Op-ed – Defining Quality of Life for Seniors: A Never-Ending Journey of Continuous Improvement
By Michael Kary
One of the key areas that is often discussed in health care or health reform is how to improve quality of care. While improving quality is worthwhile as an overall goal, many in health are still not sure how to properly measure or define what is quality care. While an exact definition may be allusive, as outlined by Health Quality Ontario, health quality is best shaped by understanding the experiences and wisdom of patients, families, caregivers, and the public. It also acknowledges the multiple facets of quality exist – that care be accessible, effective, safe, patient-centered, efficient, adequately resourced, integrated, focused on population health and equitable.[i]
Even more difficult than defining quality care is attempting to define quality of life, as the latter involves many areas outside of the traditional medical or health system, including social determinants of health and socio-economic factors. The measurement or determination of quality of life could also include areas such as one’s overall happiness or even their levels of participation in various social activities or life enhancing therapies.
In the fall of 2016, the BC Care Providers Association (BCCPA) released its 2017 Provincial Budget submission where quality of care and quality of life for seniors were key areas of discussion.[ii] As outlined in that paper, today’s seniors face critical challenges such as having multiple chronic conditions, increasing levels of dementia and mental health concerns, high rates of falls, as well as escalating levels of social isolation and depression. These have very negative effects on quality of life and strategies to address these areas will be critical going forward.[iii]
The BCCPA budget submission recommended the provincial government establish a Seniors Quality of Life Fund (SQLF) to support quality of life for seniors in residential care and the community, which focuses on improving the physical, spiritual, psycho-social and mental well-being of seniors through various initiatives. Such initiatives included increasing access to life enhancing therapies such as recreational or occupational therapy as well as reducing seniors’ isolation through increased Adult Day and similar programs and enhancing the overall quality of food and nutrition in residential care homes.[iv]
The recommendations from this report were well received, as seen by a subsequent report released in November 2016 by the BC Select Standing Committee on Finance and Government Services Report on the Budget 2017 Consultations. In the Committee’s report, it specifically identified the submission by the BCCPA in several areas including to improve quality of life for seniors, both in the community and in residential care. For example, one of its first recommendations of its report was for government to increase supports available to improve quality of life for seniors in long-term care, such as dental care and programs that support mental, physical, spiritual and emotional well- being.[v]
The BCCPA released further details regarding its proposed SQLF in its January 2017 report, entitled Strengthening Seniors Care: A Made-in-BC Road Map. In this report, the area of quality of life was also one of the four key areas identified for specific investments along with health human resources, innovation and infrastructure. Like the BCCPA Budget submission, this report recommended that the BC government establish a new SQLF to support quality of life for seniors in residential care and in the community. Specifically, along with providing services to the community, the SQLF would provide up to $100 per month per senior living in a non-government operated residential care setting. Overall, this would total approximately $22 million per year[vi] and would include funding to enhance seniors quality of life in the following key areas:
- Increased access to recreational therapy as well as occupational and physiotherapy;
- Increased access to a broad array of music programs, such as Concerts in Care and Sing for Your Life, both in residential care and the broader community;
- Reducing seniors’ isolation through increased Adult Day and similar programs; and
- Maintaining and enhancing the overall quality of food and nutrition in residential care homes, including meeting therapeutic diet requirements and providing culturally appropriate meal options.[vii]
While the BCCPA believes that an $22 Million SQLF would benefit the overall lives of seniors living in residential care and the community, this is just the beginning. While the priority areas identified within the report for the SQLF are crucial, there are other areas outlined in the document that are equally as important in improving the quality of life and care for seniors. These areas include investments for increasing the length of home care visits to a minimum of 30 minutes, enhancing the level of direct care hours provided in residential care, and support for training and education to attract and retain care workers. It also includes investing in infrastructure, ensuring seniors safety, and the development of new care models, including for those living with dementia, to ensure the appropriate living environment for a rapidly aging population.
In an earlier BCCPA opinion piece published in the Vancouver Sun, Daniel Fontaine discusses the development of the BCCPA paper Strengthening Seniors Care as a journey that began early last year.[viii] While the paper may be complete, the journey to improving quality of care and quality of life for BC seniors has only just begun. Some might even say that the path to quality is a never ending one, and that quality is not a destination but rather a journey of continuous improvement.
The BCCPA’s journey to improve quality of life for seniors will continue through the work of our new Quality Improvement Committee (QIC),[ix] and at the BCCPA’s 40th Annual Conference in Whistler BC. As part of the Conference’s theme, Providing 40 Years of C.A.R.E: Collaboration, Achievement, Research and Excellence, on May 30th a plenary Care to Chat panel on quality and collaboration will be held where panelists will discuss ways to improve quality and highlight examples of promising initiatives that are occurring in BC’s continuing care sector as well as across Canada and internationally. Moderated by Ann Marie Leijen, the chair of the BCCPA’s new Quality Improvement Committee, the panelists include a number of forward thinkers on the issue of seniors quality of life, including Isobel Mackenzie (BC’s Seniors Advocate), Michael Marchbank (CEO Fraser Health Authority) and Gordon Daman, (President of the Red River Group). We hope you will join us in continuing this journey.
[i] Health Quality Ontario. Accessed at: http://www.hqontario.ca/What-is-Health-Quality/Quality-Is.
[ii] It’s about time. Improving Quality of Life for BC Seniors. October 2016. Accessed at: http://bccare.ca/wp-content/uploads/2016/10/BCCPA_2017_budget_submission.pdf. For the purposes of this paper, quality of life was defined as the mental, physical, psychosocial and spiritual well-being that allows seniors to enjoy normal life activities while remaining in the appropriate care setting and as measured by various indicators both clinical and non-clinical.
[iii] National Health Leadership Conference. The Great Canadian Healthcare Debate. Issue Briefs: Top 5 motions. Second Edition. June 2016. Accessed at: http://www.nhlc-cnls.ca/assets/2016%20Ottawa/E- Issues%20Brief%20Booklet.pdf
[iv] It’s about time. Improving Quality of Life for BC Seniors. October 2016. Accessed at: http://bccare.ca/wp-content/uploads/2016/10/BCCPA_2017_budget_submission.pdf
[v] BCCPA. BC Care Providers Association Responds to Provincial Budget Consultation Report. November 16, 2016. Accessed at: http://bccare.ca/2016/11/bc-care-providers-association-responds-to-provincial-budget-consultation-report/
[vi] According to the March 2016 Facilities report, in BC there were approximately 27,422 residential care beds in BC including 18,338 non-government and 9,084 government operated. To determine SQLF it equates to number of non-government operated care beds (18,338) x $100 x 12 months.
[vii] BCCPA. Strengthening Seniors Care: A Made-in-BC Road Map. January 2016. Accessed at: http://bccare.ca/wp-content/uploads/2017/01/BCCPA_Roadmap_Full_Jan2017.pdf
[viii] Vancouver Sun. Opinion: Care can be there for B.C. seniors. January 27, 2017. Accessed at: http://vancouversun.com/opinion/opinion-care-can-be-there-for-b-c-seniors
[ix] BCCPA. New BCCPA Committee Aims to Improve Quality of Life for BC Seniors. October 19, 2016. http://bccare.ca/2016/10/new-bccpa-committee-aims-improve-quality-life-bc-seniors/