By Michael Kary
By now, those of us who are familiar with seniors care have heard loud and clear that Canada’s population is rapidly aging. Some have referred to it by the dramatic phrase “silver tsunami,” but we prefer to compare it to a “rising tide” – which is much easier to prepare for than the shock of a tidal wave.
Canada’s policy makers have been aware for decades about our aging population, and particularly the challenges it poses. The increased healthcare costs, for example, as well as higher levels of acuity and chronic conditions including dementia. These challenges are well-documented in recent reports from the National Institute on Aging[i] or BC Care Providers Association (BCCPA) paper Bedlam in BC’s Continuing Care Sector that highlighted issues related to access including increasing demand for long term care.[ii]
While it is important to be cognizant of this rising tide, the time has ended for endless studies of the issue, and begin implementing a new vision for the future of seniors care. This is the purpose of BCCPA’s latest report entitled When a Hub Becomes Home: Placing Seniors at the Heart of B.C.’s Communities, which outlines such a vision, in particular, the development of new Continuing Care Hubs.
The Continuing Care Hub concept was first discussed in the 2015 BCCPA paper entitled Quality-Innovation-Collaboration (QIC) which included several other recommendations to improve BC’s seniors care system.[iii] In that paper, for example, it discussed Care Hubs as a model where operators could provide an expanded level of services to seniors in the community either centrally located or perhaps as part of a virtual network with two or more care homes. That paper also identified at a high level some of the key elements of such hubs including integrating health professionals and family in seniors care; new roles for care providers; new funding models and an expanded role and co-location of services. In late 2016, as part of BCCPA’s first Collaborative event[iv] that included over 150 stakeholders from across the province, over 80% of participants identified Care Hubs as a moderate to high priority in both urban and rural areas.
The Care Hub concept was also discussed in subsequent papers such as Strengthening Seniors Care (2017)[v] and BCCPA Bedlam paper. [vi] In the latest report released today entitled When a Hub Becomes Home: Placing Seniors at the Heart of B.C.’s Communities, BCCPA provides an overview of what such Care Hubs could look like in more detail including different models and services that could be provided to seniors in care or the community. This report also highlights some of the key benefits in the creation of such Care Hubs such as:
- Improving access to care and services as well as allowing seniors to live in the most appropriate type of care setting;
- Potentially reducing future demand for long term care as well as addressing system pressures including higher levels of acuity, reducing unnecessary hospitalizations, emergency room visits and Alternative Level of Care (ALC) days[vii];
- Improving quality of life for BC seniors including those with dementia; and
- Better integrating seniors care (including long term care and assisted living) with the broader community.
Along with highlighting benefits, the latest BCCPA report outlines various models under the Care Hub concept including the:
- Integrated Home and Long Term Care Model where care homes or private companies could provide home health care services to seniors in the community;
- Enhanced Specialized Services Model where Care Hubs could provide more specialized services such as sub-acute care, and dialysis;
- Enhanced Community Health Services Model where Care Hubs could provide more basic or less specialized care services including primary or preventative care as well as mental health; and
- Enhanced Community non-medical services model which would focus on services or supports that are more non-medical in nature such as adult day programs, recreational therapy, social supports, worker housing, transportation, etc.
While all of these are discussed in the latest paper, particular attention is given to the Community non-medical services model as a way to better integrate seniors care with the community. This model was also the focus of a paper[viii] based on a successful forum event BCCPA held in Kelowna in September 2018 that included over 30 stakeholders across the province.[ix] Around the same time, BCCPA through an external consultant, the Howegroup, led stakeholder consultations across the province including with seniors to discuss further ways to improve seniors care and, in particular, better integrate such care with the community. As part of over 20 stakeholder interviews as well as focus groups with community stakeholders and seniors across the province, a separate complimentary paper was also produced outlining key areas discussed as part of any future care hub model and areas for further collaboration.[x]
As noted in the BCCPA paper there are various operational considerations that need to be considered further in the development of Care Hubs such as ensuring appropriate funding arrangements and contractual arrangements are in place; developing appropriate staffing or health human resource (HHR) plans; revising as necessary regulations or legislation; access to transportation and other services as well as accounting for municipal and rural considerations. For example, while a virtual network may be more feasible in urban areas where more care homes exist, a Care Hub where services and supports are co-located may be more appropriate in rural areas such as the Niverville example from Manitoba.[xi]
As also highlighted in the paper, it is important to note that one size does not fit all and the type of Care Hub will ultimately depend on the needs of the community. Likewise, the models as mentioned earlier are not distinct or stand-alone models as a Care Hub could provide services or supports under each of the models. In this light, the BCCPA paper also outlines a hypothetical care hub model that exists in the future to highlight how it could provide better seniors care that is integrated with the community.
In the paper, for example, it outlines a hypothetical virtual Continuing Care Hub group that has been established in Victoria, BC. This network or group, which consists of five care homes (non-profit and for-profit) not only provides long term care to about 600 residents but also home health care services to over 500 seniors living in the community. The network as a whole also provides a wide range of other services and supports to seniors both in long term care and living in the community, including:
- Sub-acute care services as well as dialysis, IV, wound and foot care;
- Primary care services including a medical clinic located at one of the care homes;
- A dementia care program that provides a comprehensive care plan to address the mental, physical and social needs of persons living with dementia;
- Respite and end-of-life beds;
- A Community Centre (including tavern and restaurant) that hosts various festivals, music and other events / activities;
- Rehabilitation and recovery centre;
- Worker and student housing;
- Various adult day programs;
- Intergenerational programs including a children’s day care on site;
- Culturally appropriate and faith based care; and
- Independent and Assisted Living
As part of the Victoria Continuing Care Hub Group (VCCHG), the care homes also share staff when required including not only health care aides but social workers as well as recreational and physical therapists. With an agreement with the local health authority the network is also allowed to meet an average hours per resident day target that allows greater flexibility for staffing. Along with appropriate contractual arrangements, the Care Hub group receives additional sources of funding to support their development through partnerships with businesses and community stakeholders as well as further private pay and/or revenues generated through various amenities, events, etc. Last, but not least, the VCCHG is also supported by a transportation network which includes a Handi-Dart bus.
Along with highlighting various services that could be provided in the Victoria area, the BCCPA paper also demonstrates how such a hypothetical Care Hub could provide person-centred care. In the paper, for example, it highlights a senior living in the community named Betty who is of Asian descent, 85 years old and along with having multiple chronic conditions was recently diagnosed with dementia. Along with providing regular daily home care visits to Betty, over the previous two years the network has provided her with sub-acute and primary care services, including preventative and mental health, as well as rehabilitation and respite care. Betty is also part a dementia program which addresses the mental, physical and social needs related to her condition.
Along with medical care, the Care Hub network also addresses Betty’s other needs particularly social ones through participation in various adult day programs and events including those that are more culturally focused and intergenerational in nature, which area held in the various care homes or the Community Centre. Betty is also able to participate regularly in such events or programs as part of the integrated transportation network. Likewise, the Care Hub allows Betty to continue to remain at home, as along with trialing stay at home technologies, she receives regular visits from a social worker and is assessed regularly to determine her care needs.
Overall, as highlighted in part from the hypothetical example, BCCPA believes that the Care Hub model has the potential to fundamentally change how seniors care is provided to those in long term care or in the community. In particular, along with providing a wide array of potential services that can improve quality of life and provide greater person-centred care, the Care Hub can better integrate seniors care with the community. Care Hubs also have the potential to help address some of the major HHR challenges we currently face including recruiting and retaining care providers. The Care Hub concept, for example, not only can provide greater flexibility with regards to staffing it also has the potential to become a viable recruitment mechanism for care providers looking for housing accommodation or an innovative and exciting model of care to work in.
As mentioned earlier, the Care Hub is not a one-size fits all approach but would be voluntary and a sector driven initiative that would evolve or grow over time. Ultimately, how the Care Hub is configured will depend on the needs of the community as well as ability of providers to deliver such services or supports. While obtaining government support, including funding, will assist with the development of such Care Hubs it will also be important to advance the Care Hub model forward by looking at alternative means to support their development such as partnerships with businesses and community stakeholders as well as further private pay and/or revenues generated through various amenities, events, etc.
Over the coming years, BCCPA will continue to advance the idea of the Care Hub as a viable approach and vision to improve seniors care going forward. In particular, the time for further study is ending as now is the time for action including implementing new approaches or models to strengthen seniors care while improving quality of life. BCCPA looks forward to continuing the dialogue on Care Hubs and the future seniors care at its 2020 Conference: A Vision for Seniors.[xii]
In lead up to that event, however, BCCPA will be engaging with stakeholders including seniors on ways we can work collaboratively to implement Care Hubs. In this regard on November 26, 2019 BCCPA CEO, Daniel Fontaine and Board President Aly Devji will be presenting at a Vancouver Board of Trade event discussing how businesses can potentially support this future vision including the implementation of Care Hubs across BC.[xiii] On November 28, 2019 BCCPA will also be participating in a panel discussion at the Vancouver Club on the future of seniors living, including the exploration of Continuing Care Hubs.[xiv]
To learn more about this subject, see BCCPA’s new Care Hubs resource page.
[i] BCCPA. NIA releases report on the Future Provision of Long-Term Care in Canada. September 12, 2019. Accessed at: https://bccare.ca/2019/09/nia-releases-report-on-the-future-provision-of-long-term-care-in-canada/
[ii] BCCPA. Bedlam in BC’s Continuing Care Sector: Projecting Future Long Term Care Bed Needs. May 2019. Accessed at: https://bccare.ca/wp-content/uploads/2019/05/Bedlam_in_BC_Continuing_Care_Sector.pdf
[iii] BCCPA. Quality-Innovation-Collaboration: Strengthening Seniors Care Delivery in BC. September 2015. Accessed at: https://bccare.ca/wp-content/uploads/BCCPA-White-Paper-QuIC-FINAL-2015.pdf
[iv] BC Continuing Care Collaborative (2016). Accessed at: https://bccare.ca/bcc3-2016/
[v] BCCPA. Strengthening Seniors Care: A Made-in BC Road Map. January 2017. Accessed at: https://bccare.ca/wp-content/uploads/2017/01/BCCPA_Roadmap_ExecSummary_Jan2017.pdf
[vi] BCCPA. Bedlam in BC’s Continuing Care Sector: Projecting Future Long Term Care Bed Needs. May 2019. Accessed at: https://bccare.ca/wp-content/uploads/2019/05/Bedlam_in_BC_Continuing_Care_Sector.pdf
[vii] BCCPA. Op-ed: Op-ed: Let’s Stop Seniors from Languishing in Hospitals. February 2016. Accessed at:
https://bccare.ca/2016/02/op-ed-lets-stop-seniors-languishing-hospitals/
[viii] Urban Matters. What We Heard Report: Communities of Care Workshop. September 2018. Accessed at: [include link]
[ix] BCCPA. Wrap Up Report: Communities of Care Kelowna Forum. September 19, 2018. Accessed at: https://bccare.ca/2018/09/wrap-up-report-communities-of-care-kelowna-forum/
[x] Howegroup. May 2019. Operationalizing the Community Non-Medical Services Model. Accessed at: [include link]
[xi] BCCPA. BCCPA Pays Visit to Manitoba Care Campus. May 19, 2016. Accessed at: https://bccare.ca/2016/05/bccpa-pays-visit-manitoba-care-campus/
[xii] BCCPA. 20/20 Vision: Announcing the BCCPA Annual Conference theme. October 21, 2019. Accessed at: https://bccare.ca/2019/10/20-20-vision-announcing-the-bccpa-annual-conference-theme/
[xiii] BCCPA. BCCPA CEO to speak at Greater Vancouver Board of Trade on baby boomers’ impact on businesses. September 26, 2019. Accessed at: https://bccare.ca/2019/09/bccpa-ceo-to-speak-at-greater-vancouver-board-of-trade-on-how-baby-boomers-are-impacting-businesses/
[xiv] BCCPA. Register for a panel discussion on the future of seniors’ living. November 6, 2019. Accessed at: https://bccare.ca/2019/11/register-for-a-panel-discussion-on-the-future-of-seniors-living/
