From the Smoky Lake Signal, November 28, 2001

Lakeland Regional Health Authorities Continuing Care Forum

The forum in Smoky Lake, of elected officials, doctors and community Health  Council members was to allow Lakeland RHA to get their input on developing the plan. While the fear across the province is that aging baby boomers will overload the present system, in fact only 15% of Lakeland's population will be over 65 by the year 2016. It will take 30 years before 25% of the population is that old. Most of the baby boomer population left the area long ago, although some are starting to return.

Mayor Carole Carpenter welcomed the forum to Smoky Lake, the Pumpkin Capital of Alberta. "We're here to discuss what continuing care will look like in our community in the next ten years. We know the meridian age of the population of Canada is rising. Seniors expectations vary, but generally they want to remain in their homes and in their communities. They don't want to move away from family and friends, and all that is familiar when they are most vulnerable."

Ernie Isley, the new chairman of the board of Lakeland Regional Health Authority said they are beginning phase two of the continuing care plan and this was the first of a series of consultative opportunities to give input into what continuing care should look like in the future. "We are trying to develop healthy environment for elderly people so they can live in dignity and respect."

The Broda Report

MLA Dave Broda, now in his second term, explained his report. He chairs the Healthy Aging and Continuing Care Implementation Advisory Committee, along with his other position as chair of the Council for Alberta Ukrainian Relations. He is also a member of other committees: Public Accounts, Members Services, Health and Community Living, Law and Regulations, Agriculture, Environment and Rural Affairs.

Born in Waugh to Ukrainian immigrants Mike and Annie Broda he was owner of Choice One Real Estate Ltd. in Redwater before being elected. He was previously an auction clerk for Prodaniuk's, and a draftsman for Butler Buildings.

Dave Broda said he is proud of his strategic plan for healthy aging. It's the result of a lot of collaboration and research by the long term care committee. It recognizes that where people live, and therefore their ability to maintain contact with family and friends, is part of healthy aging. He's now chairing the committee to implement some of the recommendations that came out of the Broda Report. The health system is facing changes as a result of technology, an aging population and a shift to community based multi-disciplinary care. The changes create challenges and opportunities.

In 1997, when Dave Broda was first elected, the health minister of the day, Halvar Jonson, appointed Mr. Broda to chair the long term care committee to decide where the province is heading in the next 10-25 years. By the year 2015, one in four Albertans will be over age 65. After consulting with 1,700 individuals in the two years, the committee heard people say they want continuing care services to be there when they need them. The committee also got advice on continuing care from across Canada and around the world. Then they employed KPMG to conduct an analysis on the impact of various scenarios, to identify specific policy implications.

Mr. Broda's committee developed a vision on how aging in the 21 century should look like in Alberta. "In the 21 century, all Albertans will be treated with respect and dignity. They will have access to information that allows them to make responsible choices regarding their health and well being. Lastly, they will be able to achieve quality living, supported as needed by relatives, friends and community networks and by responsive services and settings."

In Alberta, according to Mr. Broda's report, quality living for seniors will come from being supported by relatives and friends. For some it is a scary vision. The Broda committee envisions that establishing healthy aging is a priority of government.

"For example," said Mr. Broda, "there has been little priority in the past placed on healthy promotion and accident prevention for the elderly. Another difference, in the past, services for seniors have been attached to sites and buildings. In the future, services will be unbundled, we will bring the services to the people. The range of services can be provided in any setting, a home, in supportive living units or in long term care centers. The priority will be having seniors remain in their own homes. Albertans have told us they want a variety of choices open to them, something they haven't had in the past. Usually their choices were staying at home or being admitted to a long term care center. In the future the majority of seniors will receive services at home or in supportive living. Long term care centers will be reserved for those with the highest and most complex medical needs.

"The report also promotes a single point of entry program to coordinate access to services for seniors. What we found was limited linkage between seniors, acute care services, housing and other agencies. Streamlining will mean clients are referred to the most appropriate and least costly service," said Mr. Broda.

Health Care Forum

Mr. Broda said his report suggests increasing the number of skilled health care providers for seniors by providing more training. Pharmacists will be involved even more. They are the ones who provide the medications after they are prescribed by physicians.

The report also noted that the long term care buildings are out of date. A new generation of continuing care centers with improved designs, responding to residents with higher care needs will be built.

Mr. Broda said his healthy aging report is unique in Canada. Of the 50 recommendations presented to the minister, 47 have been accepted.

Mr. Broda said he has had a lot of questions as to when it will actually be implemented. He points to increased home care already as a positive step, and there have been some new facilities built: Aspen House in Morinville is one. The community received it welcomely. It's an assisted living unit, and we're looking at funding more dollars into Aspen House. One thing it is lacking, said the MLA, is an Alzheimer's unit. There's an announcement coming shortly to enhance the facility.

Aspen House, although Mr. Broda didn't mention it, is a privately owned facility (owned by some Calgary lawyers) that recently saw the management company running it go bankrupt, along with its partner, Heritage House in Vegreville. They were early examples of private enterprise that didn't work.

Mr. Broda talked about the need for a paradigm shift in the way the Alberta health system responds to the need of a new generation of older people. The recommendations in my report, said Mr. Broda, describe a very different future for seniors in this province.

The report recommended three streams for seniors - a home living stream, a supportive living stream, and a facility based stream. The three streams would work in partnership with one another to support seniors no matter which living stream they have chosen. Home living will be the most prominent.

Throughout our consultation, the new generation of seniors told us they want to stay in their own homes as long as possible. Seniors can stay in their own homes longer with the support of more community services. This will lessen the number of people needing institutional care.

In the past, we grew up in a system where once older people had health problems, they could stay in a hospital or move to a long term care facility. Other options, like staying at home with the support they needed, was not available. In the future people will move to long term care centers only when it's no longer appropriate or cost effective for their assessment needs to be met at home. Hospitals will only be for acute episodes of illness and injury. Seniors will also be able to choose to buy additional services beyond their assessed needs, said the MLA.

Alberta has taken a leadership role in the single point of entry system, which will be renamed coordinated access. People's needs should be assessed only once, said Dave Broda, and it should lead to the most appropriate continuing care program.

It sounded to some like a formula for a two tier health care system for seniors.

Supportive Housing

The committee recommended an expanded role for supportive housing, but only after expanded home care services are available. The demand for supportive housing will increase with the aging population. They will not replace long term care centers, those centers will still be needed.

Supportive housing is appropriate living for the frail and older adults who do not need the services of a residential care facility, said Mr. Broda. The types of privatized housing will vary from those providing minimal services such as property management and security to assisted living arrangements where health and social services are provided as well. The committee recommended the expansion of home care and community care services. Their services can be provided in any of the three streams - home, assisted living or long term care facilities. RHAs may choose to block fund so care services are managed by the private operators of the supportive housing units.

The Broda Report also suggests providing for people with Alzheimer's Disease and other forms of dementia.

To implement the new direction, it is important to have the essential supports in place, said Mr. Broda. Comprehensive legislation, well trained professionals, transportation, ambulance services, research technology and drugs, as well as appropriate funding levels are needed.

"I know," said Dave Broda, "that in rural Alberta we have some inequities. Ambulance services and transportation are an issue to be resolved."

Premier Ralph Klein has announced a six point plan for health, in response to the Broda Report. It improves access to health and community care. It increases emphasis on wellness promotion, disease and accident prevention, and it will provide support to Albertans so they can age in place and remain in their communities as long as possible. $40 million was provided to expand long term care and home care in Alberta, and to support the plan for healthy aging. The money has paid for in service education and a new provincial Alzheimer's initiative.

In November of 1999, $265 million was allocated for capital investment. A lot of communities have also put in requests for continuing care beds. Thorhild is getting a little closer, but with cutbacks it may be held back a bit, said Mr. Broda.

"There is also great need in St. Albert. Most rural seniors are going to cities to live. We need to address those issues," said Mr. Broda. "I have met with a couple of contractors, builders and developers. It looks like we'll see more supportive housing coming out to rural Alberta. But we have to look at the initiatives that are there."

$37.1 million has been provided under the "Hapi" fund, to expand supportive housing spaces in rural Alberta.

Hapi is the Health Aging Partnership Initiative, well named to keep private developers happy through government funding to privately owned centers.

Another $4 million has been allocated to provide the drugs to assist Alzheimer's patients. It is not a cure, but it alleviates some of the advancements of the Alzheimer's Disease, said Mr. Broda. $15 million was provided to address immediate pressure points, to enhance home care and long term care services.

In 1999, $3 million was allocated to the palliative care drug program for people receiving palliative care at home. If an individual chooses to spend their last days at home, the drugs should be provided by the government free to patients at home, just as they are in institutions.

If we want to ensure the continuing care system is sustainable, we have to look at whether the requests are sustainable in the future.

Another key word, said the MLA, is cross ministry initiatives, whether it is health, housing or education, we all have a role to play. Some of the silos that were there before are coming down. A continuing care system that is consumer focussed, integrated, accessible, equitable, and affordable now and into the future is the goal.

Health Strategy

Carol Thorowsky, a health strategy consultant with Alberta Health and Wellness, a former registered nurse at the forum, explained that the baby boomers have just started to turn 55 this year. The baby boomers have different lifestyle expectations than other aging groups in the past. It's anticipated that baby boomers will be healthier, have more disposable income, but we should keep in mind, said Mrs. Thorowsky, that there is a disparity between the rich and the poor. We have to change methods of delivering health care services to seniors.

Lakeland region now has 127 facility based beds per 1,000 population for age 75 and older. The average in the province is 109 beds. Only North Western RHA has as many beds, and only Peace RHA, with 155 beds has more. According to the RHA stats, Ontario has 92 beds per 1,000 age 75 and over patients. Prince Edward Island has 110, Quebec has 113, Saskatchewan has 118, and Manitoba has 126.

The Smoky Lake County has a population of 1,015 who are over age 65. There are 54 continuing care beds available for them. That works out to 53.2 beds per 1,000 population for seniors age 65 and older.

The highest is Fort Saskatchewan. They are a larger, but younger community, with 1,080 of their population age 65 and over, and 84 beds for a ratio of 77.8 beds per 1,000.

Bonnyville with 2,335 seniors has 150 beds available or 59.2 per 1,000. St. Paul County, with 1,870 seniors and 133 community care beds, has a 71 bed per 1,000 ratio.

The long term occupany rate is 99%. There is a waiting list for long term care beds. 32 seniors now in acute care are waiting for beds, 60 are still living in the community, for a waiting list of 92 people.

In the lodges, the vacancy rate this year is 6.7%. There is a waiting list of 229 people.

In the Lakeland region there are 607 spaces in self contained and cottage units, six adult based support sites, 720 lodge units and 11 Alzheimer's care units, all at Myrnam. There are 80 assisted living units.

In facilities there are 714 continuing care beds, 32 respite beds, 12 specialty geriatric beds in Two Hills.

The Lakeland district has approximately 13,000 seniors age 65 and over, over 5,000 seniors age 75 and over.

Bruce West, director of Housing, Innovation and Policy, for Alberta Seniors Ministry, said the issues include a lack of housing options between lodges and long term care. There are few housing options at all in smaller communities, and there is a shortage of affordable housing in the major urban communities. Too many couples are separated when spouses require long term care.

In rural communities there is a lack of transportation. There needs to be better coordination of discharges between hospitals and senior centers. You can't just send the patient out without a place to go.

There is also a lack of standards for private care in Alberta. The continuing care framework has three streams. Home living is for seniors who want to remain in their own homes, supported living is the second stream. These are the privately owned facilities that are now making a business of looking after seniors. To qualify they must provide basic support services on site with at least one meal a day. There must be common areas available and 24-hour, 7 days a week, monitoring for safety and security.

The facilities owned by the government are under the Nursing Home or Hospital Act and provide 24-hour RN service. The facilities are especially designed and built to much higher standards. These are the nursing homes and the auxiliary hospitals that the province wants to designate only for the seniors who truly need them for medical reasons.

One of the issues for the privately owned supportive housing is who pays for what, and what happens when people can't pay, said Bruce West. A problem is how to support low income seniors. They now live in lodges, but the provincial government is building no more lodges. Today, half the cost of any deficits in the lodges are born by the local municipalities. In the future the provincial government is trying to get the non-profit and the private sector to build more senior housing. How will they house low income people in a facility when it costs $1,500 a month to operate, which is $300 more than a low income senior earns in pension. Should the government fund the facilities or should the funding follow the seniors?

The seniors minister, Stan Woloshyn believes the funding should follow the seniors, so they can choose where they want to live, explained Bruce West. The problem therefore, is how do you encourage the development of seniors housing in rural communities, where there isn't enough market to attract private investors.

Following the Broda Report they are hoping to move up to 80% of seniors out of the long term care system. The health authority has to be comfortable in knowing there will be a place for the people who they are responsible for. Housing and Health have to coordinate it, said Bruce West.

Over the last three years, $50 million has been allocated for supporting the development of new supportive living facilities (privately owned). The Healthy Aging Partnership Initiative recognized that they are not getting a lot of development in rural communities. The government will have to do something to encourage that development, said Mr. West.

We are getting a lot of development for high end supportive living facilities in the cities, but not a lot of affordable stuff.

Much of the funding for supportive housing is now coming from municipalities. They are responding to the needs in their communities, and there is a lot of involvement in volunteer organizations as well. This added obligation is not what local councillors at the meeting wanted to hear.

Vilna Lodge, said Mr. West, is a good example of ways of taking a facility that was largely vacant and by providing higher services, it has met both the needs of the people in the community and the individuals. Other examples include the Bonnyville Lodge, which has a SHIP grant, to provide new services.

What am I saying? said Mr. West. Vilna is the problem. The vacancy is there. It's Myrnam I was thinking of when I was describing a good solution. Vilna we still have to work out.

The Smoky Lake Seniors Foundation in charge of Vilna has been asking that enhanced medical services be available at Vilna Lodge to solve the vacancy problem, but so far Lakeland RHA has not agreed. Obviously they knew the problem.

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