https://thetyee.ca/News/2024/03/28/BC-Long-Term-Care-Funding-Review/BC Aims to Revamp Senior Care. The First Step Stirs Controversy‘Clearly there are a group of people who are benefiting from the current funding model,’ cautions seniors advocate.
28 Mar 2024 The Tyee
B.C. will pay a large international accounting firm up to $1.5 million to tell it how to redesign the province’s funding model for long-term care As the contract gets underway, critics worry the process is in danger of getting hijacked by business interests more invested in protecting their profit margins than bolstering public health care. In December the Ministry of Health signed a 43-page contract with PricewaterhouseCoopers to pay the accounting firm $319 an hour for financial and technical expertise to “support the phased development, implementation and evaluation of a standardized long-term care funding model for all publicly funded long-term care homes in the province.” The BC Health Coalition, which has more than 800,000 members and significant union involvement, received the contract in response to a freedom of information request. “The stakeholder engagement is now up to this contracted-out consultant who might not know the primary stakeholders in the communities that are being impacted,” said Ayendri Riddell, campaigner with the coalition. “The worst-case scenario is that the lobbyist group that represents the private long-term care providers, which is the BC Care Providers, would hijack this process and would be in charge of shaping these mechanisms that were supposed to be implemented to hold them accountable.” This scenario would represent “the fox guarding the hen house,” Riddell said. ‘The worst-case scenario is that the lobbyist group that represents the private long-term care providers, which is the BC Care Providers, would hijack this process,’ says Ayendri Riddell, a campaigner with the BC Health Coalition. Photo submitted. PricewaterhouseCoopers isn’t talking publicly about how it plans to proceed. Venkat Somasundaram, a Calgary-based partner with PwC who signed the contract, referred all questions to B.C.’s Health Ministry. The BC Care Providers Association confirmed it is participating in the process, but also directed questions to the ministry. “We are involved but are working under a nondisclosure agreement so any comments would have to come from the Ministry of Health,” spokesperson Jamie Lozano said in an email. A spokesperson for the ministry did not respond to messages asking for details of who PricewaterhouseCoopers would be consulting on long-term care. Opportunity to engage, says minister Health Minister Adrian Dix told The Tyee that hiring PricewaterhouseCoopers offered “an opportunity to engage and get the best possible information available so there was a common base of understanding.” The contract names seven PwC key personnel. Besides Somasundaram, they include Richard Ainley, a health-care consultant based in Australia, and Corrie Barclay, who was a senior official in the B.C. Health Ministry before joining the accounting firm. Dix said the BC Health Coalition’s concerns about the review getting hijacked were “incorrect.” ‘We want to make sure when we deliver long-term care that people deliver a high level of care everywhere, regardless of which care home you end up in,’ says BC Health Minister Adrian Dix. Photo via BC government. There are 30,000 long-term care beds in B.C. and the system has long comprised a mix of for-profit, not-for-profit and public providers. About two out of three beds are contracted out to either for-profit or not-for-profit providers. The remainder are owned and run by the province’s health authorities. Contracted long-term care homes are now all required to provide 3.36 daily hours of care to each resident and are funded to do so. They are also governed by a detailed and complex set of laws and regulations, and there are more than 200 conditions operators have to show they meet. Concerns about for-profit operators failing to provide the same level of care as other providers go back several years. In the February 2020 report “A Billion Reasons to Care,” B.C. Seniors Advocate Isobel Mackenzie found that despite receiving similar funding from the government, for-profit long-term care operators were spending about $10,000 less each year per resident than their non-profit counterparts. Those concerns became amplified in the early days of the COVID-19 pandemic when the government ordered that workers could only work at a single site to limit disease transmission. Responding to fears from private facilities that they would lose their workforce as employees opted to keep the positions that paid more, the government began providing $165 million a year for wage levelling to bring the pay at private facilities up to what workers would make in other facilities. To the BC Health Coalition, the top-up amounted to the private providers getting paid a second time to provide the care they were already supposed to be providing. The government gives all the homes enough funding to pay industry standard wages as set out in an agreement between the government and health-care unions, but as private homes aren’t subject to the agreement, this can lead to them underpaying their staff and shortchanging residents on hours of care in order to increase profits, said the BCHC’s Riddell. A September 2023 update to the “A Billion Reasons to Care” report found issues in the sector persisted. Looking at five years of financial reports, the Office of the Seniors Advocate found that in the 2021-22 fiscal year, not-for-profit facilities delivered 93,000 more hours of direct care than they were funded to provide, while the for-profits fell short by 500,000 hours. At the same time, the for-profit facilities made seven times as much profit as their not-for-profit counterparts. “Actually holding them accountable means there’s no profit in long-term care,” said Riddell. “We want public long-term care, ultimately, and not-for-profit, because we know those are the operators that actually operate well and are better for seniors and better for the workers. It’s very clear it’s the for-profits that are really creating the holes in the system and the worst quality of care is in those kind of facilities.” For example, a 2021 report from the Office of the Seniors Advocate found that there were more than twice as many COVID-19 cases in contracted homes (both for-profit and not-for-profit) per 1,000 beds as in the ones operated by the health authorities. NDP’s platform promises, review, delayed During B.C.’s October 2020 election, held in the first year of the pandemic, the BC NDP campaigned on improving long-term care. The party’s platform ahead of that vote said, “BC Liberals doled out hundreds of millions to for-profit corporations to create new care homes — and it failed miserably.” The platform mentioned four private care homes that were put under public administration for failing to provide the required levels of care and highlighted that for-profit care home operators had failed to deliver more than 200,000 hours of care the public paid them to provide. There was a need, the platform said, for “building better, public long-term care homes.” Dix said the work on reviewing the funding model, which would have begun much sooner if not for the COVID-19 pandemic, has started with gathering up-to-date information from providers. BC Boosts Pay for Long-Term Care Workers amidst COVID-19The ministry and health authorities consult with stakeholders like the Hospital Employees’ Union and the B.C. Health Coalition in many ways, he said in response to questions about who is being included in the review. “Obviously the issue around accountability and funding formulas for different care homes is not the only place that we consult on seniors’ services,” Dix said. “I’m sure the health coalition is supportive of the massive investment in public long-term care that’s unprecedented in recent history.” The health authorities spent $2.87 billion on long-term care in 2021-22, according to the seniors advocate, an amount that had increased 45 per cent over five years. The goal is to improve the sector broadly, Dix said. “We want to make sure when we make investments that they go to better care for seniors and others in long term care… and we want to make sure when we deliver long-term care that people deliver a high level of care everywhere, regardless of which care home you end up in.” Among the contract requirements, PricewaterhouseCoopers is to develop and recommend an approach to managing the change and to develop and implement “an evaluation framework to ensure the funding model objectives of equity, transparency, consistency and sustainability are achieved.” The province’s desired outcome, it says, is “the delivery of quality long-term care services to residents” where funding is aligned with its objectives “across all publicly funded long-term care homes in the province.” The contract says the parties all agree that PricewaterhouseCoopers “does not warrant that these outcomes will be achieved.” Focus on needs of residents, say advocates Observers say the results of PricewaterhouseCoopers’ review will depend on who the accounting firm talks to and whose interests are given priority. Isobel Mackenzie, who is retiring this month after 10 years as the province’s first advocate for seniors, confirmed she had been consulted as the review got underway. “I think it’s not moving as quickly as anybody was hoping it would move,” Mackenzie told The Tyee. “Whether it addresses the concerns my office has raised remains to be seen.” The province needs a funding model, Mackenzie said, that better reflects a focus on the needs of residents by introducing an incentive for the facilities receiving the funding to actually spend the money on delivering the care. “The funding model we have now doesn’t do that because we give them an amount of money and they keep whatever they can’t spend and I think we need to shift that,” she said. “I think there’s a belief that a new funding model will achieve that, but we’ll see.” Mackenzie said she expects it will be at least two years until the new funding model is ready to be implemented. Asked about the prospect of the review process getting hijacked, Mackenzie said she too is concerned that could happen. “Clearly there are a group of people who are benefiting from the current funding model,” she said. “It is not in their interest to change the funding model. I think that has to be explicitly acknowledged.” One organization that would like to be involved in the review but has not yet been brought in is the Independent Long-Term Care Councils Association of BC, an organization with provincial funding to help set up and support family councils at long-term care facilities. “We have not yet been contacted,” said the organization’s executive director Marc Tassé. “But we have been asking the ministry to push us forward and get us involved.” ‘We want to see that every dollar that’s spent goes directly to improvements of the quality of care,’ says Marc Tassé, the executive director of the Independent Long-Term Care Councils Association of BC. Throughout the review its essential to keep the focus on residents and their families and making long-term care as pleasant and humane as possible, Tassé said, adding that it would be a mistake to think the answer is to spend more on the system. “Talking to the family councils and looking at the results coming out from the office of the seniors’ advocate, even though we’ve got this almost 50 per cent increase in funding [over the last five years] we haven’t seen a dramatic increase in the quality of care within the long-term facilities,” said Tassé. “A lot of it is bleeding off into capital projects and other places that are not directly leading to improvements in quality of care,” he said. “We want to see that every dollar that’s spent goes directly to improvements of the quality of care and somehow significantly changes that process and improves it as we go forward and we’re not necessarily seeing or hearing that those improvements are coming through.” Funding that’s supposed to be spent on direct care should be spent on direct care, he said, and if it’s not spent on that then it should be clawed back. Tassé said it can make sense to bring in outside consultants that have expertise like PricewaterhouseCoopers to provide advice. “It also creates a sense of transparency and independence, so it’s not the people who are administering the budget that are doing the assessment of how effective the budget is,” he said. Another benefit, he added, is if the government doesn’t like the advice it ends up getting, it has some distance from it. The key will be in how much engagement the consultants do, and how far into the community they’re willing to go to ask questions, dig and analyze, Tassé said. It’s reasonable and even important that a group like the BC Care Providers Association be at the table, Tassé said, but the ministry should be pushing PricewaterhouseCoopers to make sure consultants reach out to other key stakeholders, too |
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https://globalnews.ca/news/9449535/b-c-long-term-care-standards/ B.C. already moving on new long-term care standards, but ready to do more: DixBritish Columbia’s health minister says the province has done much to improve conditions in its long-term care homes, but is ready to do more if necessary to meet new national standards released Tuesday.
“These are the most comprehensive standards that have ever been created in Canada, and it’s a real opportunity to really elevate the care we are providing for every single resident at every care home in the country,” said Dr. Samir Sinha, the chair of the technical committee that developed the updated standards. “We actually led the world with the highest percentage of deaths occurring in our long-term care homes (during the pandemic) basically because we were poorly staffing our homes across the country. We weren’t actually enforcing clear accountabilities towards standards, and it really made it clear we need to have better standards and we need to be better funding the care that actually occurs in homes.” The standards also call for more single rooms — both for privacy and improved infection control — improved pay for workers, and new guidelines for the design of care homes and practices to prevent infection. British Columbia’s current standards call for 3.36 hours of direct resident care per day, however about 80 per cent of care homes in the province are accredited, meaning one in five are not bound by those requirements. The latest health and medical news emailed to you every Sunday. “(B.C.) should follow the example of Quebec. Quebec has said this is the national standard, and they legislate their homes to all be accredited against the standard and to publicly report their findings as well,” Sinha said. The pandemic exposed significant flaws in Canada’s long-term care system, which was the site of more than 80 per cent of COVID-19 fatalities, accounting for over 17,000 deaths. British Columbia’s long-term care homes fared better than many provinces, but still experienced deadly outcomes. A 2021 report from the province’s seniors’ advocate found residents were 32.6 times more likely to die of COVID-19 than the general population. B.C. has made significant changes to the system since 2020, including wage levelling for long-term care workers and improved training and retention. It has also upgraded facilities to include better infection control, more single rooms and better ventilation. Health Minister Adrian Dix said many of the standards outlined in Tuesday’s report dovetail with work B.C. is already doing, including implementing resident and family councils to inform care. “Which is I think a big emphasis I think in this report, the need to ensure that the resident voice and the family voice be heard,” Dix said. “B.C. has gone absolutely in the direction of these standards, and we’re of course prepared to review this and do more if that’s required.” British Columbia’s seniors representative welcomed the new standards, adding she was pleased to see they centred around the rights of residents, the importance of family members, the focus on ensuring home-like environment and the discussion around autonomy and choice. But she said she still has concerns about how they will be applied. “How are care homes going to be monitored in their compliance with these standards, and what’s going to be the accountability if a care home does not meet the standards?” Isobel Mackenzie said. “You can have the best standards in the world. And arguably these could be. But they are meaningless if they are not enforced.” Terry Lake, CEO of the B.C. Care Providers Association, said the new standards showed the need for investment in two crucial areas: staff and infrastructure. He said the province had made “tremendous” investments on the labour side, with regards to training and wage levelling. But on the infrastructure, he said B.C. is lagging. While there are some new spaces in development in the province’s Interior, he said there has been little announced for the Lower Mainland or Vancouver Island. Not only does the province need new spaces to accommodate an aging population, he added, but it needs to replace aging facilities that aren’t up to modern infection control standards. “They don’t have air conditioning, they don’t have the ventilation systems that are needed, so there’s a lot of money that needs to be invested there,” he said. “Unless the federal and provincial government, and largely the provincial government, invest more money in care it simply won’t occur. I mean you will get more private spaces built, but it will be at the higher end of cost.” |
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https://www.cbc.ca/news/canada/new-brunswick/hospitals-struggling-beds-patients-1.7288968
Hospitals struggling to make a dent in beds taken by patients awaiting long-term careHorizon Health Network head says 'new assessment process' on the waySavannah Awde · CBC News · Posted: Aug 08, 2024 2:15 PM PDT
Horizon Health Network CEO Margaret Melanson said the number of alternate level of care patients has been a difficult issue to address. (CBC) Hospitals are struggling to reduce the number of people using hospital beds while awaiting long-term care, according to a regional health authority report. Alternate level of care (ALC) patients represent one of the biggest barriers to improving New Brunswick's health-care system, Horizon Health Network CEO Margaret Melanson said at a press conference Thursday. "This continues to be a challenge for us. So at this time there are some potential partnerships with the Department of Social Development. And we're looking forward to those hopefully moving forward in the months ahead," Melanson said. "However, at this point in time, I will be honest that we continue to have our ALC challenges, and we need to really address this as expeditiously as possible." Melanson made the comments as part of a quarterly update from the regional health authority
Horizon CEO Margaret Melanson says the health authority has been recruiting nurses, physicians and other health-care workers due to stronger marketing efforts. She said ALC patients are currently using about 35 per cent of hospital beds meant for acute-care patients. That's despite Horizon hospitals all sitting at or over 100 per cent capacity, Melanson said. The proportion of beds taken up by ALC patients has hovered around one third, with the same figure reported in earlier updates from the network in March and January. The network's report says a "new assessment process for ALC patients" will soon be rolled out in the Fredericton area. "This new process includes long-term care placement assessments, arranging interim home support services, and co-ordinating support services for patients transitioning back to the community or into long-term care facilities," the report says. "Horizon will oversee assessments for placing patients in community care settings in the Fredericton area.... This new assessment process is expected to expand to other Horizon hospitals in the future." The Department of Social Development was not immediately available to comment on Thursday. Horizon previously asked the department to put four Fredericton-region hospitals in a "critical state," where ALC patients are temporarily given priority access to long-term care placement but its request was declined. Physician recruitmentAs part of the quarterly update, Melanson also reported 65 physicians have been recruited since March, for a net gain of 44. She credited an "aggressive" marketing campaign and targeted communication with medical students across the country. Of the 44, 19 physicians will be employed in Moncton, 22 in Saint John, one in the Fredericton and Upper River Valley region, and two in Miramichi. Of the 65 new hires, 18 will work in family medicine and 47 in a specialty. Ten of the 18 newly recruited family physicians will work in Saint John, according to Horizon Health Network. (CBC) Horizon says six of those new family doctors will work in Moncton, 10 in Saint John and two in Miramichi. Over the same period, 14 family physicians and seven specialists left the network. Horizon reports that four family doctors were lost in Moncton, seven in Saint John, and three in Fredericton and the Upper River Valley. Horizon also reported higher wait times in emergency rooms for those triaged as urgent — at 169 minutes, up from the last report and significantly over the network's target of 30 minutes. Melanson said recruitment efforts should help bring that number down. "Having those emergency departments fully staffed is obviously the best way for us to achieve the reduced wait times to the level that we require," she said. "However, the other side of this is ... every day we have large numbers of individuals within our facilities who are admitted, require inpatient beds, and due to congestion issues and certainly the increase of ALC patients," she said. "We need to be better organized to have admitted patients move to patient units." ABOUT THE AUTHORReporter Savannah Awde is a reporter with CBC New Brunswick. You can contact her with story ideas at |
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https://beta.ctvnews.ca/local/british-columbia/2020/9/30/1_5127272.html
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https://bc.ctvnews.ca/b-c-ottawa-announce-733m-in-federal-health-funding-for-seniors-1.6765711
$733M in new fed funding for B.C. seniors welcome, but won't go far
“These are jobs that require human beings for and that direct person-to-person care is absolutely critical,” said federal Health Minister Mark Holland. Adrian Dix pointed out the province’s demographics are rapidly changing, with life expectancy growing as an exceptionally large portion of the population ages, meaning massive strain and demand on the health care and social supports seniors count on, and that’s why “the federal minister and the federal government working with the provincial government to increase and make improvements to the system.” But one of his predecessors is cautioning the public not to expect too much from what appears, at first blush, to be a massive number. “Health care can chew up dollars very, very quickly and seniors care is expensive,” said Terry Lake, current president of the BC Care Providers Association, who points out the provincial government has already plugged huge amounts of new money into seniors care. “Any new funds injected into the system will be welcome, but I think we have to be cautious that it's not going to revolutionize the system,” he said in a one-on-one interview with CTV News. “We still need to remind ourselves that the demand for seniors care is outstripping the supply and will continue to do so, so this is a start, but it's not going to turn everything around.” The Hospital Employees Union issued a statement applauding the funding, which they describe as going a “considerable way to continue improving access to proper, unrushed seniors’ care” but say “fragmentation” of the system has made the BC NDP investments less effective. CTV News asked Holland whether he had any expectations for numbers of beds opened or people hired with the funds. He said “the provinces, of course, are responsible for the administration of their health system, and our job is to be supportive in meeting their objectives,” but he expects detailed annual reporting on spending that he expects will demonstrate improvements in measurable outcomes. When CTV News pressed both ministers as to what they would do to attract workers to the health-care field in the face of a society-wide staffing crisis, Dix said they’re already expanding training spots, working to expand scope of practice to maximize impact, while speeding up credentialing of foreign-trained professionals. “The answer is not that we have to do one thing,” he said. “It's that we have to do all those things and more.” CTV News Vancouver Journalist
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