SALT LETTER TO CARP ON CONTINUING CARE

Seniors’ Action and Liaison Team (SALT)
May 20, 2009
Ms. Susan Eng
Vice President, Advocacy
Canadian Association of Retired Persons
27 Queen’s Street, Suite 702
Toronto, Ontario
M5C 2M6
Dear Ms. Eng,
This letter comes to you on behalf of the Seniors’ Action and Liaison Team
(SALT), a group of Edmonton seniors concerned about social justice issues.
I have been asked to raise our concern with you about the April 13, 2009 CARP
Action Online newsletter. That issue contained a reference to the Alberta Budget
2009:
“CARP congratulates the government for the creation of the new
Continuing Care Strategy . . . Older Albertans will benefit from the creation
of the new Continuing Care Strategy. . . ”
We have been monitoring the Alberta Government’s Continuing Care Strategy for
20 years, and can assure you and your readers that this announcement is neither
new, nor will it benefit older Albertans, their families, or their communities.
The original policy was described in a report titled A New Vision for Long Term
Care in 1988, which proposed centralized control of access to all continuing
services, a shift from formal institutional care to “community care”, a moratorium
on long term care facilities, and increased integrated and coordinated community
care services including expanded home care services.
This was followed by a series of reports from the Long Term Care Policy Advisory
Committee (Broda, 1999 – 2002), where the focus was more clearly shifting the
costs of continuing care to seniors; in this respect, it was in keeping with the
Mazankowski and Graydon reports from the same period concerning Alberta
health care reform.
The “new” Continuing Care Strategy has simply upped the ante and increased
the rate of change. The $41 million is a drop in the budget bucket, no matter
how it’s divided among all of the “initiatives” in the Strategy. It may all be an
illusion anyway, since Health Minister Liepert has said that the funding may very
well involve redirected dollars, rather than new money. As of this date, we have
no details about the allocation of funding for any of the initiatives.
Seniors’ Action and Liaison Team, May 20, 2009; page 2
Meanwhile, the number of seriously ill seniors waiting in an acute care hospital
(and, for that matter, in the community) for a long term care bed has doubled in
the last two years. We have fewer long term care beds in our nursing homes
than we had 20 years ago, despite the population growth and the aging of our
population. Today, Alberta has the second lowest ratio of care beds (to
population over 65, and for population over 75) in Canada. The moratorium on
new nursing home beds continues, with the Strategy promising to replace facility
beds with assisted living.
Home care services have been reduced in range, redirected to sub-acute care to
off-set the reduced capacity and services of acute care hospitals, and shifted
from providing support and care for seniors in their own homes to substituting
for care staff in the new institutions – private sector assisted living.
The latest promise of extra funding for home care is as empty as the 1999,
2005, and 2009 government press releases each promising “600 new long term
care beds”, or the 2005 extra funding for care in nursing homes (prompted by
the Auditor General’s scathing report and the government’s own MLA Task Force
report). The money was spent, somewhere, but the staffing did not improve,
and 3 years later, the nursing homes were “working short” and closing beds
because there were no staff – even untrained persons – to hire.
We expect what will happen with the ”increased hours of home care” for the
seniors most seriously in need of care and support will work out much as similar
earlier initiatives to increase home care have: the range of services will be
reduced, and those not in urgent need of care will go on the wait list.
You may be beginning to see that government promises need to be decoded.
The new Strategy will “adjust the framework for setting fees”; what this means is
that nursing home accommodation fees, which have tripled since 1988, and
increased 90 percent since 2003, will no longer be regulated by the government.
The providers have indicated that they need at least $100 a day from residents
(in addition to the basic medical costs covered by health care).
Care services in these facilities will be reclassified (again) to “basic” and
“enhanced” services, with the operators free to charge extra for “enhanced”
services. Operators currently offering “enhanced” service packages in assisted
living have just increased the prices, by 25 to 50 percent; an extra bath a week
is now $75/month, up from $60.
Twenty years ago, nursing homes were funded as part of the hospital system.
The new strategy makes it quite clear that a minimalist reading of the Canada
Health Act has determined that residential care facilities, no matter the care
needs of the residents, are “non-hospital facilities”. Among other things, this
means that prescription drugs (and perhaps even medical supplies and
equipment) are the responsibility of the resident. One facility has already told
Seniors’ Action and Liaison Team, May 20, 2009; page 3
families that residents will have to pay for their prescriptions and be responsible
for administering them. (The price for “medication assistance” in the assisted
living sector is now $200/month.)
But even these initiatives are not new. For several years now, thousands of
persons assessed for nursing home care have been diverted to private sector
assisted living or “Designated Assisted Living” facilities. In many cases, entire
continuing care centres (nursing homes) have been converted to, or replaced
with, assisted living facilities. The new Strategy promises to increase the trend
to leave seniors and their often beleaguered families even more responsible for
finding, coordinating, and paying for both accommodation and care.
The Stelmach government, like the previous reigns of Premiers Getty and Klein,
have been consistent in regard to these “reforms”. Indeed, long term care has in
many respects served as a pilot project for the rationing of publicly funded health
care, the assaults on universality of health care and social programs, the creation
of market opportunities and subsidies to for-profit care and service providers,
delegation of responsibility, and the messages that we can’t afford care for frail
and ill seniors and, in any event, the individual and his or her family is primarily
responsible for their health and their health care.
We would encourage you to be more careful in your assessment of government
policy, particularly in regards to Alberta. The fine art of presenting cut-backs in
the language of advertising and public relations spin is alive and well in Alberta;
continuing care is not.
Yours sincerely,
Carol Wodak, Vice Chair, SALT
213 Village Close,
Sherwood Park
Alberta T8A 4Y2
cc. Bernice Cassady
CARP (Edmonton)
14620 - 109 Avenue N.W.
Edmonton AB T5N 1H7