Navigating the health care system in British Columbia can be particularly challenging for seniors, a situation exacerbated by various systemic and structural issues. These problems span across different aspects of healthcare, including long-term care, home support services, and the general accessibility and coordination of services.
Long-Term Care
Long-term care in BC has seen a shift towards a standardized funding model, a move that could potentially enforce better accountability regarding the use of public funds. However, over the past two decades, there has been a reduction in funding and access to seniors’ care, with a notable trend towards for-profit service delivery in long-term care facilities. This shift has led to a decrease in access to publicly subsidized units. Between 2008 and 2017, access to these units fell by 17%, resulting in subpar care for seniors over many years and a fractured system that struggled even before the COVID-19 pandemic.
The BC Seniors Advocate’s 2020 report “A Billion Reasons to Care” found significant differences in spending between for-profit and non-profit long-term care operators. Despite receiving the same level of public funding, for-profit operators spent about $10,000 less per resident annually than non-profit operators, with the designated public funds often being diverted to profits.
Home Support Services
Home support services are crucial for seniors who wish to live independently at home for as long as possible. However, access to publicly funded home support has consistently declined in BC since 2001. The decline in these services often results in a rapid deterioration of seniors’ health, overburdened family caregivers, and increased costs which push seniors into long-term care facilities earlier than necessary.
BC is one of the last provinces in Canada that still restricts access to home support by charging a fee. These co-payments represent a significant financial barrier to essential services. The Canadian Centre for Policy Alternatives (CCPA) points out that eliminating these co-payments would likely lead to a significant increase in demand for home support services, necessitating public investments but potentially reducing the overall burden on long-term care.
System Fragmentation and Confusion
The current home support system in BC is fragmented and confusing, making it difficult for seniors to navigate and access the necessary services. A recent investigation by BC’s Ombudsperson highlights these serious limitations. The CCPA suggests that a more comprehensive and better-coordinated system of home and community care for seniors can help alleviate these issues. It could enable seniors to live independent and healthy lives in their own homes and communities, reduce pressure on family members acting as caregivers, and lessen the strain on hospitals.
Policy Recommendations and Reforms
Several policy recommendations and reforms have been proposed to address these challenges:
- Increase Access to Services: There’s a need for greater access to home and community care services, especially home support and long-term care. Investments are required not only to keep pace with future growth in the senior population but also to expand availability in the short term.
- Integration of Services: Integrating home and community care with primary care services for seniors with complex health needs is crucial. Many basic home support services that seniors need are no longer publicly provided, leading to challenges in living well at home.
- Patient Involvement in Care: Encouraging greater patient involvement in decisions about their care can improve both the quality and cost-effectiveness of care. When patients with complex chronic conditions are empowered to manage their care, their health improves, and they use fewer hospital and physician services.
- Social Support as Integral to Care: Recognizing social support as a major determinant of health is important. High levels of social support and social connectedness can help seniors remain independent and healthy.
- Improve Public Reporting and Accountability: More transparent, accessible reporting on home and community care services, funding levels, and health outcomes is needed. This includes data on Alternate Level of Care patients, hospital occupancy rates, and hospital utilization.
Conclusion
The challenges faced by seniors in navigating the healthcare system in BC are multifaceted and require a holistic approach to reform. Improving long-term care, enhancing home support services, integrating different aspects of senior care, and increasing transparency and accountability are critical steps towards building a more senior-friendly healthcare system. Addressing these issues is not just a matter of policy but also a matter of ensuring dignity and quality of life for the aging population in British Columbia.
