A recent landmark investigation by BC’s Ombudsperson highlighted the serious problems seniors experience in accessing affordable high-quality home and community-based services (such as residential care, home nursing and home support). At the same time, BC continues to grapple with overcrowded hospitals and long waitlists for emergency care and surgeries.
Taken together, these challenges can seem overwhelming, prompting dire warnings about the “financial sustainability” of Medicare and fears that aging baby boomers are about to overwhelm the health care system, leaving few resources for younger British Columbians.
But a more comprehensive and better-coordinated system of seniors care can help us move beyond this impasse. It can help seniors stay healthy and independent in their own homes and communities. It can reduce strain on family caregivers, many of who are already balancing full-time work and parenting. And it can reduce pressure on hospitals, the most expensive part of our health care system.
However, a decade of underfunding and restructuring has led to a home and community care system that is fragmented, confusing to navigate, and unable to meet seniors’ needs.
A research report I published this week finds, for example, that access to home support for seniors 75 and older dropped by 30% since 2001/02. Access to residential care dropped by 21%.
In both residential care and home support, eligibility criteria have become increasingly restrictive, to the point that seniors often have to wait until they are in crisis and admitted to hospital before they can access the community services they require. And even then, it can be very difficult.
The impact of these changes can be seen in the increasing number of patients who can’t be discharged from hospital because the appropriate residential or home health services are not available. These patients are called “Alternate Level of Care” or ALC patients. Over the five years since 2005/06, the number of ALC patients in BC hospitals increased by 35.5%.
For elderly patients, being stuck in hospital can lead to a decline in their mobility and their ability to live independently. It also contributes to overcrowded hospitals.
Research shows that hospital occupancy rates of 85 per cent or lower are optimal. When hospitals operate above optimal capacity, it is harder to isolate patients with antibiotic resistant viruses, respond to emergency admissions without having to delay elective surgeries, or control wait times in emergency departments. Overall hospital occupancy rates in BC are about 97%, and many hospitals are struggling to function at well over 100% capacity 105% [corrected 10/Sept/2012].
The most cost-effective way to address these problems is to create a more accessible and integrated home and community care system, one that focuses on early intervention and supporting seniors to live well and die with dignity.
This shift requires, at least initially, increased funding to improve access to key services. It also requires changes in how health care is organized. For example, seniors with complex needs frequently have multiple health providers (a family doctor, one or more specialists, a home nurse, etc.) who often don’t even communicate with one another, let alone work as a team. Many of the basic home support services they need, such as assistance with transportation and meal preparation are not publicly provided.
These challenges can be resolved when services are reconfigured around a senior’s needs, delivered by an interdisciplinary team of health professionals and front-line workers, and available 24/7.
A more accessible and integrated system also will save money down the road by reducing the need for expensive emergency room visits and hospital stays. The cost of treating a senior in hospital ranges from $825 to $1,968 per day, whereas the cost of residential case is approximately $200 per day.
The provincial government’s stated goal is to support seniors as they age to live well in their own homes and communities. What is missing is strong leadership to make this goal a reality. The province has not committed the resources and infrastructure needed to rebuild BC’s home and community care system or implement the Ombudsperson’s recent comprehensive recommendations. These commitments are needed if we are to resolve the challenges in seniors care and the problems of hospital overcrowding and wait lists.
Marcy Cohen is the author of Caring for BC’s Aging Population: Improving Health Care for All, published by the Canadian Centre for Policy Alternatives and BC Health Coalition, and available at policyalternatives.ca/hcc-for-seniors.