BC Seniors Living Association s. Recommendations to Enhance and Promote Independent Living and Assisted Living for BC Seniors

Transcription

1 BC Seniors Living Association s Recommendations to Enhance and Promote Independent Living and Assisted Living for BC Seniors September 2015 Central Park Business Centre # Kingsway Vancouver, BC V5R 5W

2 Acknowledgements BC Seniors Living Association (BCSLA) would like to acknowledge the work of the Steering Committee members Marc Kinna, Pat Frewer, Tony Baena and Marlene Williams in preparing this report and all BCSLA members who took the time to complete surveys that informed this report. Thanks are also given to the Office of the Seniors Advocate, Ministry of Health, Vancouver Island Health Authority, Northern Health Authority, Fraser Health Authority, Interior Health Authority and Vancouver Coastal Health Authority for responding to our information requests and sharing data and other reports on services to seniors in British Columbia (BC). And finally, thanks to Leigh Ann Seller and Effie Henry for completing this report on behalf of our Association and to the over 16,000 seniors in BC who reside or will choose to live in Independent Living and Assisted Living communities. 2 P a g e

3 Enhancing Independent Living and Assisted Living for BC Seniors Executive Summary Independent Living and Assisted Living are important housing and/or care options for seniors in BC that need to grow and evolve to meet the needs of the increasing senior population in BC. Older adults clearly state that they prefer to remain independent and reside in their own homes as long as possible. As people age they may need to change their living arrangements due to social, mobility, health or other issues and having access to these housing and care options is vital to keeping seniors healthy and well. The purpose of this paper by the British Columbia Seniors Living Association (BCSLA) is to review the benefits and current utilization of Independent Living and Assisted Living, the interaction with home support/care services and to identify actions to further support and sustain these housing and care options for seniors. BCSLA represents 162 Independent Living and Assisted Living communities who provide 14,546 suites for over 16,000 seniors in BC. BCSLA members have been key partners with government in the development of this sector. BCSLA is committed to innovation, excellence and freedom of choice for seniors. Growing health care costs, limited supply of quality residential care, public demand and the realization that institutional settings were not appropriate for many led to the development of publicly subsidized Assisted Living facilities and, simultaneously, private pay Assisted Living and Independent Living options for seniors. Both have grown dramatically since 2004 and are often integrated and co-located. Independent Living and Assisted Living have commonalities: communal living environment, costeffectiveness through economies of scale, and a supportive community of neighbours. They both enable socialization, respite for supporting caregivers, opportunities for ongoing observation of the resident and a platform for cost-effective delivery of home support and personal care services. Benefits of Independent Living are validated in satisfaction surveys, continued high demand for units and a decline in vacancy rates over the past years. Surveys also indicate that residents feel very safe and experience a high quality of life in Independent Living. Seniors in Assisted Living demonstrate improved health outcomes, and reduced use of hospital and physician services despite the fact that they may have multiple risks. Both Independent Living and Assisted Living reduce the reliance on higher cost residential care and unnecessary hospitalizations. Recently a number of BCSLA members have reported increased vacancies in Health Authority publicly subsidized Assisted Living residences. Current placements tend to be residents with higher care needs due to efforts to maintain clients longer in their own homes. Members also state there are inconsistencies in whether residents living in Independent Living are offered the Health Authority s Home is Best/Home First program. 3 P a g e

4 Several sources of data relating to seniors care were used to determine current utilization of Independent Living and publicly subsidized Assisted Living. The information provided by members indicated vacancy rates of over 5% in some publicly subsidized Assisted Living sites. The Ministry of Health and Canada Mortgage and Housing Corporation (CMHC) data indicated that publicly subsidized Assisted Living is not growing with the increasing senior population while Independent Living has seen a steady increase of approximately 20% over the past 5 years with a shift in offered amenities to include new technologies, nursing and personal care services. BCSLA conservatively forecasts a 15% growth rate in Independent Living and private pay Assisted Living facilities in the next 5 years. The Home is Best/Home First program is a relatively new home health service initiative to reduce inappropriate hospitalizations and assist in a senior s transition back home in a more timely, safe and supportive manner. A recent BCSLA survey identified that home health services and home support care are rarely provided to residents in Independent Living despite the benefits to residents and the health care system by preventing early or unnecessary admission to residential care or hospital. The BC Seniors Advocate reported that a significant percentage of BC seniors in residential care may be incorrectly housed, with Assisted Living or community care, including Independent Living, being more appropriate. The Fraser Health Authority found Assisted Living clients with more significant cognitive and functional impairment than expected, confirming that this service sector can manage such clients in expanded format (e.g. clients with mild to moderate dementia) with appropriate facility characteristics. Both the Independent Living and Assisting Living sectors could be more fully utilized and expanded to accommodate clients with a broader range of health and social needs and to reduce reliance on more costly institutional care. Better integration of home support and home health services, including end of life/palliative care, could extend a senior s stay in Independent Living or Assisted Living potentially avoiding unnecessary hospitalizations and admission to residential care while providing a more supportive caring environment. BCSLA is committed to work with government, the Seniors Advocate, Health Authorities and industry to ensure optional effectiveness of these programs to meet the needs of BC s seniors. Independent Living: Independent Living communities include a combination of housing and hospitality services for functionally independent seniors capable of directing their own lives, yet who choose to live in a congregate care setting with supportive hospitality services. Assisted Living: Assisted Living is a semi-independent form of housing that is regulated under the Community Care and Assisted Living Act, in which housing, hospitality services, and at least one but not more than two prescribed services are provided to individuals who require regular help with daily activities. 4 P a g e

5 Recommendations It is recommended that: Supporting the Continued Growth of Independent Living 1. Government, including Ministry of Health, Health Authorities, Assisted Living Registrar, all branches of government and the Seniors Advocate, acknowledge that Independent Living is unique and distinct from Assisted Living in the continuum of housing and care services and plays a vital and essential role in assisting seniors to live independently in congregate environments. 2. Government, including BC Housing and municipal governments, support the development of more Independent Living housing as a cost-effective alternative to Assisted Living and Residential Care for those seniors who would benefit from these congregate care living environments. 3. Government partner with BCSLA to develop strategies, including reviewing the Shelter Aid for Elderly Renters (SAFER) program, to promote the growth and greater access for all seniors to Independent Living housing units across the province, especially in the rural areas. Supporting Seniors Living in Independent Living 4. All existing home health and support programs be made available when needed to seniors living in Independent Living to supplement existing services and support their continued health and wellbeing. 5. Government revise the definition of the term home in the Home and Community Care policy to clearly include Independent Living housing as a senior s home. This policy will also direct the delivery of Health Authority Home is Best programs and contracted home support services. 6. Health Authority provide information on Home is Best/Home First programs to clearly identify that seniors who live in Independent Living are eligible for this program following hospitalization or by referral due to chronic health care conditions. 7. Government develop an effective way of communicating the revised policy and new term home to the public and all Health Authority workers to ensure consistency in the application of the policy for all seniors regardless of where they live. 8. BCSLA work together with the Ministry of Health and Health Authorities to establish approaches to improve communication, planning and implementation of home health services, including Home is Best, in Independent Living housing to allow seniors to continue to reside in this housing option as long as possible. 5 P a g e

6 Improving Utilization of Assisted Living 9. BCSLA together with the Assisted Living sector, Seniors Advocate, Ministry partners and Health Authorities develop access, education and marketing strategies to fully utilize the current Assisted Living capacity including a transparent, consistent assessment and admission process across BC. 10. Ministry of Health explore regulatory and policy options to allow registered Assisted Living facilities to provide two prescribed services by resident (rather than by site) allowing more flexible, tailored care for residents. 11. Ministry of Health explore options to allow experienced Assisted Living providers with the necessary qualifications the option of arranging for additional prescribed services on a short term basis to facilitate a senior s hospital discharge or premature entry into residential care. 6 P a g e

7 Introduction The British Columbia Seniors Living Association (BCSLA) currently represents 162 Independent Living (IL) and Assisted Living (AL) communities who have been key partners with government in the development of this sector. Members of BCSLA account for 60% of the total Independent Living and Assisted Living units in BC providing 14,546 suites for over 16,000 seniors in BC. BCSLA promotes continuous improvement and a collaborative approach to ensure the highest standard of service and safety for seniors who choose to live in one of the many retirement communities across the province. In BC, there are approximately 355,777 seniors over 75 years old of which 8.2% live in senior residences. With increasing senior population, it is important that these housing options are sustained and enhanced, new options developed and there is appropriate growth and resources to meet increasing demand. Recently a number of BCSLA members have reported an increased number of vacancies in Health Authority publicly subsidized Assisted Living residences coupled with an increased emphasis on supporting seniors in their own homes through enhanced services rather than offering Assisted Living as a viable option to address their care needs. Additionally, members state there are inconsistencies in whether residents living in Independent Living are offered the Health Authority s Home is Best/Home First program. The overall purpose of this paper is to review the benefits and current utilization of Independent Living and Assisted Living, the interaction with home support/care services and to identify actions to further support and sustain these housing and care options for seniors. BCSLA wishes to work with government, the Seniors Advocate, Health Authorities and industry to ensure optional effectiveness of these programs to meet the wishes and needs of BC s seniors. Background Older adults in British Columbia prefer to remain independent and reside in their own homes as long as possible. Some people change their living arrangements and move into senior retirement communities if they feel overwhelmed by home upkeep, cut off from transport and social amenities, or desire more companionship with others. Additionally, some people develop conditions that result in them needing more assistance with everyday living activities, such as dressing, special diets, medication oversight and social contacts. Meeting these needs may be challenging in a senior s home through home-based services, especially in the rural areas. There is often a tradeoff between maintaining independence, safety and well-being as seniors age and their health conditions require additional supports. Each person s situation is unique, and in BC, there is a continuum of housing and care options that individuals can access, including both private pay and publicly subsidized, allowing for choice while ensuring health and safety of the residents. Two of these housing options are Independent Living and Assisted Living. Additionally, to accelerate a senior s discharge from hospital, Health Authorities are providing more 7 P a g e

8 intensive home support and home health services to allow recuperation at home rather than waiting in hospital. In the past, residential care was the primary housing and care option available when individuals needed additional personal care and support. Growing health care costs, limited supply of quality publicly subsidized residential care facilities, and the realization that these institutional settings were not appropriate for many, led community and health care leaders to look for alternatives. Through extensive consultations and collaboration with the private sector, publicly subsidized Assisted Living facility based care advanced in BC in 2002 as a housing and care alternative for the elderly who did not require 24/7 assistance (as in residential care) but would benefit from this form of care as they were unable to live completely independent. Private pay options were also developed to provide more choice for seniors to respond to market demand and ensure the development of a sustainable model. Both Independent Living and Assisted Living have grown dramatically and are often integrated and even co-located. Independent Living housing with hospitality services are a choice that seniors can access through private pay. Assisted Living can be accessed through Health Authority referral (publicly subsidized) or directly with the provider through private pay. Independent Living Independent Living retirement communities provide an extremely flexible option for seniors in BC and are not regulated under the Community Care and Assisted Living Act. Independent Living housing varies considerably from apartment-style living to more communal housing but is generally designed exclusively for seniors age 75 and over and access is by individuals directly, fully independent of Health Authorities. These retirement communities offer hospitality services, amenities, a communal living environment, with social and recreational programming and usually 24/7 call response. In both private pay and subsidized, some residents make private arrangements to receive home health care services to supplement the base program of services bundled with the housing. In general, the housing is friendlier to older adults, often more compact, with easier navigation and no maintenance or yard work to worry about. The residents function independently with minimal assistance and have access to a variety of amenities, activities and services including arts and crafts, continuing education classes, movie nights, onsite spas, beauty and barber salons, daily meals, basic housekeeping and laundry services. In addition, Independent Living facilities may also offer facilities such as a swimming pool, fitness center, tennis courts, even a golf course or other clubs and interest groups. Independent Living provides a safe and socially rich environment for seniors. However, there are no medical or health care services included as standard in Independent Living, yet as with any regular housing, the residents may receive inhome help (e.g. home health services) separately on an as needed basis through private arrangements or through the operator. Independent Living and Assisted Living Units in BC Independent Living Registered Assisted Living 16,636 units 7,600 units 4,441 publicly subsidized 3,159 private pay Sources: Seniors Housing Report 2015, BCSLA and Detailed Facilities Report P a g e

9 As of June 2015, there were 16,636 independent living units in BC with a monthly average rent of $2,868, up from $2,811 in Demand for this housing option outpaced supply resulting in lower vacancy rates across the province (9.1% compared to 10.9% in 2014). Most residents in Independent Living pay all of the housing and hospitality service and the government provides home care if needed. In British Columbia some sites are subsidized by BC Housing for those with lower incomes. BC Housing also offers the Shelter Aid for Elderly Renters (SAFER) program to help make rents affordable for BC seniors with low to moderate incomes. SAFER provides monthly cash payments to subsidize rents for eligible BC residents who are age 60 or over and who pay rent for their homes. BC Housing provides SAFER subsidies to more than 17,000 senior households renting apartments in the private market, including singles, couples and people sharing a unit. A number of seniors who meet the eligibility requirements access this program when residing in Independent Living housing. Assisted Living The Assisted Living model provides hospitality services, housing and personal care for adults who can make decisions on their own behalf and direct their own care but also require a supportive environment due to physical and functional health challenges. Units are generally small apartments and provide opportunities for socialization. BC regulates Assisted Living residences under the Community Care and Assisted Living Act. BC requires registered operators to offer five hospitality services, and provide at least one, but not more than two personal assistance services (referred to as prescribed services), such 9 P a g e

10 as regular assistance with activities of daily living, medication services, or psychosocial supports. The model provides a less medical, more social environment that was established to be affordable to all seniors with access controlled by Health Authorities. In publicly subsidized Assisted Living the client pays 70% of their income and the government subsidizes rent, hospitality services and care. As of September 2014, there are 7600 Assisted Living units in BC. Of these, 4,441 units are publicly subsidized, the rest are fully private pay. Benefits of Assisted Living and Independent Living Independent Living and Assisted Living have many commonalities: congregate, communal living environment, cost-effectiveness through economies of scale, and a supportive community of neighbours. They both enable socialization and companionship, respite for the supporting caregiver (spouse) and opportunities for ongoing observation of the resident. They also facilitate a platform for cost-effective delivery of supplementary home support and personal care services based on individual need, but clustered demand. Independent Living Benefits Benefits of Independent Living are indicated by documented satisfaction surveys and the continued high demand for units evidenced by an increase in the average rents and a decline in vacancy rates over the past year. Satisfaction surveys indicate that residents feel very safe and experience a high quality of life. In many parts of the province the high re-sale value of real estate makes this form of housing affordable to many seniors once they sell their homes. These housing settings are not publicly subsidized by Health Authorities or government and residents access health care services individually, both public and private. Innovation continues in this sector as Independent Living providers are increasing the variety of amenities that are being provided to their residents including transportation services, on-site movie theaters and internet access as well as offering larger units that allow for more flexible use of space. Most offered services include 24 hour call-bell and access to nursing and person care services. Increased access to services and amenities make this housing option more attractive, promotes greater socialization, and supports continued contact with family and friends as well as continued engagement in community activities. There is significant flexibility in this housing option as residents are able to purchase additional personal care supports through the provider and private external providers, including health care services, to meet individual needs. Many seniors who live alone experience social isolation due to a decreasing social network, infrequent participation in social activities, often due to lack of transportation that leads to feeling of loneliness. Older adults are likely to experience bereavement and encounter chronic health problems that increase their need for social support and companionship. Research demonstrated a strong association between loneliness and poor health, including all-cause mortality, increased morbidity, diminished immune function, depression and cognitive decline. Independent Living offers a setting that maintains seniors independence in their own unit and promotes the residents physical and mental health through the provision of nutritional meals served in a restaurant-like setting, social and recreational activities, a large social network that functions as a neighbourhood watch, as well as continued access to community 10 P a g e

11 events through transportation services. Overall, results from research suggest that seniors who adjust their circumstances to limit their sense of isolation fare better both physically and mentally than those who feel isolated. A recent BC report cited an emergency nurse stating that social isolation leads to inappropriate emergency visits as they are lonely and the diagnosis on the chart often reads failure to thrive. Independent Living provides a setting where relationships are developed and seniors feel loved, nurtured and cared for. Psychologist Dr. Barbara Fredrickson argues that for human beings to flourish they need to get essential daily nutrients not only from food, but also from a laugh, a hug or even a smaller moment of positive emotion, especially with someone with whom they relate. Independent Living is a setting that provides multiple relationships and increases opportunities for seniors to experience these essential nutrients that increase their overall health. Assisted Living Benefits Research demonstrated positive outcomes for seniors residing in both Assisted Living and Independent Living. Seniors in Assisted Living demonstrate improved outcomes despite the fact that they may have multiple risks. The health and social benefits are significant. Some of the benefits are the result of improved lifestyle and medication and chronic disease management that is possible in Assisted Living sites. Also the social disconnectedness and isolation associated with lower levels physical health and increased risk of dementia are improved in this more supportive environment. Some promising outcomes are reduced need for and use of physician and hospital services. There is a lower likelihood of admission to acute care and a smaller number of days in care for those admitted. The extent of multiple medication use also decreases somewhat after admission to Assisted Living, suggesting better medication management. Assisted Living is a cost-effective alternative to institutional care. The average annual cost per client is significantly less for Assisted Living than for Residential Care. The BC Seniors Advocate recently reported that up to 15% of BC seniors who are living in residential care may be incorrectly housed, with Assisted Living or community care being a more appropriate use of resources and a better option for the senior. The Advocate commented, If we are filling even 5 percent of these scarce beds with folks who could live independently that is 1500 beds that could open up province-wide. Also BC has a persistently high Alternate Level of Care (ALC) rate in hospital, over 13% of total days, another indicator of inappropriate placement and subsequent poor use of resources. Assisted Living has the potential to moderate the demand for more costly acute and institutional care. Many factors are influencing the future of Assisted Living facilities in BC especially the publicly subsidized units some of these are: competing needs for the health care dollar with more urgent need taking priority, competition with home support and home care programs, and restrictions in legislation on who can be placed in these facilities. Experience by some Assisted Living providers identified that the lack of consistent communication and understanding of the current limits of the Assisted Living model by Health Authorities makes it challenging when planning for new residents who have more significant health care needs or existing clients returning from hospital. Additional support is needed from Health Authorities and greater flexibility in this model of care needs to be considered to address the needs of seniors and ensure sustainability and growth of this care option. 11 P a g e

12 Community Home Care and Support Programs Publicly Subsidized Home Health Services Description and Benefits Home medical care and home support delivered in seniors homes are critical to helping them remain independent and in their own homes as long as possible. Approximately 92% of seniors live in private households. Although most prefer their independence, some require formal and/or informal support to do so. The services provided to them vary by age and need and include both home health and home support services. Most unpaid informal care comes from family members, friends and neighbors and is often provided by spouses who may have care needs of their own. As the time they spend providing care increases, so does the distress they experience. Health Authority home support and health services includes short-term health care to those recovering from surgery or acute medical conditions, long-term care and support to allow people with chronic conditions to continue living in the community and specialized programs, such as end-of-life care and rehabilitation. Home care is delivered in the community in private homes. The Home is Best/Home First program implemented by Health Authorities in some parts of the province aims to decrease hospital length of stay/early discharge, and prevent institutionalization (to residential care) by supplying intensive home medical and supportive care. Home support services are included in this category these are direct care services provided by community health workers to clients who require personal 12 P a g e

13 assistance with activities of daily living such as: mobility; nutrition; bathing and dressing as well as some specific nursing and rehabilitation tasks that have been delegated by health care professionals. As home care is limited to a senior s personal care needs, its effectiveness in supporting a senior to remain at home is often dependent upon the level of informal care and degree of social connectedness in the community. Better at Home Program Description and Benefits In BC the Better at Home program, a community based non-medical services program was launched in 2012 as part of the Seniors Action Plan. The aim of the program is to help seniors live longer in their own homes by providing simple non-medical support services like help with housekeeping and transportation to appointments while remaining socially connected to their community. The range of Better at Home services available varies from community to community, depending on the specific needs of local seniors. Examples of Better at Home services include friendly visiting, transportation, light yard work, minor home repairs, light housekeeping, grocery shopping, and snow shoveling. Service fees are established on an income-based sliding scale, which ensures that services are free for low income seniors and market rate for seniors with an income above the BC average. Better at Home effectiveness is likely highest for individuals whose needs match these services, as long as socialization and isolation are not the primary issues. For individuals who require more socialization or are at risk of isolation-related depression, a congregate living environment is a better fit. Early evidence suggests that the key components of Better at Home have a positive impact on seniors and service providers. The program has increased awareness of seniors needs and increased the number of non-medical support services available for seniors. It has also enhanced collaboration between key community stakeholders. Discussion and Analysis Housing and Care Data Review Several sources of data relating to seniors care were used to determine current utilization of the publicly subsidized Assisted Living program. Client count and service volume rates (BC provincial rate and for individual health authority), 1000 population, age 75 plus, for 2009/2010 to 2013/2014 by type of service were provided by the Ministry of Health through a formal request. This included data on Residential Care, Assisted Living, Home Support, Professional services and all Home and Community Care services (see appendix). Also current trends in ALC in hospital and a Detailed Facilities Report were provided and reviewed. The days rate for Assisted Living has remained fairly stable from in 2009/10 to in 2013/14 ( 1% increase) with the client rate declining marginally suggesting a stable utilization of the sector and some clients staying slightly longer in Assisted Living. Assisted Living client rates were highest in Vancouver Coastal and the Northern Health Authorities. Residential Care utilization showed a drop of 12% in days rate and a decrease in client count rate over the same time period from 95.4 to 80.2 with client count rates highest in more rural regions - the Interior Health and Northern Health Authorities. 13 P a g e

14 This indicates a slight decrease in provincial utilization of Residential Care. The home support client rate has remained fairly stable while the client hours increased. Professional services client rate and visits appear fairly stable. The client count rate for all Home and Community care services has gone down likely due to decreased use of residential care. The data does not reflect a substantial increase of home care and home health services despite the investment by Health Authorities in Home is Best/Home First programs in 2013 and This may be due to alternate forms of reporting to the Ministry of Health on these programs or limited impact on the overall rates. ALC in hospital, an indicator of inappropriate utilization of acute services, remained high at 13% of inpatient days, with Vancouver Coastal Health Authority showing the best performance as historically has been the case. Detailed Health Authority bed inventory reports for 2013 and 2014 were reviewed. Overall there has been no growth in publicly subsidized assisted living units (4,441 as of September 2014) with a small increase in residential care beds (.07%) with temporary beds being purchased on an as needed basis. Assisted Living units are approximately 15% of the publicly subsidized units/beds, although it is not consistent across all Health Authorities with Northern Health Authority at 19% and Vancouver Coastal Health Authority at 10%. CHMC reports indicate that Independent Living/Assisted Living suites overall have increased by (2,746 suites) 20% in the last 5 years. BCSLA reports another 1,758 units are slated to be built over the next 3-5 years a 15% increase. Demand for seniors housing in British Columbia outpaced supply, pushing vacancy rates lower across all bedroom counts, all regions and all rent ranges. Also the demand for units with more than 1.5 hours/day of care is strong. The BCSLA also surveyed the membership to determine the extent of current vacancy rates. The information provided by the members who responded indicated rates of over 5% in a few sites (above the 2% acceptable rate) possibly due to an inappropriate match with need in those areas and/or more emphasis on care at home. Overall it appears that Assisted Living is not growing with population in comparison to Independent Living which has seen a steady increase, especially in the Lower Mainland area. Home Health Services and Home is Best/Home First Programs The Home is Best/Home First program is a relatively new Health Authority funded home health services initiative that seeks to reduce inappropriate hospitalizations and assist in a senior s transition back home in a more timely, safe and supportive manner. It acknowledges the evidence that leaving hospital as soon as possible and recuperating at home with home supports and community services is better than waiting in hospital to fully regain strength. Results reported in a Ministry of Health March 2013 news release stated that patients who received these services in Vancouver Coastal Health Authority resulted in a 30% decrease in acute care and 25% reduction in emergency visits. Additional program outcomes have not been publicly reported as the client numbers continue to be relatively small and the program is not available in all parts of the province. 14 P a g e

15 BCSLA made requests to all Health Authorities on the policy for this program and whether it is available to seniors residing in Independent Living. All Health Authorities reported that there is no specific policy on eligibility as it is considered a service, stating that eligibility is defined in the provincial Home and Community Care Policy. Public information posted by Fraser Health Authority on the program focuses on providing the service in a senior s own home and does not state that seniors residing in Independent Living are eligible. Vancouver Island Health Authority did confirm that residents in Independent Living housing are eligible. A recent BCSLA survey identified that home health services and home support care are rarely provided to residents in Independent Living. However, the provincial Home and Community Care policy does permit Health Authorities to provide these services in this housing option, although this is not clearly stated. BCSLA acknowledges that some of its members have expressed concerns about residents returning from hospital without the necessary supports as they do not provide home health services and they are concerned for the safety and well-being of their clients. They have also reported that some residents have been advised that they are not eligible for this service as they reside in Independent Living. These issues can be easily addressed through better communication and liaison with Health Authority staff involved in the program. The community based Better at Home program is not offered to seniors in Independent Living or Assisted Living as many of the services provided are included in these housing options. 15 P a g e

16 Summary The data confirms that the Assisted Living sector age standardized utilization rate is stable and there is no growth in the publicly subsidized portion of this sector. In contrast, the Independent Living sector and private pay Assisted Living have increased more over the last five years based solely on market demand. The BC Seniors Advocate reported that a significant percentage of B.C. seniors who are living in residential care may be incorrectly housed, with Assisted Living or community care being more appropriate. The Fraser Health Authority 2012 finding of Assisted Living clients with more significant cognitive and functional impairment than expected indicates that this health service sector can manage such clients in expanded format (e.g., clients with mild to moderate dementia) with appropriate facility characteristics. Overall both the Assisted Living and Independent Living sectors could be more fully utilized and expanded to accommodate clients with a broader range of health and social needs and reduce reliance on institutional care. Better integration of home support and home health services, including end of life/palliative care could extend a senior s stay in Independent Living and Assisted Living potentially avoiding hospitalizations and admission to residential care, two key priorities of the Ministry of Health. Understanding the health and housing needs of older people is important as the proportion is expected to reach close to 25% of the total population over the next 25 years. Along the continuum from living on your own to institutionalization, both Independent Living and Assisted Living offer an intermediate level of care that is appropriate to the needs of many seniors. Housing and care needs play an increasingly important role in seniors lives as they age. With advanced age, seniors are more likely to live alone and need a variety of housing and care options to choose from to support their health and well-being that includes both in-home support and congregate care models. BCSLA strongly recommends that continued flexibility and evolution is needed in both Independent Living and Assisted Living to make sure these housing and care models remain relevant and accessible for all seniors in British Columbia. Recommendations It is recommended that: Supporting the Continued Growth of Independent Living 1. Government, including Ministry of Health, Health Authorities, Assisted Living Registrar, all branches of government and the Seniors Advocate, acknowledge that Independent Living is unique and distinct from Assisted Living in the continuum of housing and care services and plays a vital and essential role in assisting seniors to live independently in congregate environments. 16 P a g e

17 2. Government, including BC Housing and municipal governments, support the development of more Independent Living housing as a cost-effective alternative to Assisted Living and Residential Care for those seniors who would benefit from these congregate care living environments. 3. Government partner with BCSLA to develop strategies, including reviewing the Shelter Aid for Elderly Renters (SAFER) program, to promote the growth and greater access for all seniors to Independent Living housing units across the province, especially in the rural areas. Supporting Seniors Living in Independent Living 4. All existing home health and support programs be made available when needed to seniors living in Independent Living to supplement existing services and support their continued health and wellbeing. 5. Government revise the definition of the term home in the Home and Community Care policy to clearly include Independent Living housing as a senior s home. This policy will also direct the delivery of Health Authority Home is Best programs and contracted home support services. 6. Health Authority provide information on Home is Best/Home First programs to clearly identify that seniors who live in Independent Living are eligible for this program following hospitalization or by referral due to chronic health care conditions. 7. Government develop an effective way of communicating the revised policy and new term home to the public and all Health Authority workers to ensure consistency in the application of the policy for all seniors regardless of where they live. 8. BCSLA work together with the Ministry of Health and Health Authorities to establish approaches to improve communication, planning and implementation of home health services, including Home is Best, in Independent Living housing to allow seniors to continue to reside in this housing option as long as possible. Improving Utilization of Assisted Living 9. BCSLA together with the Assisted Living sector, Seniors Advocate, Ministry partners and Health Authorities develop access, education and marketing strategies to fully utilize the current Assisted Living capacity including a transparent, consistent assessment and admission process across BC. 10. Ministry of Health explore regulatory and policy options to allow registered Assisted Living facilities to provide two prescribed services by resident (rather than by site) allowing more flexible, tailored care for residents. 17 P a g e

18 11. Ministry of Health explore options to allow experienced Assisted Living providers with the necessary qualifications the option of arranging for additional prescribed services on a short term basis to facilitate a senior s hospital discharge or premature entry into residential care. 18 P a g e

19 References 2013 Survey of Assisted Living Residents, Assisted Living Federation of America A Focus on Seniors and Aging Health Care in Canada, CIHI; Assisted Living Operators Survey Results, John Howard Society of the Thompson Region; Barre, L. Fredrickson, B. Tugade, M; Psychological Resilience and Positive Emotional Granularity: Examining the Benefits of Positive Emotions on Coping and Health; Journal of Personality; Journal of Personality. December; B.C. Seniors Survey Bridging the Gap, Office of the Seniors Advocate; Better at Home Program Evaluation; Canada Mortgage and Housing Corporation. Seniors Housing Report. BC; Canada Mortgage and Housing Corporation. Seniors Housing Report. BC; Cohen, M. Caring for BC s Aging Population Improving Health Care for All; HC Health Coalition; Cohen, M. and Franko, J. Living Up to the Promise: Addressing the High Cost of Underfunding and Fragmentation in BC s Home Support System; Integrated Care Advocacy Group and the BC Health Coalition; Cohen M, Murphy J, Nutland K, Ostry A. Continuing Care Renewal or Retreat? BC Residential and Home Care Restructuring Vancouver, BC: Canadian Centre for Policy Alternatives; Cornwell, E Y, Waite, L. Social Disconnectedness, Perceived Isolation, and Health among Older Adults; Journal of Health and Social Behavior. March; Evaluating transitions in care processes and outcomes, Fraser Health Authority; Lum J, Ruff S, Williams P. When Home is Community - Community Support Services and the Well-Being of Seniors in Supportive and Social Housing. Toronto: Ryerson University, Neighbourhood Link / Senior Link and the University of Toronto; McGrail KM, Broemeling AM, McGregor MJ, Salomons K, Ronald LA, McKendry R. Home health services in British Columbia: a portrait of users and trends over time. UBC Centre for Health Services and Policy Research; McGrail K M, Lilly M, McGregor MJ, Broemeling AM, et al, Who Uses Assisted Living in British Columbia? An Initial Exploration. Centre for Health Services and Policy Research University of British Columbia; P a g e

20 Ministry of Health Services BC. About Assisted Living in B.C. Province of British Columbia - Office of the Assisted Living Registrar, Ministry of Health; Placement, Drugs and Therapy We Can Do Better; Office of the Seniors Advocate; Report on the Social Isolation of Seniors; National Seniors Council, Government of Canada; Seniors Care: Supportive Housing; Ontario Ministry of Health and Long-Term Care; Seniors Housing in BC, Office of the Seniors Advocate; The Journey Begins, Together, We Can do Better, Office of the Seniors Advocate; P a g e

21 Appendix Client Counts and Service Volumes 21 P a g e

22 22 P a g e