This op-ed was originally published in the Edmonton Journal
The many Albertans alarmed at the long and steady decline in the quality of seniors care may finally have cause for hope.The new NDP government has already made a good start by putting one minister, Sarah Hoffman, in charge of both the health and seniors departments. For too long, we have put the medical needs of seniors in a different category from the medical needs of the rest of the population, with dramatically negative results.
There is also good reason for encouragement in the NDP platform commitment to build 2,000 public long-term beds over four years. The Wildrose opposition’s call to invest $50 million per year in home care and annually increase home care funding thereafter to keep up with enrolment is also helpful in terms of finding common ground.
While these are welcome first steps, they do not address many of the reasons why Alberta’s continuing care system has been consistently failing to provide high-quality home care, drug coverage and facility care for seniors suffering from cognitive impairment, chronic conditions, or the inevitable frailty of old age.This failure has three principal causes: chronic underfunding, the lack of control mechanisms to ensure that seniors are receiving high quality care, and overreliance on delivery of care by private, for-profit corporations.
The magnitude of this underfunding was highlighted in a Canadian Institute for Health Information study pointing out that in 2014, the $506 per capita spending of public dollars on seniors care in Alberta is a full 19 per cent below the Canadian average of $625.This underfunding is a clear result of misguided government decisions such as the 2008 Continuing Care Strategy that, in an effort to save money, froze the number of nursing home beds at a totally inadequate 14,500. With the population of Alberta’s seniors approaching half a million, we probably require about 20,000 long-term care beds.
Ineffective Control Mechanisms
The former government pointed with pride to what it called its Care and Accommodation Standards. In reality, these standards are largely meaningless because they do not address the minimum ratio of staff to patients or the minimum number and qualifications of staff required for any particular mix of patients and needs.Effective regulations require an accurate and up-to-date assessment of the needs of all patients. Those assessments must then be used to determine both the number and qualifications of staff needed to meet those needs. Such regulations are required not just for home care, but for all care facilities.Notifying facilities in advance of inspections renders them virtually meaningless. Ensuring compliance must involve unannounced inspections.
Privatization of Delivery
The former government used privatization of delivery of both home care and facility care as a way of abdicating its responsibilities, reducing its costs and rewarding its corporate friends. The primary and fiduciary responsibility of corporations is to ensure return on investment — not quality care. Yes, there are privately owned care facilities that do provide high-quality care, but only for those wealthy enough to afford the costs.Our new government must stop subsidizing private, for-profit delivery and must operate on the principle that care for seniors should be publicly delivered in the same way that hospital care for other Albertans is delivered.
The art of the possible
Given the province’s challenging financial situation, it is clearly going to take time to address all of these major shortcomings. But address them we must.There are a number of ways that improvement can be implemented in the short term at minimal cost. These include:- Reopening some of the many long-term care centres that were closed to provide enough clients for new facilities while complying with the arbitrary limits of the Continuing Care Strategy,- Requiring patient/family councils in all care facilities, and- Giving the Seniors Advocate more power my making the position an officer of the legislature.But above all, we need a fundamental shift away from the previous path of underfunding, deregulation and privatization — and we need our government to begin to do so now.
Noel Somerville chairs the Seniors’ Task Force of Public Interest Alberta.