Op-ed: Seniors safety in continuing care & the need for a holistic approach
By Lara Croll
The issue of seniors’ safety in continuing care has gained significant media attention across Canada over the past few years, in part due to high profile events such as fires at seniors’ care residences, and incidents of elder abuse. Yet issues pertaining to seniors’ safety are not just restricted to unusual and extreme events, but also include challenges such as the risk of falls, as well as adverse drug events (ADEs) caused by the use of multiple medications. While these everyday risks may not be highlighted regularly by the news media, they do adversely affect the health of seniors and impose significant costs to the health system. For these reasons, improving seniors’ safety must be seen as a critical opportunity to ensure that our aging population remains healthy for as long as possible.
Falls, for example, are overwhelmingly the most common cause of injury among BC’s seniors, as each year one in three seniors in BC experiences at least one fall. Moreover, injuries from falls account for 85 percent of all injuries to seniors, costing the provincial government over $155 million annually in health care expenses.[i] Frail seniors, particularly those in residential care, are at increased risk for falls, with the Office of the Seniors Advocate reporting that in 2015/16 there were over 3,000 reported incidents of a resident falling and being injured or experiencing another adverse event.[ii]
Along with being the focus on a recent editorial by the BC Care Providers Association (BCCPA),[iii] the issue of resident-on-resident aggression in long term care has also been highlighted by the BC Office of the Seniors Advocate.[iv] While fortunately such incidents are rare in the larger context, the OSA estimates that in 2015 there were anywhere between 425 and 550 reported incidents of resident-on-resident aggression that resulted in some level of harm to another resident.[v] Along with physical harm, these incidents cause emotional and psychological distress for the victim and other residents of the care home. The causes of such incidents are diverse and include factors such as the resident’s own personal history, physiological factors, situational triggers, physical environments, and biomedical factors. Due to the wide range of factors that contribute to these acts of aggression, any solutions to this area must also be holistic.
A more prevalent, though less visible safety risk for older adults is the inappropriate use of multiple medications, known as polypharmacy. Polypharmacy is an issue that affects many older adults in Canada and can increase the risk of drug interactions and side effects, including ADEs such as falls, hospitalization and even death.[vi] Older adults living in residential care homes are at high risk for polypharmacy, since they are often frail and suffer from multiple illnesses. According to the Ministry of Health residents in long term care in BC are prescribed an average of 9 medications, ranging between 1 to 42.[vii] While deprescribing and polypharmacy related initiatives in British Columbia have made some progress towards addressing this issue, according to a 2015 report by the Office of the Seniors Advocate, fifty-one percent of residents in BC care homes are taking nine or more different medications.[viii]
The BC Government has acknowledged some of the challenges related to seniors’ safety recently, with the development of a $10 Million BC Seniors Quality and Safety Program for the long-term care sector.[ix] This program, announced in March 2017, will provide residential care homes in BC with funds to invest in seniors’ safety and mobility equipment, such as resident lifts and wheelchairs. This initiative is significant, as it should reduce falls for frail seniors, as well as resident handling injuries for continuing care workers.[x] The fund is being managed by the BCCPA and overseen by an Advisory Committee, who will determine appropriate guidelines for the allocation of these investments over the coming months.
While the BC Seniors Quality and Safety Program is a significant step in the right direction, it is still limited to residential care and is narrowly focused on investments in equipment. As a result, it will likely not address other risks to seniors’ safety, such as preventing falls, as well as reducing levels of ADEs and resident-on-resident aggression. In order to address these issues further, the BCCPA has recommended that the BC government create a Provincial Seniors Safety Strategy (PSSS). As outlined in the 2017 BCCPA report entitled Strengthening Seniors Care: A Made-in-BC Roadmap, this strategy would take a comprehensive approach to seniors’ safety in the home and community care sector, addressing issues such as the use of technology, falls prevention, resident-on-resident aggression, reducing ADEs and elder abuse, to name a few.[xi] The BCCPA has also recommended that any such strategy be undertaken collaboratively, including not only the BC Ministry of Health and the Health Authorities, but also care providers, universities, research institutes, NGOs, and other stakeholders.
The development of a PSSS should take a holistic and multiple-pronged approach to improving the safety of seniors in the continuing care sector. While working with the Advisory Committee from the BC Seniors Quality and Safety Program on issues pertaining to equipment, the development of a PSSS could also examine other strategies, including building retrofits and redesigns to prevent falls; safe deprescribing initiatives to reduce polypharmacy and ADEs; as well as expanding access to life-enhancing therapies to prevent aggressive and responsive behaviours. Likewise, along with looking at ways to reduce elder abuse, the PSSS could look at technological solutions, such as monitoring and alarm systems as well as improving reporting systems so that safety incidents can be properly tracked and the root cause addressed.
With the aging population, it is imperative that the we work collaboratively to prevent serious injuries from occurring in the first place. Though the creation of the BC Seniors Quality and Safety Program is a significant step towards this goal, it should be part of a larger initiative, particularly a Provincial Seniors Safety Strategy (PSSS) to address the spectrum of seniors’ safety issues through a diversity of approaches. In this respect, the BCCPA will continue to seek innovative ways to address safety issues and risks faced by seniors in the continuing care sector.
Lara Croll is BCCPA’s Policy Analyst
[i] BCCPA. Exploring Options for Improving BC’s Continuing Care Sector: White Paper on New Care Models and Innovation. May 2016. Accessed at: http://bccare.ca/wp-content/uploads/BCCPA_part_2_HR-1.pdf
[ii] Office of the Seniors Advocate. Monitoring Seniors Services. 2016. Accessed at: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2016/12/OSA-MonitoringReport2016.pdf
[iii] BCCPA. Op-ed: Reducing Resident on Resident Aggression in British Columbia. January 2016. Accessed at: http://bccare.ca/2016/01/op-ed-reducing-resident-on-resident-aggression-in-british-columbia/
[iv] Office of the Seniors Advocate. Resident to Resident Aggression in B.C. Care Homes. June 2016. Accessed at: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2016/06/SA-ResidentToResidentAggressionReview-2016.pdf
[v] The OSA reports a range because of methodological challenges, which include the fact that incidents of resident-on-resident aggression are reported under two overlapping systems, and the fact that such incidents may be underreported.
[vi] Keith J. White, MD, Chris Rauscher, MD. Tackling polypharmacy in BC—The Shared Care approach. BCMJ, Vol. 56, No. 10, December 2014, page(s) 516-517 — Shared Care.
[vii] BCCPA. BCCPA Backgrounder: Reducing Polypharmacy in BC’s Continuing Care Sector. December 2016. Accessed at: http://bccare.ca/wp-content/uploads/2016/12/BCCPA-Backgrounder-on-PolyRx-December-2016.pdf
[viii] BC Office of the Seniors Advocate. Placement, Drugs and Therapy… We Can Do Better. April 2015. Accessed at: http://www.seniorsadvocatebc.ca/wp-content/uploads/sites/4/2015/09/PlacementReport.pdf
[ix] Ministry of Health. Significant funding boost to strengthen care for B.C. seniors. March 9, 2017. Accessed at: https://news.gov.bc.ca/releases/2017HLTH0052-000529
[x] Resident handling injuries are the most common cause of workplace injury among frontline staff and a significant driving factor behind shortages of frontline workers.
[xi] BCCPA. Strengthening Seniors Care: A Made-in-BC Roadmap. January 2017. Accessed at: http://bccare.ca/wp-content/uploads/2017/01/BCCPA_Roadmap_Full_Jan2017.pdf