By Noel Somerville

As printed in the Edmonton Journal, June 6, 2007

In April of this year, Ms. Vivien Lai, a senior policy advisor with Alberta Health and Wellness made a presentation at a symposium in Japan. Entitled “Alberta’s Continuing Care System”, this presentation outlined with scary candor the changes Alberta has been making and plans to make in light of an anticipated increase in the percentage of our provinces’ population aged 65 or older (from 10% in 2006 to 21% in 2030).

The first victim is the long-term care facility (nursing homes) that the government sees as a needlessly expensive way of caring for seniors. A few years ago, nursing homes provided full nursing, medication, personal care, rehabilitation and physiotherapy to disabled adults and ‘frail seniors’ — those who require help getting out of bed, toileting, getting dressed, getting to and from the dining room, feeding, administering medication, etc — all covered under Medicare.

The first step in dismantling this system is called “unbundling” and separates the costs of health and housing services. The presentation states “Individuals are responsible for paying fully their room and board costs in long-term care facilities. Since 2003, accommodation charges in nursing homes have been increased to reflect the actual costs of room and board so that those who can afford it have to pay the full cost.”

The second step has been to limit the number of available long-term care beds. The presentation states that we will need an additional 14,000 long-term care beds to meet the expected increase in the senior’s population, (a doubling of the current number of beds), but the government policy is to not expand to meet the growing demand. In fact, several locations in Alberta have converted long-term care facilities to “assisted living” in which even the medical care, beyond the restricted amount that RHAs provide as Homecare, is a billed ‘extra’. Operators of long-term care facilities have actually been paid to downgrade these facilities, thereby dispensing with the need for a staff of trained nurses.

This is all part of a so-called “aging in place strategy” specifically designed to lower the demand for long-term care beds, which are considered too expensive in operating and capital cost. Supposedly, this strategy “enables individuals with high health needs to receive services at home.” These ‘aging in place’ strategies are largely private-for profit operations catering to clients with the financial resources to fully absorb the cost of their own accommodation and health care needs.

For those not able to afford such costs, the proposed alternative to long-term care facilities is called the CHOICE program. This is described as “a community based day program aimed at reducing the use of long-term care beds and acute care hospital beds. The program is a day program, providing physician, nursing therapy and medication management services. Transportation buses usually pick up clients from their homes to go to the programs which are located in long-term care facilities.”

If any of this sounds familiar, perhaps you are remembering what Premier Klein called the ‘Third Way’, the key elements of which were:

Sell off, demolish, or downgrade existing public health care facilities.

De-list or ration some of the services previously covered under the national health care plan.

Privatize the delivery of such discontinued services and the construction of new facilities.

Open the market for private insurance companies to underwrite the costs of services no longer covered under Medicare.

While Alberta has abandoned the Third Way for delivery of health care, all of these same elements are now appearing in continuing care for seniors. Long-term care facilities are being converted to assisted living. The medical and personal care that a frail senior requires has largely become a de-listed service under Medicare, even though proper feeding, personal hygiene and administration of medication are medically necessary for frail seniors to sustain life. Most of the new seniors facilities are built and operated privately so that the operator recovers both operating and capital costs from the end user.

Finally, numerous insurers offer long-term care insurance. As the presentation states, “Alberta has hired a consulting firm to develop different scenarios for funding of health care services. This includes insurance programs for long-term care, drugs and non-urgent acute care cases.”

The presentation on “Alberta’s Continuing Care System” may not be of much concern to baby boomers who are healthy and wealthy. However, the prospects for those who experience a slow, steady decline in physical and mental capabilities are terrifying. Nor is the future very bright for the children of those baby boomers who will look after them and who will be required to pay more and more for the care of their loved ones once the expected inheritance has been spent. (It costs around $5000/month for most families in the US who have a parent in a seniors care facility.)

The fact that you paid health care premiums and taxes all of your working lives so that you would be taken care of in your declining years doesn’t seem to square with government policy. They think you will be satisfied with unaffordable insurance for unavailable or unsatisfactory services.

Noel Somerville is Chair of the Seniors’ Task Force for Public Interest Alberta