On Tuesday the Office of the Seniors Advocate (OSA) released its annual Monitoring Seniors Services (MSS) and Long Term Care Quick Facts Directory (QFD) reports in a combined announcement. The sixth edition of the annual MSS report highlights where seniors’ needs are being met and where improvements are most needed in areas such as access to health care, housing, transportation, income supports and elder abuse. The QFD, also in its sixth edition, highlights information including statistics on the resident population living in long-term care, raw food costs, as well as per diem and direct care hours for publicly subsidized care homes.
These annual reports present key findings specific to the continuing care sector, and provide a useful snapshot of the state of seniors care in B.C. What are the trends in this year’s reports that are most noteworthy for the province’s decision-makers? While there are several highlights — which we list below — it is the access to care and growing waitlists (a 27% increase) that the general public might be most concerned about.
Other key takeaways from the reports…
- 85% of long-term care residents and just 69% of staff were vaccinated for influenza, a decrease of 2% for residents and a decrease of 5% for staff — a detail that is more noteworthy as we are on the cusp of a wide-scale COVID vaccination program;
- The population 65 and over increased 4% in the last year — a trend that will continue as the “baby boom” generation enters their retirement years — and the majority of B.C. seniors (94%) continue to live independently in their own home (3% of seniors live in long- term care and 3% live in seniors independent/assisted living);
- There was a 67% increase in the number of long-term care homes funded for 3.36 hours of care, the most significant annual increase to date;
- There have been reductions in injury falls in long-term care, but more limited progress in reducing the use of anti-psychotics — particularly in government owned and operated vs. contracted sites.
Overview: Long Term Care Quick Facts Directory
As noted in the Quick Facts Directory (QFD) Summary Report, along with increases to per diems and raw food costs, the number of care homes meeting the 3.36 direct care hour (DCH) guideline increased from 30% in 2018/19 to 50% in 2019/20. While 100% of health authority owned care homes met the guideline, however, less than a quarter (22%) of contracted care homes were funded to deliver 2.26 DCHs in 2019/20. This highlights the importance of additional government funding to support the health human resource (HHR) needs of contracted care homes. This is even more critical as all care homes deal with the challenges related to COVID-19.
Likewise, in the recent report on the pandemic commissioned by BC Care Providers Association (BCCPA), ensuring that vaccination rates for influenza and reducing the number of multi-bed rooms will be crucial to preventing the spread of COVID-19. In the QFD, 76% of residents reside in single-occupancy rooms, although the levels are much higher in contracted homes (57%) than contracted care homes (85%).
According to the Directory, additional areas that warrant improvement include access to vital therapies including occupational, physical and recreational therapies and reducing the use of anti-psychotics (see BCCPA’s report on this issue, here). These are all areas our association has also advocated for in order to improve quality of life for seniors.[i][ii]
Overview: Monitoring Seniors Services Report
Like the Quick Facts Directory (QFD), the OSA’s Monitoring Seniors Services (MSS) report provides very useful data. With regards to seniors’ care, there are encouraging signs when it comes to improving access to areas such as adult day programs (ADPs). According to the MSS report, in 2019/20 there were 7,690 clients accessing ADPs across the province, an increase of almost 12% over the previous year, while program days also increased over this time by 14%. Though we should be encouraged by these increases, it should be acknowledged that COVID-19 pandemic has resulted in lower access to these services.
Other positive developments noted in the MSS report include fewer home care complaints[iii] and an overall increase in number of care aides and community health workers (about 8%).
However, there are a number of concerns highlighted in the latest MSS report, such as a rise in elder abuse, as indicated by increased calls to hotlines and reported cases to designated agencies and other authorities. This has led to the OSA recommending the establishment of a better system of tracking abuse. A report on the topic is expected from the office in early 2021.
Concerns over access to care
Some of the statistics in the MSS report indicate decreased levels of access across the continuing care sector including in long-term care, assisted living and home health services. These include:
- Alternate Level of Care (ALC) days (a term which refers to the days which someone who is not acutely ill occupies a hospital bed) increased 12% in 2019/10 as the average length of stay in ALC increased across all health authorities in 2019/20;
- The average hours of care delivered per home support client increased less than 1% to 255 hours per client per year;
- There was a 3% decrease in the number of subsidized registered assisted living units (4372 to 4262) and a 6% decrease in the number of clients living in those units (5494 to 5192) as the waitlist for subsidized assisted living increased 6% in the last year (870 to 920);
- The number of long-term care beds have remained relatively unchanged increasing only 3% from 2016 to 2020 (26,743 to 27,505) while the population aged 85 or older grew 13%;
- The standard of admission to long-term care within 30 days decreased to 55% of admissions in 2019/20 compared to 66% in 2018/19; and
- There was a 27% increase in the waitlist in long-term care in 2019/20 (1780 to 2259).[iv]
As outlined in the OSA media release, the long-term care bed rate per 1,000 of population age 85 plus has decreased 9% in the last five years, and a variety of measures show increased wait times for care in the past year including those on wait list (27% increase), and increases to the average wait time (3% increase to 133 days), while the average wait time of 52 days for clients admitted to long-term care increased by 37% and the number admitted within 30 days decreased by 11%.[v]
These areas have been discussed at length in a BCCPA report released in 2019 titled Bedlam in BC’s Continuing Care Sector.[vi] In that report, BCCPA highlights the need for new long-term care beds in addition to discussing the ALC issue,[vii] and advocating for wait list targets[viii]. Using data from the Conference Board of Canada the report demonstrates that that over 30,000 new long-term care beds will be required across the province over the next twenty years to meet the needs of a rapidly aging population. When the Bedlam report was released the number of seniors waiting for admission for long-term care was less than 1400 (1,379) while is now at 2259 – an increase of more than 50% since the latest OSA MSS report.
While part of the solution to addressing growing waitlists is to build new long-term care beds, it will also require looking at alternative approaches, such as new care models that includes improving and expanding other supports such as home care and assisted living. BCCPA has recommended that the B.C. government invests up to $50 million per year over the next four years to support the introduction of new models or approaches of care — such as the Continuing Care Hub — to improve access to seniors care. Assisted living and home health care services can also mitigate and/or reduce future demand for long-term care. BCCPA has also recommended that a tax credit be established to support seniors who choose independent living or privately retained home health services, in order to age in place.
The findings of these OSA reports should be a signal to all sector stakeholders that more work is needed to improve access to the appropriate services, to address HHR challenges (including increasing direct care hours), to reduce the use of anti-psychotics and give access to vital therapies. Furthermore, every effort possible should be made to reduce elder abuse.
END NOTES
[i] BCCPA. Quality of Life Framework. 2019. Accessed at: https://bccare.ca/qualityoflife/
[ii] BCCPA. A Pathway to Ensuring Appropriate use of antipsychotics in Continuing Care. 2018. Accessed at: https://bccare.ca/wp-content/uploads/2018/04/BCCPA-Antipsychotics-Guide-2018.pdf
[iii] As outlined in the OSA MSS report, there was a 15% decrease in the number of home care complaints in 2019/20, where in past years the number of complaints had been steadily increasing since 2015/16.
[iv] BC Office of the Seniors Advocate. Monitoring Seniors Services (2020). Accessed at: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2020/12/MonitoringReport2020.pdf
[v] BC OSA. From Health Care to Housing, BC Seniors Advocate Issues Snapshot on the Wellbeing of BC Seniors. News release. December 8, 2020. Accessed at: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2020/12/MonitoringReport-QuickFacts2020-NR.pdf
[vi] BCCPA. Bedlam in BC’s Continuing Care Sector. 2019. Accessed at: https://bccare.ca/wp-content/uploads/2019/05/Bedlam_in_BC_Continuing_Care_Sector.pdf
[vii] In the Bedlam report BCCPA recommends the BC Ministry of Health establish a target in its Annual Service Plan to have no more than 5 percent of acute care beds occupied each day by seniors who have been assessed as capable of being transferred into a more appropriate long term or home care setting and that this target be met by the end of 2024.
[viii] In the Bedlam report, BCCPA recommends that the BC government reduce the number of people on long term care wait lists by establishing a target within its Ministry of Health Annual Service Plan to ensure at least 65 per cent of those waiting for a bed can access one within 30 days.
