those living with dementia.[v] Further details on the Ministerial review will be forthcoming, but the BCCPA, which generally supports such a review, hopes that some of the options outlined in these papers may also help assist the government in this process.

Over the next four to six months, the BCCPA will also be seeking input from those receiving care, our members, key partners, and a wide range of other stakeholders on many of the options and ideas presented in the papers.  The consultation process will begin at the BCCPA Annual Conference in late May 2016, including at the Policy Café event that is to be held in Whistler.

As part of the consultation process, the BCCPA also plans to gather over 100 individuals in September 2016 to attend the inaugural BC Continuing Care Collaborative at the SFU Wosk Centre for Dialogue in Vancouver. Attendees will be provided with a summary of our consultations to date, as well as an opportunity to provide direct feedback regarding the options outlined in the White Papers.  After compiling the feedback from the consultations, the BCCPA will use this information to assist in drafting a final paper with recommendations.

As such, the BCCPA is encouraging its members, as well as other stakeholders, to review the White Papers further including to consider which ideas, concepts and options outlined could help foster a vibrant and sustainable continuing care sector, while also ensuring excellent seniors care moving forward into the future. In summary, the BCCPA looks forward to having a productive and collaborative discussion over the coming months on the papers in order to find solutions to challenges facing care providers and seniors.

Overview of Options for Consideration from Sustainability and Innovation White Papers

Funding and Financing of Continuing Care

  • Ensuring that funding for care providers better accounts acuity and complexity of clients in care, as well adhering to the core principles of timeliness, sustainability, equity and transparency.
  • Moving towards a funding model that separates the bodies that fund, allocate funds and regulate care homes from those that operate care homes.
  • Development of funding models that accurately factor in increases to operating costs including wages, inflation, overhead as well as other areas such as increasing levels of acuity.
  • Increasing stability in the sector through policies such as Managing Changing Need and ensuring a fair and equitable return on the cost of capital.
  • Exempting property taxes for residential care homes to allow non-government operators to recoup capital operating expenses.
  • Review of new funding models such as activity and outcome based funding, social finance and vouchers in continuing care as well as new financing approaches such as long term care insurance and co-payments.

New Care Models

  • Explore new delivery models such as the Continuing Care Hub to reduce acute care congestion and ER visits as well as better care for frail elderly and seniors with chronic conditions and dementia.
  • The development of new continuing care models in which residential care homes could provide home support services to seniors and/or be integrated as part of age friendly communities.
  • Development of new care models such as Green House care homes and specific models of care for dementia (i.e. Butterfly Care Homes and Dementia Villages).
  • Establishing a dementia friendly program, in which a specific designation could be provided to care homes that have made specific redesign changes to accommodate residents with dementia and/or where specific dementia training has been provided to staff.
  • Better utilize the existing excess capacity in the continuing care sector to increase capacity with respect to end-of-life (EOL) care.
  • Adoption of new palliative care models including, where necessary, providing funding to improve the integration between long-term and end-of-life care.

Dementia and use of technology

  • Advancement of a National Dementia Strategy / Declaration with federal participation.
  • Use of technology and the existing residential care infrastructure to facilitate seniors ageing in place and/or reducing social isolation of seniors.
  • Adoption of new electronic information systems, including electronic health records and telehealth that facilitate the sharing of resident information across the continuing care system.
  • Adoption of new technologies that improve the safety of seniors particularly through new monitoring and surveillance systems.

Seniors Safety and Health Promotion

  • Advancement of a collaborative Provincial Seniors Safety Strategy focusing on specific issues including falls prevention, resident-on-resident aggression, reducing adverse drug events, suicide prevention, elder abuse and/or safety within home and community care.
  • A joint federal-provincial fund to improve the safety of residents and health care workers including funding to install ceiling lifts and other retrofits to residential care homes across Canada.
  • Development of a National Seniors Health Promotion Strategy to promote seniors physical and mental well-being, including for the frail elderly.

END NOTES

[i] BCCPA. Op-ed: Quality, Innovation, Collaboration – Strengthening Seniors Care Delivery in BC. October 2015. Accessed at: http://bccare.ca/op-ed-quality-innovation-collaboration-strengthening-seniors-care-delivery-in-bc/

[ii] BCCPA. Sustainability and Innovation White Papers. May 2016. Accessed at: http://bccare.ca/whitepapers2016/

[iii] BCCPA. Quality-Innovation-Collaboration: Strengthening Seniors Care Delivery in BC. September 2016. Accessed at: http://bccare.ca/wp-content/uploads/BCCPA-White-Paper-QuIC-FINAL-2015.pdf

[iv] Office of the Seniors Advocate. British Columbia Residential Care Facilities: Quick Facts Directory. January 2016. http://www.seniorsadvocatebc.ca/osa-reports/british-columbia-residential-care-facilities-quick-facts-directory/

[v] Vancouver Sun. BC Health Minister Orders Review of Staffing Guidelines in Long-Term Care Homes for Seniors. April 7, 2016. Lori Culbert and Rob Shaw. Accessed at: http://vancouversun.com/news/local-news/b-c-health-minister-orders-review-of-staffing-guidelines-in-long-term-care-homes-for-seniors