By Terry Lake
As the CEO of the BC Care Providers Association and the former Minister of Health for British Columbia, I’ve seen firsthand the profound impact accurate data and complete research can have on policy decisions. This underscores my deep respect for the BC Seniors Advocate’s role, and the importance of the Advocate’s reporting.
Regretfully, I believe the “Billions of More Reasons to Care” report recently published by the Office of the Seniors Advocate has not met the standard worthy of the office.
Three and a half years past since the COVID-19 virus began to wreak havoc on the lives of vulnerable elderly British Columbians, their families, and the dedicated staff in nursing homes around the province. From this terrible experience we learned valuable lessons as a result of unprecedented cooperation, collegiality, and commitment on the part of the provincial government, health authorities and contracted operators of long-term care and assisted living. This was again reflected during the recent wildfires in BC and the resulting need to evacuate 900 residents from nursing homes in the Interior. Staff and administrators from all parts of the sector worked around the clock to ensure the safety of residents.
In the midst of what has been heralded as a nation leading response to the pandemic’s impact on nursing homes, the Office of the Seniors’ Advocate recently published a report, “Billions of More Reasons to Care”, which mischaracterises the operations of contracted providers of long term care in British Columbia. The report, a follow up to the 2020 “Billions of Reasons to Care”, continues to rely on inconsistent data and non standardized financial reporting to draw conclusions that serve to divide the sector rather than improve it.
Perhaps most frustrating is the absence of consultations with the seniors care sector. Even basic consultation with sector operators could have clarified many of the misconceptions that seem to underpin the report’s conclusions. As an example, the report states that there is no requirement to have registered nurse on site 24/7. This is inaccurate, and Health Authorities can claw back funds if this requirement not met. Operator insights would have provided a richer, more comprehensive perspective on the challenges and opportunities in the sector.
The report describes a BC funding model for contracted LTC services when, in fact, there is no one funding model. Each operator, whether a not for profit society or for profit company, contracts with one or more of five health authorities through a “Request for Proposal” process or historic contracts that are updated each year through a funding letter. Some of these operators are part of the Health Employers Association Master Collective Agreement, some have their own negotiated union contracts, while some are non-unionized environments. This means that the per diem paid to each operator varies, both within a health authority and across different health authorities. As the report notes, the reporting system also varies within and across health authorities, which makes an “apples to apples” comparison almost impossible and yet the Advocate ignores this fact.
This latest report continues that fundamentally flawed approach and exacerbates the problem by examining a year (2021-22) in the middle of a pandemic when operations were far from normal and that had not been financially reconciled at the time of gathering information used in the report. Issues such as the single site order, wage leveling, extreme overtime costs, nursing agency costs, infection prevention and control costs, and other factors meant that the true performance of the system could not be evaluated until both significantly increased investments by the Ministry of Health could be reconciled with these increased costs – a process that has taken over a year to accomplish.
As this process for 2021-22 is drawing to a close we know that operators who received more funding than they needed have been instructed to apply these funds to the extraordinary costs for the 2022-23 fiscal year when these same factors were in play – essentially giving back the money. This was not captured in the report and the OSA refuses to acknowledge this fact. Operators used their resources to ensure the delivery of quality of care and worked cooperatively with government to balance the books long after these expenditures occurred. This has been challenging for some, particularly not for profit societies, while a perhaps easier for companies that have some reserve capacity.
The OSA report does acknowledge that given the lack of a consistent and reliable financial reporting tool it is important to finalize the work currently underway to develop a tool that captures all operators; health authority homes, not for profit homes, and for profit homes, in a fair, transparent, and consistent manner. Once this is accomplished we can then make progress on a real funding formula that guarantees the principles of equity, fairness, transparency, quality and sustainability to ensure vulnerable elders in our province receive the care they deserve and that tax payers can be assured of value for money. Long term care operators look forward to the hard work to make this happen to support the continuing delivery of high-quality care to our residents.
