ASSISTED LIVING BACKGROUNDER

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1 ASSISTED LIVING The Best of Care: Getting it Right for Seniors in British Columbia (Part 2) Issues Investigated Staffing of the Office of the Assisted Living Registrar Powers of the assisted living registrar Costs of Receiving Services Availability of Information Eligibility and Assessment Placement Process Quality of Care Complaints Complaints about Tenancy Issues Monitoring and Enforcement Key Recommendations Ministry of Health stop contracting with the Health Employers Association of BC to staff the Office of the Assisted Living Registrar (R51) Assisted living registrar delegate investigative powers to staff who require those powers (R52) Ministry of Health immediately require compliance with its policy on benefits and allowable charges (R53) If Ministry of Health believes that its practice of allowing operators to provide additional services is useful, it should ensure a statutory basis for doing so (R54) Ministry of Health create a legally binding process for assessing the decision making capacity of assisted living applicants and residents (R59) Ministry of Health establish a timeframe within which eligible seniors receive subsidized assisted living (R63) Ministry of Health, after consulting with stakeholders, establish legally binding minimum requirements for assisted living residences in key areas including staffing, residents rights, food safety and nutrition, emergencies, record management and assistance with daily activities (R69) Ministry of Health establish a legal requirement for assisted living operators to have a complaints process (R72) Ministry of Health revise the complaints process used by the Office of the Assisted Living Registrar to include time limits, process for investigating complaints, and a requirement that complainants be informed in writing of the outcome of their complaint and any further action they can take (R75) Ministry of Health take the steps necessary to expand the powers of the Office of the Assisted Living registrar so that it has the authority to respond to complaints from residents about all aspects of care in assisted living (R78) Ministry of Health consider whether to expand the jurisdiction of the Office of the Assisted Living Registrar to deal with tenancy disputes in assisted living (R83) Ministry of Health require assisted living operators to report serious incidents (R85) Ministry of Health develop an active inspection and monitoring program for assisted living (R88) Ministry of Health expand the authority of the assisted living registrar to obtain information about incidents under investigation (R90) Ministry of Health review of the Office of the Assisted Living Registrar s enforcement program to ensure that it has adequate resources and more power to ensure compliance with standards (R93) Page 1

2 ASSISTED LIVING Description of Services Assisted living is a form of housing that combines private units in apartment-style residences with the provision of hospitality and prescribed care services. These services include meals, housekeeping, personal care and help with medications. Assisted living is meant for seniors and others who are able to direct their own care, but can no longer live safely on their own. It is often seen as falling between home support and residential care on the spectrum of seniors care services. Number of People Served As of March 2011, there were 194 registered assisted living residences in British Columbia, containing a total of 6,832 units, the majority of them single occupancy. Of this total, 4,380 units were subsidized and 2,452 were not. Cost of Providing Services In 2010/11, the total funding the five regional health authorities provided for assisted living was $74.7 million. This includes the cost of both the housing and the services. In 2007/08, the average per unit subsidy paid by health authorities was $55 a day, or $1,650 per month. Cost of Receiving Services Subsidized residents pay a maximum of 70 per cent of their after-tax income. As of March 2010, this amount ranged from $801 to $3,860 per month, and averaged $1,224 per month. People who experience serious financial hardship as a result of paying the monthly rate can apply to their health authority for a hardship waiver. Non-subsidized residents typically pay between $1,500 and $5,000 per month. Service Delivery Assisted living residences can be owned and operated by health authorities, non-profit groups or private companies. Individual facilities may contain only subsidized units, only non-subsidized units or both. Health authorities administer subsidized assisted living services, overseen by the Ministry of Health. Private companies and some non-profit groups provide non-subsidized assisted living services. Legislation Assisted living is regulated by the Community Care and Assisted Living Act, which requires assisted living operators to register their residences with the assisted living registrar and to ensure that they are operated in a manner that does not jeopardize residents health or safety. The Assisted Living Regulation establishes the standards that operators must meet for storing and administering medication. Page 2

3 HOME AND COMMUNITY CARE The Best of Care: Getting it Right for Seniors in British Columbia (Part 2) Issues Investigated Obtaining Information Assessment Fees Complaints Regulation of Care Aides Reporting Abuse and Neglect Key Recommendations Ministry of Health include key home and community care data in an annual report that it makes publicly available (R3) Health authorities ensure that seniors are assessed for home and community care services within 2 weeks (R7) Ministry of Health ensure that all seniors and their families are informed of the availability of home and community care services and that they can meet with health authority staff to determine what support is available (R9) Ministry of Health and health authorities include information about how to apply for a fee reductions and waivers when they mail fee notices to seniors (R11) Ministry of Health establish a process that permits sponsored immigrants charged home and community care fees between March 31, 1997 and April 1, 2011 to apply for a review of the fees paid and a reimbursement (R14) Ministry of Health provide specific direction to the patient care quality offices on the steps they should follow in processing care quality complaints (R16) After the patient care quality offices and review boards have been operational for five years, the Ministry of Health review their complaint handling processes and implement improvements (R17) Health authorities ensure that the patient care quality offices inform all complainants in writing about the outcome of their complaints (R21) Ministry of Health, by January 2013, establish a program to provide support for seniors and their families to navigate the home and community care system and bring forward concerns and complaints (R22) Ministry of Health, by January 2013, require care aides and community health workers at all home support, assisted living and residential care facilities to register with the BC Care Aide & Community Health Worker Registry (R24) Ministry of Health require staff providing care to seniors to report information indicating that a senior is being abused or neglected (R27) Ministry of Health require service providers to immediately notify the police of all incidents of abuse and neglect that may constitute a criminal offence (R30) Ministry of Health ensure that seniors who receive home support or live in assisted living have same protection from financial abuse as seniors who live in residential care (R32) Ministry of Health provide protection from adverse consequences for anyone, including staff, who complain about home and community care services (R33) Page 1

4 HOME AND COMMUNITY CARE Home and Community Care Services Home and community care services provide a range of health care and support services for seniors with acute, chronic, palliative or rehabilitative health care needs. Services include home support and choice in supports for independent living, assisted living, residential care, hospice, palliative, end-of-life care, home care nursing and community rehabilitation, adult day services and case management. Number of People Served In 2009/10, the health authorities provided home support to more than 24,500 people. In 2010/11, there were more than 4,300 subsidized assisted living units. On March 31, 2011, there were more than 24,000 subsidized residential care beds. Cost of Providing Services In 2009/10, the health authorities spent approximately $339 million on subsidized home support. In 2010/11, the health authorities spent approximately $74 million on subsidized assisted living. In 2010/11, the health authorities spent approximately $1.6 billion on subsidized residential care. Cost of Receiving Services In many cases the person receiving home and community care must pay something towards the cost. Payments can range from $10 a day for home support to over $2,900 a month for residential care. Service Delivery Delivering home and community care services is the responsibility of the regional health authorities. The services themselves may be provided by employees of a health authority, or by staff working for a not-forprofit or for profit organization that has a contract with a health authority. Services may be provided in a seniors home, community center or supportive residence including assisted living or residential care facility. Legislation There are several pieces of legislation that regulate the provision of these services including the Continuing Care Act, the Community Care and Assisted Living Act and the Hospital Act. Much of the operation of home and community care is guided by Ministry of Health policy. Page 2

5 HOME SUPPORT The Best of Care: Getting it Right for Seniors in British Columbia (Part 2) Issues Investigated Changes in Home Support Policy Number of Seniors Supported Funding Levels Public Information Eligibility, Assessment and Access Waiting for Service Cost of Receiving Services Continuity of Care Quality of Care Complaints Monitoring and Enforcement Key Recommendations Ministry of Health analyze whether the home support program is meeting its goal of assisting seniors to live in their own homes as long as it is practical and make any necessary changes (R34) Ministry of Health evaluate home support eligibility criteria to ensure they are consistent with program goals and make any necessary changes (R34) Ministry of Health analyze the costs and benefits of expanding the home support program up to the cost of providing subsidized residential care (R34) Ministry of Health work with the health authorities to develop a consistent process for determining time allotments for home support activities (R35) Ministry of Health set a timeframe within which eligible seniors are to receive subsidized home support (R36) Health authorities track the time it takes for seniors to begin receiving home support services (R37) Ministry of Health extend the $300 cap on home support services to seniors who do not have earned income (R39) Ministry of Health establish clear, specific and enforceable quality of care standards for home support services (R42) Health authorities require contracted home support providers to inform residents and families about how to complain (R45) Ministry of Health ensure all seniors who receive home support have access to the same complaints process (R47) Ministry of Health and health authorities establish clear and consistent processes for monitoring home support services (R49) Home Support Services Home support services are provided to seniors in their homes and also while living in various supportive housing, including assisted living residences. Page 1

6 HOME SUPPORT Services are intended to help seniors (and others) who are still able to live independently in their homes and communities for as long as they can safely do so. They are meant to supplement the care that families and others provide. Home support workers, also referred to as community health workers, help seniors with daily activities such as getting up and around, getting dressed, using the bathroom, preparing meals and taking medications. Number of Seniors Served In 2009/10, there were at least 24,500 seniors receiving subsidized long-term home support services in British Columbia. Cost of Providing Services In 2009/10, the regional health authorities spent a total of approximately $339 million providing subsidized home support services throughout British Columbia. It typically costs the health authorities $30 to $40 to provide each hour of subsidized home support. Cost of Receiving Services Health authorities use a formula set by regulation to calculate the amount subsidized home support clients will be charged. The formula is based on income tax information from the previous year. As a result of applying this formula: approximately 71 per cent of home support clients pay nothing to receive these services 3 per cent pay up to $10 per day 6 per cent pay between $10 and $20 per day 20 per cent pay more than $20 per day seniors with earned income pay a maximum of $300 per month for home support Service Delivery Subsidized services may be provided by employees of health authorities or by other organizations, either nonprofit or for-profit, with which a health authority has made a contract. Seniors and their families can obtain funding from the government to hire and manage their own home support services through the Choice in Supports for Independent Living Program. Seniors who do not qualify for subsidized home support services may opt to privately purchase various services that are similar in nature to subsidized home support services. Legislation Subsidized home support services are administered under the Continuing Care Act. The Act does not include specific standards for home support but does authorize the Minister of Health to issue standards, guidelines or directives that are binding on service providers. Page 2

7 RESIDENTIAL CARE The Best of Care: Getting it Right for Seniors in British Columbia (Part 2) Issues Investigated Regulation of Residential Care Facilities Funding Waiting Times for Placement Seniors in Hospital Waiting for Transfer Consenting to Admission Moving in Costs of Receiving Services Use of the Mental Health Act for involuntary admissions Quality of Care Restraints Administering Medication Staffing Services for Residents with Dementia End-of-life Care Complaints Monitoring Enforcement Facility Closures Key Recommendations Ministry of Health harmonize the residential care regulatory framework by either bringing s.12 of the Community Care and Assisted Living Act into force or taking other steps to ensure the same standards, services, fees, monitoring, enforcement and complaints process apply to all residential care facilities (R94) Ministry of Health working with the health authorities conduct an evaluation to determine whether the residential care budget in each health authority is sufficient to meet the current needs of its population (R97) Ministry of Health establish a consistent method to determine the funding requirements of residential care facilities (R98) Ministry of Health require health authorities to ask seniors to identify their three preferred facilities and accommodate those preferences whenever possible (R103) Ministry of Health establish a timeframe within which eligible seniors are to receive subsidized residential care after assessment (R108) Health authorities track the extra costs that result from keeping seniors in a hospital bed when they require residential care (R112) Ministry of Health ensure that health authorities stop charging fees to seniors in hospital who are waiting for a residential care placement (R114) Ministry of Health bring Part 3 of the Health Care (Consent) and Care Facility (Admission) Act into force (R115) Ministry of Health develop a standard consent to admission form for residential care facilities (R116) Ministry of Health develop a policy that allows more flexibility on the length of time to move into a facility (R117) Ministry of Health provide detailed public information on how the additional revenue from the rate increase is being spent and what improvements have resulted in each facility (R123) Ministry of Health immediately require compliance with its policy on benefits and allowable charges immediately (R126) Ministry of Health develop a clear policy on when to use the Mental Health Act to involuntarily admit seniors to mental health facilities and then transfer them to residential care (R130) Page 1

8 RESIDENTIAL CARE Health authorities stop charging fees to seniors that they have involuntarily detained in mental health facilities and transferred to residential care (R131) Ministry of Health develop a process for seniors who have paid fees for residential care while being involuntarily detained under the Mental Health Act to apply for reimbursement (R132) Ministry of Health establish specific and objectively measurable regulatory standards for key aspects of residential care, such as meal preparation and nutrition, and bathing frequency (R133) Ministry of Health develop a province-wide policy on the appropriate use of chemical restraints (R138) Ministry of Health create enforceable standards for use of medications administered on an as-needed basis (R141) Ministry of Health establish appropriate staffing mixes, a minimum number of direct care hours, and a minimum number of staff required at different times in residential care facilities(r142) Ministry of Health develop a policy to guide the delivery of dementia care in residential care and ensure that all residential care staff receive ongoing training on caring for people with dementia (R145) Ministry of Health develop standards for end of life care in residential care facilities (R146) Ministry of Health establish the community care licensing offices as the single process for responding to complaints about residential care, require them to inform people in writing of the outcome complaints and establish a right of review or appeal (R149) Director of licensing issue a public annual report on the community care licensing program (R152) Ministry of Health require all health authorities to conduct a set number or percentage of unscheduled facility inspections and inspections outside of regular business hours (R157) Fraser, Interior, Northern and Vancouver Island health authorities immediately begin inspecting all residential care facilities under the Hospital Act in the same manner and with the same frequency as those under the Community Care and Assisted Living Act (R160) Ministry of Health require operators under the Hospital Act to report reportable incidents (R162) Ministry of Health expand the enforcement options under the Community Care and Assisted Living Act (R166) Ministry of Health require operators to notify residents, families and staff promptly of a decision to close, reduce, expand, substantially change operations or transfer residents because of funding decisions (R171) Health authorities ensure that seniors and their families impacted by a pending facility closure decision, are informed when an operator requests an exemption, informed of how to provide input before a decision is made, notified of the decision, and informed about how to appeal the decision (R172) Description of Services Residential care facilities provide 24-hour professional nursing care and supervision in a protected, supportive environment to seniors with complex care needs. This type of care is meant for people who have the highest level of care needs and can no longer safely live on their own. Seniors reside in private or shared rooms. They are provided with meal service, medication administration, and personal assistance with daily activities including bathing and dressing, laundry, housekeeping and social and recreational services. Page 2

9 RESIDENTIAL CARE Number of People Served As of September 2011, there were 26,491 publicly subsidized residential care beds. Cost of Providing Services In 2010/11, the regional health authorities spent approximately $1.6 billion providing subsidized residential care The Ministry of Health estimates the average monthly cost of operating a residential care bed at approximately $6,000. Cost of Receiving Services People in subsidized residential care pay up to 80 per cent of their after-tax income, provided that they have at least $275 remaining from their income each month. On December 11, 2011 the Ministry of Health announced that the minimum remaining amount would be increased to $325 effective February 1, The residential care fee paid by individuals is referred to as a co-payment and ranges from $898 to $2,932 per month. Service Delivery Subsidized residential care services are part of the provincial home and community care program, which is overseen by the Ministry of Health and delivered by the health authorities. In some cases, subsidized services are delivered directly by health authority employees and, in others, by nonprofit or for-profit agencies under contract with a health authority. One hundred and twelve or 32 per cent of residential care facilities are owned and operated by the health authorities. The remaining 236 or 68 per cent are operated by private operators. Seniors who can afford to do so can also arrange to receive these services directly from a private provider. Legislation Residential care is provided in three types of facilities: community care facilities, extended care hospitals and private hospitals. Seventy-one per cent of residential care beds are in facilities licensed under the Community Care and Assisted Living Act and Residential Care Regulation, both of which set the mandatory minimum health and standards in these facilities, as well as the requirements for staffing, food service, medication administration and other matters. The remaining 29 per cent of beds are in either extended care hospitals or private hospitals, both of which are governed by the Hospital Act. Page 3

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