SUMMARY

Public Interest Alberta's advocacy for seniors in Alberta centres around the following priorities:

  1. The provincial government must pass legislation establishing the Independent Office of the Seniors Advocate which would report directly to the legislature and the public, and be appropriately empowered and funded to promote the rights and well-being of Alberta seniors.

  2. The government must commit to building a system of comprehensive service delivery that ensures the well-being of seniors including health needs, housing, income/financial supports and social supports.

  3. The government must commit to provide and fully fund high-quality care that meets the physical, emotional, mental and social needs of seniors residing in congregate care facilities and ensure that care is provided by full-time, full-benefit workers who are employed in only one facility.

  4. Expand the funding, scope and accessibility of services that will permit seniors to continue to reside in their own homes or communities and experience optimal health at all stages of ageing.

  5. Lobby the federal government to establish a single-payer National Pharmacare Plan through and commit to Alberta’s full participation in the plan once established.

  6. Establish consistent data collection, tracking protocols, monitoring and reporting processes that apply to all services that receive any amount of government funding regardless of the ownership status of the facility or service provider.

INTRODUCTION

Every day that we wake up, we are a day older – all of us! The aging process happens differently for all of us - physically, intellectually, and socially. Some of us participate in the workforce long after others have retired from paid employment and there is substantial variation among seniors in the income we can access. Some of us have family close at hand while others have family that live elsewhere; still others have no immediate family or life partner to turn to for support and companionship later in life.

All Albertans should expect to experience a high quality of life at every age and stage of development and this applies to seniors as well. Seniors deserve a comprehensive system of services that respects their rights to independence, care, self-fulfilment, and dignity in accordance with the 1991 United Nations Principles for Older Persons. Services for Alberta seniors must be accessible to all individuals so as to allow them to live safely with dignity and comfort wherever they choose to live within the province.

We must all commit to advocacy to ensure our governments develop, implement and support services that respect the rights of seniors. Despite the abundance of research to support improvement in services, the care available to senior Albertans has continued to deteriorate as successive governments have failed to adequately invest in comprehensive policies to support high-quality, universally-accessible, and publicly-delivered seniors care and services. Cuts in provincial programs and services have resulted in downloading costs onto seniors and their families.

“The current continuing care/long term care system is rooted in ageism. It is a system developed with actual and stereotyped concepts of purpose, and has since been modified to more profitably market the presumed solutions.” (Dr. Jayna Holroyd-Leduc, Department Head of Medicine, University of Calgary, Feb. 18, 2022)

In the past four decades, governments have significantly increased the proportion of care provided by private, for-profit corporations. With this increase in contracting out, care has come with increased costs, deterioration of quality of care and erosion of oversight and accountability. For decades, we have witnessed this deterioration of services. COVID 19 has savagely victimized Canada’s seniors, including those residing in Alberta. Despite the comparative wealth of this country and this province, the loss of seniors to COVID 19 has been the worst of all of the OECD countries. It is time for a serious change of attitudes and approaches and the ageism that underpins both.

Quite simply, Alberta seniors deserve so much better!

 

As advocated by the International Longevity Centre Canada, one way to combat ageism is to endorse the UN Principles for Older Persons. A convention and its laws will:

  • offer protection to older persons
  • combat ageism
  • guide all levels of government policy making
  • improve accountability
  • empower seniors

As with other UN conventions for specific groups within society, a commitment to the UN Principles for Older Persons would provide public awareness and legally binding protection of the rights of older persons under international law (Margaret Gillis & Dr. Kiran Rabheru, ILC, June 2022).

Our governments, at neither the federal nor the provincial level, would automatically be legally bound to honour the rights specified in such a UN Convention. However, Public Interest Alberta and its members believe that each and every right specified should be respected and codified in a Bill of Rights for Alberta Seniors. The Alberta government should financially support seniors’ organizations and advocates to develop a Bill of Rights for Alberta Seniors that would provide foundational principles upon which to build a comprehensive system of services for seniors.

This document, our priorities for change, is designed to provide a specific and comprehensive basis for advocacy for and by seniors, their families, seniors’ advocates and senior-serving organizations to meet with candidates from all parties, in every constituency across the province. 

Issues and Directions

1. Independent Office of a Seniors Advocate

A position of Seniors Advocate was established through a Ministerial Order by Alberta’s NDP Government in 2016. This position, reported through the Ministry of Health, was subject to limiting restrictions as a result. When the UCP formed government in 2019, this position was immediately eliminated and seniors and their advocates were advised to direct their questions and concerns through the existing Health Advocate.

The final reports submitted by the previous Seniors Advocate in 2019 provide a wealth of information and recommendations which have been effectively ignored by the current government. Some of the important data collected included a breakdown of the issues that seniors had directed to the Advocate during her tenure. While many of the issues were related to health care (28%), almost equal numbers of concerns related to income and financial supports (25%), social supports (26%) and housing (21%). The current situation of directing seniors to the Office of the Health Advocate ignores the vast majority of seniors’ issues and concerns.

Priority Change: The provincial government must pass legislation establishing the Independent Office of the Seniors Advocate which would report directly to the legislature and the public, and be appropriately empowered and funded to promote the rights and well-being of Alberta seniors.

The Advocate must have unfettered access to private, public and not-for-profit facilities and services including the autonomy to conduct the necessary investigations arising from complaints received by the Office. Further, in its responsibility to report to the legislature and the public, the Advocate is empowered to speak with the media in fulfilling its mandate to promote the rights and well-being of seniors.

2.) An Opportunity for Innovative Public Solutions

Alberta, like every other jurisdiction in the country, has a multitude of diverse communities - diverse in size, location, age and cultural demographics, proximity to services, accessibility and needs. Services that can be more readily provided in medium- and large-sized cities are more difficult to offer in smaller, more remote communities. Yet, all Albertans have the right to access equitable services regardless of where they are living and other personal circumstances. To achieve this equity of access, innovative and cross-silo approaches to service delivery must be found or developed. Governments in Alberta and in other parts of Canada are expending little or no effort to ensure a comprehensive, rights-based system of services for seniors.

We must challenge the ageist attitudes at play in this complacency and demand better at all levels of service delivery. This system needs to be rebuilt from the ground up as it does not honour the rights of seniors in accordance with the UN Principles for Older Persons.

Priority Change: The government must commit to building a system of comprehensive service delivery that ensures the well-being of seniors including health needs, housing, income/financial supports and social supports.

There are models that work in other countries. There are models that have worked well in Alberta. We need a government that will take the bold steps to expand and fully fund public, universally accessible, integrated care programs that include comprehensive medical, rehabilitative, social and supporting services to older persons whose health needs are complex. We need a government that will empower seniors as they age, rather than determine their path through aging by imposing economic, health and housing restrictions.

3.) Improve Quality of Care in Seniors Congregate Care Facilities

For generations, seniors have expressed the desire to remain in their homes and communities throughout their lifetime. In many cultures, this is achieved through multi-generational support and cohabitation. Canada, however, relies heavily on a system of institutional congregate care facilities. Some facilities, specifically lodges and lower levels of assisted living, offer virtually no care while nursing homes and auxiliary hospitals are charged with caring for those who are dependent on others for self-care and who require regular monitoring and assessment.

The past three years have exposed the abject failure of Alberta’s mixed system of private, not-for-profit and public congregate care facilities to provide seniors with an opportunity to live in a safe and healthy environment. Over the past three decades, dozens of public reviews and independent research reports have highlighted significant failures and glaring inadequacies within the province’s continuing care system. It took a global pandemic and the loss of several thousand seniors to demonstrate the dangers in ignoring the consistent warnings that experts have voiced over and over again. These failures include:

  • inadequate staff-to-patient ratios,
  • inappropriate alignment of caregiver qualifications with patient needs
  • Lack of enforcement of legislative and regulatory standards for requisite RNs to be on site in facilities covered under the Nursing Home Act,
  • incidents of neglect and abuse,
  • overuse/abuse of pharmaceutical treatments,
  • lack of medical and personal supplies,
  • inappropriate physical structures, including size and location of facilities
  • failure to prepare for disaster circumstances,
  • inappropriate safety resources for staff, residents, and informal caregivers, and
  • lack of respect for informal/family caregivers.

An assessment of the baseline of needs of every senior such as Residents Assessment Instrument 2.0 (RAI 2.0) or equivalent tool is required by regulation to determine a person’s health and care needs. This tool must be completed by a competent health professional when a senior enters the system and must consider the full continuum of care including palliative care needs.

Priority Change: Commit to provide and fully fund high-quality care that meets the physical, emotional, mental and social needs of seniors residing in congregate care facilities and ensure that care is provided by full-time, full-benefit workers who are employed in only one facility.

Quality of care and quality of work are intimately intertwined and congregate care facilities exemplify this relationship better than most care relationships. Workers experiencing high levels of job satisfaction do so with caseloads that allow them to meet the needs of their patients/residents, and commensurate pay and benefits for reasonable hours of work that permit them to achieve a balance within their own lives.

We can improve the quality of care by ensuring that every resident receives a minimum of 4.9 hours daily of personal and nursing care by caregivers with the necessary qualifications to provide the services identified in individual care plans. To ensure optimal physical health and psychosocial services, will require that facilities and residences employ nurse practitioners, registered nurses and licensed practical nurses, as well as an appropriate number of allied professionals including registered social workers, occupational therapists, recreation therapists and other allied professionals. It will also require reimagining the physical spaces to ensure that shared personal spaces including bedrooms and bathrooms are eliminated except in the cases of couples, and that shared social spaces are maintained or enhanced to support the well-being and mental health of all residents.

Additionally, the entire system of care must honour the needs of specific demographic groups including Indigenous peoples, immigrant Canadians, LGBTQ* seniors, English language learners and patients with dementia.

4.) Appropriate Care Resources and Programmes Across the Spectrum

As seniors age, many express a desire to remain in their homes and communities so that they are close to friends and family, and/or because the familiarity of home with all of its memories provides comfort for them. Governments, including Alberta’s provincial government have acknowledged this trend and have announced plans to increase homecare services within the community surrounding their existing congregate care facilities. This approach is short-sighted and ignores the broader need for services appropriate for seniors throughout the entire community. In most cases, it is not a matter of simply providing in-home care for a few hours a week or even a few hours a day, it is a matter of ensuring that seniors who have chosen to remain in their own homes and communities have access to a broad range of social, emotional, financial, health (physical and mental) services and transportation near at hand.

However, accessing housing when mobility deteriorates causes distress and a need to have more barrier free surroundings in their own home with modifications or independent suites available to people regardless of where they live (Urban or Rural). This requires a three-tier commitment from all levels of government to enforce building standards for new builds and funds available for retrofit so that people can remain in their own homes.

If the province continues to build or partner in the building of congregational living facilities, the developer must be required to follow the 100% Barrier Free Design model in order to secure the contract to build. Permitting of any renovations to existing facilities must also require adherence to the 100% Barrier Free Design model. All new construction and major renovations should achieve net zero standards to greatly enhance the habitability, sustainability, and efficiency of facilities.

Accessible transportation to get to social activities and appointments. Also accessible transportation to get to the nearest urban area when medical appointments need to be attended and trips home from hospital are required.

Priority Change: Expand the funding, scope and accessibility of services that will permit seniors to continue to reside in their own homes or communities and experience optimal health at all stages of ageing.

Through consultation with seniors, their families and directly-involved health care professionals, the government must develop, implement and fully fund a model for the expansion of publicly operated homecare services. All seniors must be able to receive homecare services to meet their respective health care needs without charge to the patient. As part of the continuum of care, homecare and community-based services must meet the needs of the various demographic groups identified earlier.

5.) Strengthen Pharmaceutical/Dental/Hearing and Vision Coverage

At a time when our healthcare system within Alberta, as with others across the country, is under immense strain, ensuring that all citizens have access to the drugs prescribed by their healthcare professionals would reduce demand on practitioners, emergency rooms and the system overall.

Additionally, there is incontrovertible evidence of links between dental care and many other health concerns yet many seniors have little or no dental coverage. As hearing and vision deteriorates with age, seniors often face greater risk of injury often resulting in emergency room visits and hospitalization. Yet insurance coverage for dental, hearing and vision is expensive and often out of financial reach for seniors. Dr. Nav Persaud, Canada Research Chair in Health Justice at St. Michael’s Hospital in Toronto, states: “Multiple reports have detailed how including medicines in our publicly funded system would improve access, improve health, reduce the need for hospitalizations, emergency room visits, and save billions of dollars (both) through direct savings, through lowering prices and through the need for health care.” (CBC News, Apr. 6th, 2022, Lauren Pelly)

Priority Change: Lobby the federal government to establish a single-payer National Pharmacare Plan through and commit to Alberta’s full participation in the plan once established.

There is ample evidence, both research-based and anecdotal, to demonstrate that many Albertans are having to make life-threatening decisions. This may be a choice to reduce the required dose of a prescribed medication because an individual cannot afford to refill the prescription, or to pay the rent rather than refill a prescription, or the heat or food for the family. The recent rapid rise in inflation is exacerbating difficulties already being experienced by Albertans on fixed incomes, including seniors.

We can no longer support a mixed market of private/public prescription drug insurance plans and dental/hearing/vision plans that is threatening the lives of seniors and others with chronic or emergent medical needs while the pharmaceutical and insurance companies lobby to protect their profits. We must put the lives of Albertans first.

The Alberta Pharmacare Working Group (APWG), led by Friends of Medicare (FoM), is actively promoting a National Pharmacare Program. Additional information and resources are available on their website.

6.) Issues related to Accountability and Transparency

The variety of care facilities within the field of seniors care in Alberta, presents challenges for oversight and accountability. Public funds are paid to private and not-for-profit operators of congregate care facilities and homecare services, and yet the rules for financial accountability and service quality oversight vary significantly from the requirements for quality care. 

Priority Change: Establish consistent data collection, tracking protocols, monitoring and reporting processes that apply to all services that receive any amount of government funding regardless of the ownership status of the facility or service provider.

The government is accountable to the citizens of Alberta for the spending of public funds. It is, therefore, the responsibility of the government to be transparent regarding any changes within the system and the impacts of those changes, and to ensure that all service providers are fully accountable for how funds are spent in the provision of services whether facility-based or home/community-based. In the current mixed-system of service providers, this transparency is simply not achievable. A system must be developed, including regulatory changes, to ensure accurate, transparent reporting to the citizens of Alberta regarding how funds are spent and the outcomes achieved in that spending.

Conclusion

We have identified six major areas of concern that are significantly and imminently affecting the lives of seniors within Alberta. These six areas are by no means the only areas in which improvement is needed and overriding all of our concerns is the need to establish a Bill of Rights for Seniors upon which all future planning and action must be based. It is, however, important to establish a set of priorities for change as a foundation for our advocacy leading into this very critical provincial election.

These six priority areas, in the view of representatives of seniors within Public Interest Alberta, represent the most pressing and productive areas of change to address the critical concerns to improve the overall physical, social, emotional, and mental health of seniors within Alberta.