The BC Continuing
Care (CC) Story
Canadian Health Coalition Conference on Continuing Care
Marcy Cohen, BC Office of the Canadian Centre for Policy
Alternatives
The Larger Context -- Why the
focus on CC NOW?
The number one recommendation from the Canadian Medical
Association to federal government: a pan Canadian strategy for
seniors care.
WHY?
Reduced acute care in-hospital beds over the last 25
years
Today we have very high hospital occupancy rates
compared to other OECD countries – in BC 105%
occupancy compared to 76% OECD average.
Waits list for hospitals services can not be solved if the
shortfall in CC system not addressed
Progress in Implementing a Comprehensive
Public System of CC Stalled for 20+ years
• NOT new: Seen as the 2nd stage of Medicare by Tommy
Douglas, supported by BC’s Royal Commission in 1991
and by many research studies
• Continuing Care NOT covered under the five principles of
the CHA
• Without legislated protection, it is very easy to for gov’t
officials redefine eligibility and restrict access in response
to a budget shortfall.
• Until very recently Continuing Care has not been
recognized as a key component of primary health care
reform (as it was in the Romanow Report)
Resident Care (RC)
 In early 1970’s most “nursing homes” for-profit and union organizing
efforts highlighted the issue of poor “working and caring” conditions in
these facilities.
 In late 1970’s the BC gov’t initiated provincial continuing care program,
with one stop access, increased non-profit RC delivery and gradual
improvements to pay and working conditions.
 Building new RC slowed stopped in the mid 1990’s…since 2001, a 20%
reduction in access to RC for seniors 75+ and increased for-profit
provision.
 Seniors in RC frailer, much more likely to suffer from dementia and to
die in RC. BUT
 Staffing levels and training not kept pace with higher needs of residents
 Few RC facilities have team based primary care
 More people now dying in RC, but palliative care program not available
Assisted Living (AL) and
Supportive Housing (SH)
AL -- new level of care introduced in early 2000’s as a
substitute for RC using $$ earmarked for housing. About 2/3
of AL are publicly subsidized (you pay no more than 70% of
your income) and the remainder are entirely private pay.
Now serving higher needs seniors but staffing and standards
inadequate
Missing in BC is an affordable supportive housing option –
particularly important for low income senior women living
alone
Home Support (HS)
 Greatest access before the cuts in federal transfer payments in the
mid 1990’s – since 2001, 30% reduction in access for seniors 75+
 Shorter hospital stays, fewer residential care beds and new policies
like the palliative home care program and “home first” dramatically
increasing demand…but funding not kept pace.
The result: Increased focus on nursing tasks, less support for seniors
with limited needs, seniors who only need help with domestic tasks
now not eligible for services from the HA, less social support, less
continuity and less ability to monitor and report changes in clients
health…to be the “eyes and ears” of the health system
In BC the number of private agencies providing home support services
has doubled since in the last 10 years…from 39 to 84.
Home Nursing and Rehab
Not the same dramatic reductions as in home support and
residential care – actually an increase in rehab services
But because nursing clients are also more complex, less time
available for nurses to support and work with Community
Health Workers/Home Support Workers
Also an increased demand for case management as people in
community become more complex and need more coordinated care
Other Continuing Care
Priorities
More support needed for the informal and formal care givers
who are the backbone of our system of CC
Many seniors, particularly women, caring for loved one
without adequate support and recognition from the health
system – respite care at home, in RC, or in an adult day care
centre
The care aides and community health workers who are the
front line workers in RC and HS also need additional support
and recognition – many work as casuals, have inadequate
training and job security and work for very low pay,
particularly in the for-profit sector…results in high turnover
and poor continuity of care
Wishful Thinking in the
Current Policy Environment
In the current context of fiscal restraint and the perceived
unwillingness of the public to pay more taxes there is a lot of
wishful thinking going on when it comes to the role CC
1. Fallacy to think you can cut hospital services to pay for an
expansion of CC.
2. Fallacy to think you no longer a need to spend money on
residential care.
3. Fallacy to think “domestic” services can be hived off and
provided by a separate non-health agency with no link back
to the health system.
4. Problematic to pit the generations against each other in
terms of whether services to children are more or less
important than services to seniors.
Continuing Care Principles
1. CC must be understood as a key component of a
comprehensive publicly funded system of primary health
care
2. Seniors, people with disabilities and communities must have
a voice in care decisions at the individual and health system
level
3. Seniors and people with disabilities must have the services
and supports required to live and die with dignity
4. The CC system must be designed to support seniors and
people with disabilities to be as independent and socially
connected as possible
5. Informal and formal care givers, who are play a key role in
CC, must be appropriately resourced, recognized and
compensated.
Despite all the wonders of modern medical technology, seniors share with
all of us the raw and basic need for dignity and human connection. What I
now understand is that this has to be the primary focus of how society
looks after our elders and how we think about health care for seniors