Continuing Care Strategy Falls Short

The December press release from the
Alberta government promises that a
"new continuing care strategy" would
give Albertans "more support and
more choice."
Are these reassuring words for many
seniors and their families? Perhaps
for some -- if we can believe this
promise to "enhance" home care and
community support programs. But
we've heard these promises for more
than 20 years. This new strategy is
the "third stage" of Alberta's
continuing care policy, and it has a
lot in common with the "third way"
health proposals.
In 1988, the "New Vision for Long
Term Care" promised "increased
home care, more supportive-living
options and upgrades to long-term
care." So did the Broda policies in
1999. And we've learned that the
devil is in the fine print and it all
depends on government fiscal
priorities.
The "New Vision" succumbed to the
deficit fears of the mid-90s. And
Broda's been hijacked -- it turns out
that the words "seniors want to be
independent" meant to the
government that they prefer to shop
in the private marketplace for their
health-care needs (if they, or their
adult children, have the time, skills
and money).
Home-care services for seniors have
been cut to the bone and then
diverted to "sub-acute" care -- as
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have many nursing home beds -- so
that acute care hospital patients can
be discharged earlier. The "improved
assessments" have steadily raised
the bar for care needs to be
recognized. Support for family
caregivers is a referral to a private
care provider agency -- or maybe a
tax credit next year.
In many ways, Health Minister Ron
Liepert's strategy is an economic
bailout package for private-market
developers and service providers.
The "incentives" for the increased
shift to supportive living, the
"enhanced service options," and the
"equitable pharmaceutical coverage"
are good news for property
developers, private service providers,
and the insurance industry.
For seniors and their families
concerned about the long waits for
any level of care, the adequacy or
quality of the care they receive, the
cost of care no longer included in
public health care, and the increasing
level of cost and responsibility left to
families and charity, this new version
of the same-old strategy is not good
news.
Worse yet, prices of health-care
products and services are inevitably
higher in private markets.
"Aging in Place" -- or the new
version, "Aging in the Right Place" --
is a very catchy slogan. So is the
refrain of "choice." The shift to
community care is not only a good
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idea, but one that has worked
incredibly well in other countries.
They understood that what keeps frail
and ill seniors as well as possible is
providing a full range of publicly
funded comprehensive, co-ordinated
health and social care before the
situation requires emergency
intervention.
And they found that these preventive
measures reduced overall health-care
costs, as well as the need for nursing
home care for many seniors.
We do it differently here. We restrict
access to care, replace the nurse in
"nursing care" with personal care
aides, and reduce the number of
nursing home beds as the population
increases. We allow the wait lists for
urgent placement in every level of
continuing care to increase to crisis
proportions. We tell seniors they
won't have to pay health-care
premiums, "saving" each senior $500
a year --but we raise the income
eligibility levels for benefits and
increase nursing-home fees.
When the scarcity of care is wellestablished,
we tell seniors that they
need to be independent and
responsible for their own health, that
public funding for long-term care is
"unsustainable," and that more
subsidies to private providers will
give them more "choice."