Blog | December 14, 2012

People close to the Seniors’ care system know that it isn’t working very well. The chronic shortage of longterm (nursing home) care beds has not been addressed. Home care is scarce, hard to access, and often not reliable. Care facilities are frequently under-staffed and staffed by people who don’t have the qualifications they require. Yes, there are exceptions to these conditions, but many of these are in facilities that few of us could ever afford.Those of us who spend our time trying to deal with the problems that arise in care facilities soon discover how difficult it is to get corrective action on such situations. One of the few effective ways of dealing with such situations is to go public, get the media involved and generate enough pressure so that someone in authority feels compelled to act.But we also realize that what we are dealing with here are really two quite different sets of problems. There are structural problems with how the system is organized; these can only be addressed by “top-down” intervention and probably involve a high cost. There are also operational problems that could be more effectively addressed through “bottom-up” approaches.Bottom-up solutionsThe government of Alberta devised one of the prime examples of the “bottom-up” approach about 25 years ago. Realizing that schools were not being sufficiently responsive to the needs of parents, it required all schools to form school councils in which the school’s administration and teaching staff were in the minority, and the majority of the council was made up of parents and community representatives.While final decisions remained with the school’s administrations, school councils were able to review and recommend on the school’s budget and other areas of school policy, and that did make schools more accountable. A recent example of the effectiveness of school councils emerged with the challenging of the no-zero policy at an Edmonton high school. Ultimately, a provincial organization of school councils was formed that can now influence government policy.That same mechanism could well be effective in making Seniors’ care facilities more responsive to the needs of patients and their families. Patient/Family Councils could review and recommend how the facility utilizes its resources, and could use the “bottom-up” approach to deal with disputes that arise between patients and facility operators.Top-down solutionsThe government has also developed a different mechanism designed to protect vulnerable individuals with the Child and Youth Advocate whose office became effective on April 1, 2012. The Office of the Child and Youth Advocate is an external, independent advocacy system in which the Advocate reports directly to the legislature.Seniors in care are equally vulnerable and are part of a complex system that involves as many as 19 government departments, numerous municipal agencies, non-government organizations, as well as public, voluntary and private facility operators.The appointment of an Independent Seniors Advocate with authority to report to the legislature rather than any ministry could have a huge impact on addressing many of the problems in the Seniors care system. It could inventory all of the services available, establish what is and is not working, recommend on ways of improving the system and resolve disputes that cannot be resolved at the patient/family council level.The Minister of Seniors has indicated that he does intend to appoint a Seniors’ Advocate, but is clearly thinking of someone who would report only to his ministry, not to the legislature. One of the major difficulties with all publicly administered systems is that it is in the government’s interest, no matter how much it seeks to be open and transparent, to claim that things are working well.That is why PIA’s Seniors Task Force has been advocating for meaningful Patient/Family Councils in all publicly supported or subsidized Seniors care facilities and the appointment of an Independent Seniors Advocate. We believe these could do much to improve Alberta’s Seniors care system.Noel Somerville, Chair,
Seniors Task Force
Public Interest AlbertaEditor’s note: President Gary Pool serves on this committee.This article was published in the Alberta Council on Aging News, Vol.5 No.4, Winter 2012/2013.