MDs key to assisted living reforms

For years, successive B.C. governments have clung to an assisted living strategy which, literally, makes no sense. Fortunately, that is about to change. Assisted living facilities offer semi-independent housing. Some provide a single room, some an apartment-style suite. All deliver a variety of supports, such as meals, recreation and help with medications. They are intended for residents who can no longer remain in their home, but who do not require the more intensive assistance provided by long-term care facilities.

But here is the problem. Assisted living facilities may offer any given resident two, and only two, of the eight or ten services prescribed in law.

If residents requires a third form of support, they must move into a long-term care home.

Indeed, and this is where sense flies out the window, even if residents can pay for an extra service by themselves, or their family are willing to provide that support at no cost to the facility, the law still applies. The resident must leave.

That this is the acme of stupidity scarcely needs saying. There are both human and system-wide costs to consider.

Why should people who can still remain semi-independent be turned out of their living quarters? And what happens when they are?

There are nothing like enough long-term care beds in B.C. for those who already need them.

Why add to the demand?

Worse still, some of these assisted living clients will end up in hospital beds, for lack of an immediate alternative. Around 15 per cent of acute care beds on the Island are occupied by people like this who don’t belong there.

That’s one reason we have patients parked on gurneys in hallways. Our hospitals are running well above design capacity.

Starting Dec. 1, Health Minister Adrian Dix has announced, the regulations will be changed. In future assisted living clients requiring more than two services, but who can still remain semi-independent, will be allowed to stay on.

Calling this “a very significant change,” Dix added: “What this means for people is they will not be forced prematurely to leave assisted living when they neither want to or need to.”

Yet that is only part of the story. Problems like this are endemic throughout the continuum of care for seniors.

Many elderly folks are forced into assisted living in the first place because home support services are inadequate.

This, too, Dix has acknowledged. His ministry has committed $1 billion over three years to fund additional care for seniors. Some of the money will be used to provide more home support.

As well, residential care, pitifully inadequate, is being boosted. It had long been the case that long-term care staffing ratios in B.C. were close to the worst in the country. Among other things, that led to residents being sedated as a means of skimping on the support they needed.

One billion additional hours of direct care are being fed into residential facilities to bring staff ratios in line with appropriate standards.

But then, the difficult part starts. All of these changes, theoretically, should take pressure off our hospital system. And that in turn ought to save money, since acute care beds cost far more to operate than any other form of care.

But theory and practice are two different things.

There are always more patients who could be admitted to hospital, even though the severity of their condition doesn’t immediately warrant it. If the vacated beds are simply filled again with less urgent cases, overcrowding will continue.

The solution must be to bring physicians more directly into the running of our health-care system. They have an essential role to play as gatekeepers, but that requires empowering them, no easy matter.

Traditionally, there has been friction here. Doctors feared that additional responsibilities would keep them from their patients. And governments have been reluctant to share their power.

If the reforms Dix announced are to work, such mindsets must be changed. And that might be the most difficult task of all.