Strengthening Seniors Care: A Made-in-BC Roadmap#CareCanBeThere January 2017

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MESSAGE FROM THE CHIEF EXECUTIVE OFFICER

“MakingSuretheCareWillBeThere”

Withaprovincialelectiononthehorizon,BritishColumbianswillsoonbeaskedtodecidewhowillleadtheprovinceforthenextfouryears.Thereisnoshortageofsocialandeconomicchoicestocommandthepublic’sattention, but there is one issue that is having a significant impact onmanyBCfamilies.

Faced with the dual pressures of running their households whilesupporting aging parents, a so-called “Sandwich Generation” hasemergedwhose toppriority is theavailabilityof care forelderly familymemberstodayandintothefuture.

Newandincumbentcandidatesrunningforofficethisspringarewell-advisedtoacknowledgethissocietalshift.

WeknowthatBC’sseniorshaveworkedtheirwholelivescontributingtothesocialfabricofourcommunity,andoureconomy.They–andthefamilymemberswhosupportthem–deservetoknowthatthereisaplaninplace,thatisappropriatelyfunded,toensureourseniorswillreceivetherightlevelofcare,attherighttime,andintherightplace.

BeginninglastMay,theBCCareProvidersAssociation(BCCPA)kickedoffanimportantdiscussiononthefutureof seniors care. It startedwith the release of twomajorWhite Papers that outlined a number of new andinnovativeoptionstoreformthewaywedeliverseniorscareinBC.ThefirstreviewoftheWhitePaperstookplacesoonafter,atourannualconference’spolicyforum.

Thenfollowedawide-rangingconsultationprocess,whereweaskedthepublicandkeystakeholderstoweighinontheWhitePaperproposals–totelluswhichoftheconceptstheymostsupported,andhowtheyshouldbeimplemented.Wewerestruckbythefactthatover750BritishColumbianstookthetimetocompleteouronlinesurvey,withnearly60%ofthoserespondentsidentifyingthemselvesasseniors.

Next,onSeptember20,2016,BCCPAwelcomed140participantsrepresentingorganizationsandgroupsfromacrosstheprovincefortheinauguralBCContinuingCareCollaborative–ahistoricgatheringattheSFUMorrisJ.WoskCentreforDialogueinVancouver.Stakeholdersinattendancerepresentedcareproviders,aswellasindividual seniors and their family members, clinicians, non-government organizations, labour unions, theMinistryofHealth,theBCSeniorsAdvocate,andalloftheprovincialhealthauthorities.

Theday-longeventallowedparticipantstheopportunitytovoicetheirviewsontheproposalscontainedintheWhitePapers.Theeventwastheculminationofourfive-monthconsultationprocess.

Baseduponthefeedbackprovidedbyhundredsofrespondents,itbecameclearthatBritishColumbiansseetheprovisionofqualityseniorscareasanurgentpriority.

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Toaccomplishthisgoal,theBCCPAisreleasinganewreporttitled“StrengtheningSeniorsCare:AMade-in-BC

Roadmap”, which includes 30 strategic recommendations thatwill help guide government decision-makersresponsibleforthedeliveryofseniorscare.

BCCPAiscallingontheBCgovernmentforanimmediateannualinvestmentofupto$337milliontowardseniorscareoverthenextfiveyears.

Thisnewfundinginvestmentwill:

ü Invest inPeople:byimprovingseniors’accesstocareworkersbyensuringthateachresidentialcarehome is able toprovideaminimumof3.36direct carehours (DCH) forevery senioreachday, andincreasingtheminimumhomecarevisitsfrom15to30minutes;aswell,byfundingthedevelopmentofacomprehensiveprovince-widehealthhumanresourcestrategyaimedatretainingandattractingthenextgenerationofcontinuingcareandhomehealthworkers;

ü InvestinInfrastructure:bytargetingupto$100Mofexistingfederal/provincialinfrastructurefundingtowardtherenewalandreplacementofagingcarehomesacrossBC;

ü InvestinQualityofLife:byestablishinganewSeniorsQualityofLifeFundwhichwouldincreaseaccesstoprogramssuchasrecreational therapy,musictherapy,occupational therapy– forbothseniors inresidentialcareandreceivinghomecare;

ü InvestinInnovation:byincreasingseniors’choicetoselectserviceproviderthroughanewCareCreditmodel,andsupportthecreationofContinuingCareHubs.

OverthepastyearwereachedouttoBritishColumbiansfortheirviewsonseniorscareinourprovince.Itisthankstothemthatwenowhavethisroadmaptocreate21stCenturycareforBC’selderlypopulation.

Inthedaysahead,BCCPAlooksforwardtocollaboratingwithourelectedleadersintheBCgovernmenttobuilduponasystemofexcellenceinseniorscarethatnotonlyhonoursourelders,butensurescarewillbetherewhenweneedit.

Sincerely,

DanielFontaineChiefExecutiveOffice

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Special Recognition

TheBCCareProvidersAssociation(BCCPA)wouldliketoacknowledgeitsBoardofDirectors,foragreeingtosupportthisinitiativeanddedicatingthenecessaryresourcestomakeithappen.

• KarenBaillie,BCCPABoardPresident,CEOoftheMennoPlace• AlyDevji,BCCPABoardVicePresident,DirectorofHR/OperatorsforDeltaViewHabilitationCentre• RizwanGehlen,BCCPATreasurer,VicePresidentofFinanceforParkPlaceSeniorsLiving• BobBoulter,CEOofBeaconCommunityServices• AnnMarieLeijen,CEOofLoganManor• SueEmmons,ExecutiveDirectorofNorthcrestCareCentre• ElissaGamble,NationalDirectorofHomeHealthOperationsatBayshoreHealthCare• DebraHauptman,CEOofLangleyLodge• HenryLu,CFOofRetirementConcepts,• HilaryManning,GeneralManager,ChartwellMalaspinaGardensCareResidence• JoeMcQuaid,ExecutiveDirectorofAlberni-ClayoquotContinuingCareSociety• CelesteMullin,VicePresidentofGoldenLifeManagement• MichaelNuemann,ExecutiveDirector,ReveraLongTermCare• RonPike,ExecutiveDirectorofElimVillage• ElainePrice,DirectorofOperations,FraserValleyCareCentre• ShawnTerlson,PresidentandCEOoftheGoodSamaritanSociety• HendrikVanRyk,COOofH&HTotalCare

Anumberofindividualsalsocontributedtheirtimeandenergyindevelopingthispaper,andthebackgroundresearch.BCCPAwouldalsoliketogivespecialthankstotheEmergingIssuesandPolicyCommittee(EIPC):

• SueEmmons,EIPCChair,ExecutiveDirectorofNorthcrestCareCentre• KarenBaillie,CEOofMennoPlace• ElainePrice,DirectorofOperations,FraserValleyCareCentre• AlJina,OwnerandFounderofParkPlaceSeniorsLiving• ElissaGamble,NationalDirectorofHomeHealthOperationsatBayshoreHealthCare• GavinMcIntosh,DirectorofCorporateDevelopmentandAdministration,InsiteSeniorsCare• LenorePickering,ExecutiveDirector,HawthorneSeniorsCareCommunity

WewouldliketoacknowledgeBCCPA’spolicyteamfortheirhardworkanddedicationinthepursuitofanewandinnovativevisionforseniorscareinBritishColumbia:

• MichaelKary,DirectorofPolicyandResearch,BCCPA• LaraCroll,PolicyAnalyst,BCCPA

TheauthorsofthereportwouldalsoliketoacknowledgetheongoingsupportofthestaffatBCCareProvidersAssociation.

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About the BCCPA

TheBCCareProvidersAssociation (BCCPA)has representednon-governmentcareproviders for40years.Wehaveover300residentialcare,homecare,assistedlivingandcommercialmembersacrosstheprovince.Ourmembersprovidecareforover25,000seniorsannuallyandcreatingmorethan18,000directandindirectjobsacrosstheprovince.

About BC’s Continuing Care Sector

BC’sHomeandCommunityCarebudgetexceeds$2.0billion,whichisonparwiththefifthlargestMinistry.Overtwo-thirdsofallseniorscareintheprovinceisdeliveredbytheprivatesector–whichincludesbothfor-profitandnon-profitproviders.ManyofBC’sprivatecareprovidersarefundeddirectlybytheregionalhealthauthoritiestodeliverseniorscareservicesacrosstheprovince.

EXECUTIVE SUMMARY Seniorsmakeupthefastest-growingagegroupinCanada;in2010,themedianageinCanadawas39.7years,whileitwasonly26.2yearsin1971.1Thistrendisexpectedtocontinueforthenextseveraldecades;in2010,anestimated4.8millionCanadianswere65yearsofageorolder,butby2036thisnumber isexpected toincreaseto10.4million.By2038,BC’sseniorpopulationwillaccountforanestimated24to27percentofthe

population, with the proportion of seniors nearly fivepercenthigherthantheCanadianaverage.Furthermore,theMinistryofHealthreportsthatthepercentageofBCseniors over 80 years old will grow from 4.4% of thepopulationin2012to7.4%by2036.Atthesametime,itisprojectedthattheprevalenceofchronicconditionsforthose80orovermayincreaseby58percentwithinthenext25years.

Theagingof thepopulationwillput increasedpressureon thehealth system,due inpart to thegreaterprevalenceof chronicdiseases andmentalhealth issues,includingdementia.Thisisinpartbecausehealthservicestendtobeusedathigherratesasthepopulationages, with increased demand for home and residential care.2 In BC, the total public cost of subsidies forresidentialcarewereapproximately$1.7billionin2013,whichamountsfor10per centof theprovincial healthbudget. These costs are expected toincreasetoabout$2.7billionby2035.

Furthermore,inBritishColumbia,spendingonseniorsaccountedfor54percentofthe$9.2billionspentonhealthcareservicesin2009.TotaldemandinBCforhealthcareservicesbyseniorsisexpectedtoincreaseby41%overthenext10yearsfrompopulationgrowthandagingalone.Incomparison,demand for health services from the population under age 65 will only 1 Median age means that half of the population was older than that and half was younger. 2 BC Stats. British Columbia Populations 2012-2036 – September 2012. Retrieved July 10, 2013 from: www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx

“By2038,BC’sseniorpopulationwillaccountforanestimated24to27percent

ofthepopulation,withtheproportionofseniorsnearlyfivepercenthigherthan

theCanadianaverage.“

“….InBritishColumbiaspendingonseniorsaccountedfor54per

centofthe$9.2billionspentonhealthcareservicesin

2009.“

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increaseby13%.3 A2015ConferenceBoardofCanadareportnotesthattotalspendingoncontinuingcaresupportsforseniorsisprojectedtoincreasefrom$28.3billionin2011to$177.3billionin2046.Withnearlytwo-thirdsofthisspendinglikelytocontinuetobeprovidedbygovernments,spendinggrowthwillsignificantlyexceed the pace of revenue growth in mostprovinces.4

Overall, the province’s health system is notprepared to meet the challenges of an agingpopulation, as thehealth system inBC,muchliketherestofCanada,isstilllargelyacutecareorientedandnotoptimallydesignedtoprovidecareforthosewithongoingcareneeds,suchasthechronicallyillorfrailelderly.

British Columbia’s aging population, however,presents significant opportunities to enhancethe province’s economic strength bycapitalizingoncareproviders’ entrepreneurialspirit and enhancing the efficiency,sustainability, and quality of our seniors’ caresystem. Aswill beoutlined in this paper,with among thehighest average life expectancies and healthiestseniors’populationinCanada,thereisarealopportunityforBCtobecomealeaderinaging.

Theagingpopulationwillputadditionalpressuresonthehealthcaresystem,particularlyindealingwithmentalhealthandchronicdiseases.Alargepercentage(41%)ofCanadianseniors,forexample,aredealingwithtwoormoreselectchronicconditions,suchasdiabetes,respiratoryissues,heartdisease,anddepression,andmanyareexperiencingadeclineinphysicaland/orcognitivefunctioning.5Todealwithsomeofthesechallenges,theBCCareProvidersAssociation(BCCPA)outlinesapproximately30recommendationsfollowingthereleaseoftwoWhitePapersinMay2016andafterengaginginathoroughconsultativeprocesswhichculminatedintheInauguralContinuingCareCollaborative.

AsoutlinedattheBCCPAInauguralContinuingCareCollaborativeheldonSeptember20,2016whichfeaturedover150stakeholdersacrossthehomeandcommunitycaresectornowisthetimetoworktogethertofindsolutionstotherapidlyagingpopulationwhilealsoimprovingtheoverallqualityofseniors’care.

Redesigning theexistinghealth systemwithnewcaremodels andproviding targeted investments that canimprovecarewillbeanintegralpartofthisprocess.Inparticular,thereisaneedtoexplorealternativewaystosustainandinnovatetocreateahealthsystemsothatitislessacuteorientedandbetterdesignedtoprovidecare for those with ongoing care needs, particularly the chronically ill and frail elderly as well as thosewithdementia.

3BlueMatrix.BCMinistryofHealthData.4GregHermus,CaroleStonebridge,andKlausEdenhoffer.FutureCareforCanadianSeniors:AStatusQuoForecast.Ottawa:TheConferenceBoardofCanada,20155HealthCouncilofCanada.SeniorsinNeed,CaregiversinDistress(March2012).Accessedat:http://www.alzheimer.ca/kw/~/media/Files/on/Media%20Releases/2012/April%202012/HCC_HomeCare_2d.ashx

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Todealwiththechallengesofanagingpopulationin May of 2016, the BCCPA released twomajorWhite Papers outlining potential options toimprovesustainability and innovation for seniorsand the continuing care sector.v The first WhitePaper dealt primarilywith issuesaround fundingand financing of continuing care in order toimprovesustainabilityandenhancequalitywithinthe sector, including for care providers andseniors. While the second White Paper alsotouches on funding matters, it deals more withidentifyinginnovativeapproaches,focusingonfivekeyareasparticularly:exploringnewcaremodelsforseniors,improvingdementiacare,effectiveuseof technology, as well as enhancing the health,safetyandwell-beingof seniors (seeAppendix AofBCCPASupportingDocuments).

Alongwithbettermeeting theneedsof an agingpopulation, theapproachesoutlinedintheWhitePapers highlight potential ways to reduce acutecare congestion (includingalternate level of caredays)andERvisits,aswellasprovidingbettercarein the community for the frail elderly, includingseniors with chronic conditions and dementia.ThesearealsoallpriorityareasoftheBCMinistryofHealth.

TheBCCPAhasalsorecentlyfinishedasignificantpublicconsultationontheWhitePapersculminatingintheCollaborativeinSeptemberaswellasamajorpublicsurveyontheoptionsoutlinedinthepaper(seeAppendixBofBCCPASupportingDocuments).Overallthepublicsurveyreceivedconsiderableattentionincludingover750responseswithoverhalfbeingfromseniors.

AlongwithaligninginmanycaseswithBCgovernmentdocumentssuchasSettingPrioritiesfortheB.C.HealthSystem (February2014) aswell as the themesoutlined in theMinistry ofHealthPolicy papers released inFebruary20156 thispaperalignswithmanyof the concernsexpressedbytheBCSeniorsAdvocate, IsobelMackenzie,includinginareassuchasincreasingDirectCareHours(DCH)aswellasimprovingoverallqualityofcareforBCseniors.

Withinthe30recommendations,theBCCPAhasidentifiedthefollowingshort-term[1-2years]areaswhichwebelievehavesignificantpublicandstakeholdersupport.Theyarebrokenintofourkeyareasof investment:

6OnFebruary18,2015theBCMinistryofHealthreleasedaseriesofpapersonitswebsitecoveringfivebroadareasofthehealthsystemincluding:patient-centeredcare,healthhumanresources,ruralhealth,surgicalservicesaswellasprimaryandcommunitycare.

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Investing in People

• $230millioninannualfundingforcarehomestomeetaminimum3.36directcarehours(DCH)targetper care home per resident per day across BC; and increase home care visits to a minimum of30minutes.

• $20millioninannualfundingtouseexistingcapacityinresidentialcarehomesbyusingaportionof

under-usedresidentialcarebedsandtransitioningthemtoend-of-life(EOL)beds;andfurthersupporttheenhancementoftheMyCareFinder.cawebsiteasatooltobetteridentifyemptyresidentialcarebedsin“real-time.”

• $25millionContinuingCareHealthHumanResource (CCHHR)Fund tobe investedover5years to

addressthechroniclabourshortagescurrentlyfacingthecontinuingcaresector includinguptohalfofthefundingforeducation,trainingandresourcesforstafftoprovideimproveddementiacare.

Investing in Infrastructure

• EstablishanewResidentialCareInfrastructureFund(RCIF)of$100millionoverthreeyears,including:o $80Mtosupporttheimmediaterenewalandreplacementofolderresidentialcarehomes.o $20Mtosupport investments insmaller infrastructureprojectssuchassprinklerandceiling lift

installations,security,automatedmedicationmanagementanddatacollectionsystems.

Investing in Quality of Life

• EstablishanewSeniorsQualityofLifeFund(SQLF)tosupportqualityoflifeforseniorsinresidential

careandinthecommunity.AlongwithprovidingservicestocommunitytheSQLFwouldprovideupto$100 per month per senior living in a non-government operated residential care setting (totalapproximately$22millionperyear).

Investing in Innovation

• Allocateup to$2Mperyearto launchanewCareCreditsprogramwhichprovidesseniors [or thefamilymembersthatcareforthem]theoptiontoselecttheserviceprovideroftheirchoice.

• Investupto$28Mperyearoverthenextfiveyearstosupporttheintroductionand/orexpansionof

theCareHubconceptthroughoutB.C.

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While theoperational costs of these short-term initiatives are considerable including approximately $337millioninthefirstyear;giventheimportanceofseniorsandthefacttheProvinceofB.C.isforecastingsurplusbudgetsintothefuture,webelievethetimeisnowforthesecriticalinvestments.

Some of the funds required to undertake theseinitiatives could also be obtained by re-allocatingexistingHealthAuthorityacutecarebudgetstohomeandcommunitycare–anapproachalsoadvocatedbytheMinistryofHealth.7 Oneofthemajorthemesofthe BC Ministry of Health Primary and CommunityCarepaper released in February2015, forexample,was that existing expenditureswould be protected,while appropriate reallocations from acute tocommunity care services would become part ofhealthauthorityplanninggoingforward.

As outlined in the Quality-Innovation-Collaborationpaper (2015) the BCCPA has previouslyrecommendedthatHealthAuthoritiesredirectacutecareexpendituressuchasaminimumof1%annuallyoverafive-yearperiodtothehomeandcommunity

caresector.8Thispaperalsorecommendsthatstartinginfiscalyear2017/18,thePerformanceAgreementsbetween British Columbia’sMinistry of Health and Health Authorities should include a specific target forredirectingacutecareexpendituressuchasaminimumof1percentannuallyoverafive-yearperiodtothehomeandcommunitycaresector.

Asoutlinedinthispaperbyshiftingresourcesfromacutetocontinuingcare,thereisthepotentialforsignificantcostsavingsandotherbenefitsincluding:

7PrimaryandCommunityCareinBC:AStrategicPolicyFramework.BCMinistryofHealth.February2015.Accessedat:http://www.health.gov.bc.ca/library/publications/year/2015/primary-and-community-care-policy-paper.pdf8BCCPA.Op-ed:Quality,Innovation,Collaboration–StrengtheningSeniorsCareDeliveryinBC.October2015.Accessedat:http://www.bccare.ca/op-ed-quality-innovation-collaboration-strengthening-seniors-care-delivery-in-bc/

DidYouKnow?…shiftingonly1%oftheacutecarebudgetinBCtohomeandcommunitycarewouldallowforthedevelopmentof4,400newresidentialcarebeds;or8millionadditionalhomesupporthours;or12millionmorehome

carehours.

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Investing in People

$255M

Investing in Innovation

$30M

• Min3.36directcarehourspersiteperresident+min30minhomecarevisits$230Mperyear

Investing in Infrastructure

$100M

Investing in Quality of Life

$100 / senior

• Staffretentionandrecruitmentinitiatives$5Mperyear

• End-of-Lifecare$20Mperyear

• PersonalDirectedCareorCareCreditstoofferopportunitytoincreasechoiceforseniors$2Mperyear

• • CareHubsasopportunitytoage-in-placeandaccesscontinuumofservices$28Mperyear

• Agingcarehomerenewalandreplacement$80Mover3years

• Smallinfrastructuregrantsfor

ceilinglifts,automatedmedicationmanagement,security,datacollectionsystems,etc.$20Mover3years

• Increaseaccesstolifeenhancingtherapies.

• Enhancenutritionaloptionsandmealselectionforeachseniorinprivatepublicly-fundedresidentialcare

ü IncreaseChoiceü BetterHealthü HigherSatisfaction

TotalCost:$100perresidentpermonth

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• Improvingtheoverallqualityofseniors’lifeandcare,includingphysical,spiritual,psychosocialandmentalwell-beingintheirremainingyearsthroughtargetedinitiatives(i.e.RecreationalTherapy,Occupationaltherapy,Physicaltherapy,musictherapy,foodandnutrition,etc.);

• Ensuring the necessary resources, including human and physical infrastructure are available,particularlyinruralandremotecommunitiestoprovideappropriatecareandlivingforseniors;

• Keeping seniors in the community healthier including reducing levels of chronic disease andachievingbetterhealthoutcomes;

• Reducingunnecessaryhospitalizationsincludingseniorswhooccupyamore-costlyacutecarebed;• Minimizing the deterioration in physical andmental functioning that can occur among seniors

fromprolongedstaysinacutecare;• Improvingsocialengagementandreducinglevelsofseniors’isolation;• Bettermeetingtheneedsofagrowingelderlypopulationparticularlythosewithhighneedssuchasthe

frailelderlyanddementiacare;• Strengtheningtheroleandsustainabilityofthecontinuingcareincludingresidentialcare,assistedliving

andhomesupporttoreduceoverallhealthsystemcosts;• Findinggreaterefficienciesinthecontinuingcaresectorincludingpotentiallyexpandingtherolefor

non-governmentoperatorsandreducingunnecessaryregulations;• Improveddementiacareforseniorsincludingreducinglevelsofresident-on-residentaggression;• Improvingcollaborationandworkingrelationshipswiththecontinuingcaresector;and• Redirectingfundingfrommore-costlyacutetohomeandcommunitycare.

Pleasenote:allresearchandanalysistoformthebasisofourrecommendationsisdetailedinasupportingpaperavailableatwww.bccare.ca.

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SUMMARY OF RECOMMENDATIONS Section 1: Sustainable Long Term Funding IMMEDIATE TERM (1-2 YEARS)

1. ThattheBCgovernmentimmediatelysupportaminimum3.36DirectCareHours(DCH)targetpercarehomeperresidentperdayacrossBC;andthatcarehomesberequiredtoreportannuallyonhowtheyaremeetingthe3.36DCH,includingcurrentlevelsofDCHandanystepstakentomeettarget.

2. ThatastandarddefinitionofDCHbedevelopedby theMinistryofHealthandHealthAuthorities inpartnershipwiththesectorby2017.

3. ThattheBCGovernmentestablishanewResidentialCareInfrastructureFund(RCIF),whichwould:

• supporttheimmediaterenewalandreplacementofolderresidentialcarehomes;

• supportinvestmentsinsmallerinfrastructureprojectssuchassprinklerandceilingliftinstallations,automated medication management, online training technology, security and data collectionsystems;and

• investinenhancementsforimprovingdementia-friendlyenvironmentswithinexistinghomestomakethemmorehomelike.

4. ThattheBCMinistryofHealthundertakeanimmediatereviewoffundingliftsinallHealthAuthoritieswiththegoalofconsistency,fairness,andsustainabilitywithrespecttoperdiemrates.Thisincludesa process for providing greater transparency andprovince-wide standardization in respect to howfundingliftsprovidedforhomeandcommunitycarearedetermined.

5. ThattheBCgovernment,workingwithmunicipalities,exemptpropertytaxesforresidentialcarehomesto allow non-government operators to recoup capital operating expenses and further encourageprivateinvestmentinthecontinuingcaresector.

MEDIUM TERM (3-5 YEARS)

6. That the BC government and Health Authorities work with care operators to develop home andcommunitycarefundingmodelsthatareresponsivetoandappropriatetotheacuityandcomplexityofclients incare,aswellasadhering to thecoreprinciplesof timeliness, sustainability,equityandtransparency.

7. ThattheBCgovernment,inconsultationwithoperators,develophomeandcommunitycarefundingmodelsthataccurately factor in increasestooperatingcosts includingwages, inflation,overheadaswellasotherareassuchasincreasinglevelsofacuityamongresidentsandclients.

8. ThattheBCgovernmentworktowardstheestablishmentofalong-termpredictablefundingmodelbyendoffiscal2020thatisoutlinedinanycontractarrangementswiththehealthauthorities,includingmorelong-termbudgetingwithincreasestoperdiemratesoutlinedovera3to5-yearperiod.

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9. ThattheMinistryofHealthandtheHealthAuthoritiesfullyhonour negotiated funding agreements by recognizingincreasesinlabour-marketcoststocareproviderstolevelsatleastconsistentwiththemastercollectiveagreement.

LONG TERM (5-10 YEARS) 10. ThattheBCgovernmentremovetheperceptionofa

conflictofinterestbyimplementingafundingmodelthatseparatesthebodiesthatfund,allocatefundsandregulatecarehomesfromthosethatoperatecarehomes.

Section 2: New Funding Models and Approaches

IMMEDIATE TERM (1-2 YEARS)

11. ThattheBCgovernmentintroduceaCareCreditorPersonalDirectedCaremodelinthehomecaresectorandundertakeastudyincludingpossiblepilotprojectontheirpotentialuseinresidentialcare.ThestudyshouldanalyzebestpracticesfromCommunityLivingB.C.whichofferstheirclientsdirectopportunitiestoselectthecareprovideroftheirchoice.

MEDIUM TERM (3-5 YEARS) 12. ThattheBCMinistryofHealthundertakeacomprehensivereviewoftheoutcomesandlessonslearned

in the use of activity and outcome-based funding for provision of home and community care,particularlyreviewinganyresultsfromAlbertaandOntario’sexperimentationwiththeseinitiatives.

13. ThattheBCgovernmentreviewexistingco-paymentsforcontinuingcaretoensurethattheybetterreflectactualcostsofdeliveringcareandaresident’s/client’sabilitytopay,whileensuringseniorswithlowerincomesareprotected.

Section 3: New Continuing Care Models

IMMEDIATE TERM (1-2 YEARS)

14. Thatasakeypriorityany futureBCContinuingCareCollaborative reviewoptions fornewdeliverymodelssuchastheContinuingCareHubtoreduceacutecarecongestionandERvisitsaswellasbettercare for frail elderly and seniors with chronic conditions and dementia. In particular, the BCgovernmentandHealthAuthoritiesshouldexpandand/orintroducetheContinuingCareHubmodelinruralareastoincreasethelevelofmedicalandsocialservicesprovidedtoseniorsinthecommunity.

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MEDIUM TERM (3-5 YEARS) 15. ThattheMinistryofHealthsetasatargetbytheyear2021tohavenomorethan5%ofacutecare

bedsoccupiedeachdaybyseniorswhohavebeenassessedascapableofbeingtransferred intoamoreappropriateresidentialcareorhomecaresetting.

16. That theBC governmentaccelerate theadoption of newelectronic information systems, includingelectronichealthrecordsandtelehealththatfacilitatethesharingofresidentinformationacrossthecontinuingcaresystem–includingprivatecareproviders.

17. That theBCgovernmentconsider implementingsystems thatbetterenablepatient information toflowthroughthehealthcaresystemwiththeresident,particularlythesharingofinformationafterapatient’sreturnfromahospitalstay.

Section 4: Health Human Resources IMMEDIATE TERM (1-2 YEARS)

18. That theBC governmentestablish aContinuingCareHealthHumanResource (CCHHR)Fund tobeinvestedover5yearsandpotentiallymatchedbytheFederalGovernmenttoaddress theneedforstafftrainingandchroniclabourshortagescurrentlyfacingthecontinuingcaresector,including:

• fundingforarenewedBCCaresProgrambetweentheBCMinistryofHealth,HealthAuthorities,the

HealthEmployersAssociationofBCandBCCPAtoimprovetherecruitmentandretentionofcareaidesandotherkeyhealthprofessionalswhoprovidefrontlinecontinuingcare;

• fundingforaBCBehaviouralSupportsProgram(BCBSP)betweentheBCMinistryofHealth,HealthAuthorities,Alzheimer’sSocietyofBCandSafeCareBCtoprovidetraining,educationandresourcestoimprovedementiacareprovince-wide;and

• generaldementiacareeducationforcareprovidersandsupportstaff.

Section 5: End-of-Life Care

IMMEDIATE TERM (1-2 YEARS) 19. ThattheMinistryofHealthandHealthAuthorities,betterutilizeexistingcapacityinresidentialcarehomes

byusingaportionofunder-usedresidentialcarebedsandtransitioningthemtoend-of-life(EOL)beds.Tomeettheprovincialgovernment’scommitmenttodoublethenumberofsuchbedsby2020,between100 and 150 new EOL beds should be established within residential care homes by 2020 with theremainingaddedtoexistinghospices/hospitals.

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MEDIUM TERM (3-5 YEARS) 20. ThattheBCgovernmentsupporttheadoptionofnewpalliative/EOLcaremodelsincluding,where

necessary,providenewfundingtoimprovetheintegrationbetweencontinuingandend-of-lifecare.

21. ThattheMinistryofHealthandHealthAuthoritiesworkwiththeBCCPAandotherstakeholderstodevelopstrategiestobetterutilizetheexistingexcesscapacityinthecontinuingcaresectortoincreasecapacitywithrespecttoend-of-life(EOL)care.

Section 6: Seniors Well-Being

IMMEDIATE TERM (1-2 YEARS) 22. ThattheBCgovernmentestablisha

newSeniorsQualityofLifeFund(SQLF)tosupportqualityoflifeforseniorsinresidentialcareandthecommunity,whichfocusesonimprovingthephysical,spiritual,psychosocialandmentalwell-beingthroughvariousinitiativesincluding:

• Increasedaccesstorecreationaltherapyaswellasoccupationalandphysiotherapy;

• IncreasedaccesstoabroadarrayoftherapyprogramssuchasConcertsinCareandSingforYourLife,bothinresidentialcareandthebroadercommunity;

• Reducingseniors’isolationthroughincreasedAdultDayandsimilarprograms;

• Maintainingandenhancingtheoverallqualityoffoodandnutritioninresidentialcarehomesincludingmeetingtherapeuticdietrequirements(currentlytheaveragecarehomeallocatesapproximately$6perdaytofeedeachresident)andprovidingculturallyappropriatemealoptions;and

• RegularreportingbytheMinistryofHealth, includingwhatinitiativesarebeingundertakenthroughtheSQLFandhowtheyareimprovingtheoverallqualityoflifeforseniorsinBC.

23. That the Health Authorities increase the minimum home care visit time from 15 to 30 minutes.

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MEDIUM TERM (3-5 YEARS) 24. ThataspartofanyContinuingCareCollaborativeitincludesapermanentsub-committeetodealwith

theuniqueandconsiderablechallenges facingthehomecaresector includingareviewof funding,unfundedserviceexpectations,travelcostsandimprovingqualitycare.Likewise,thissub-committeeshouldexploredifferentinnovativemodelsinhomecaretodeterminetheiruseoradoptioninBritishColumbia.

25. ThattheBCgovernment,workingwithstakeholders,developacollaborativeProvincialSeniorsSafetyStrategywhichcouldfocusonspecificissuesincludinguseoftechnology,fallsprevention,resident-on-residentaggression,reducingadversedrugevents,suicideprevention,elderabuseand/orsafetywithinhomeandcommunitycare.

Section 7: Shifting Resources from Acute to Home & Community IMMEDIATE TERM (1-2 YEARS)

26. Startinginfiscalyear2017/18,thatthePerformanceAgreementsbetweenBritishColumbia’sMinistryofHealthandHealthAuthoritiesincludeaspecifictargetforredirectingacutecareexpendituressuchasaminimumof1percentannuallyoverafive-yearperiodtothehomeandcommunitycaresector.Alongwithsupportinginitiativesoutlinedearlier,suchexpendituresshouldbedirectlyreinvestedintoresidentialcareandhomecare/supporttodealwithexistingcostpressuresfacingserviceprovidersaswellassupportdevelopmentofnewcaremodelsparticularlyContinuingCareHubstoreduceacutecarepressures(includingALCdays),improveaccesstocarewhilealsoallowingseniorstoreceiveservicesinthemostappropriatesetting.

Section 8: Federal Role in Seniors Care IMMEDIATE TERM (1-2 YEARS)

27. ThattheprovincialgovernmentaspartofanynewHealthAccordadvocatethatthefollowingelementsbeincluded:

• Theestablishmentofanage-adjustedCanadaHealthTransfer thatreallocates funding toprovincessuchasBritishColumbiawithhigherandgrowingportionsofseniors;

• Newand/orreallocatedfundingtoimprovecapacityandbuildinfrastructure,reducewaittimesandsupportnewcontinuingcaremodelsforresidentialcareandhomesupport;and

• MeetcommitmentsoutlinedinthefederalLiberalplatformincludingalong-termagreementonfunding;invest$3billionoverthenextfouryearstodelivermoreandbetterhomecareservicesforallCanadians;developapan-Canadiancollaborationonhealthinnovation;aswellasimproveaccesstonecessaryprescriptionmedications,particularlyforseniors.

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MEDIUM TERM (3-5 YEARS) 28. British Columbia endorse the advancement of a National Dementia Strategy with federal

participation which should include investing in research and ensuring capacity and appropriatefundinginthecontinuingcaresector.

29. As part of any National or Provincial Dementia Strategy the BC government explore, whereappropriate,thecreationofnewcaremodelsorinitiativestosupportseniorswithdementiaincludingbut not limited to Dementia Villages, Butterfly Care Homes and Dementia Friendly Communities(DFCs). Where appropriate, the Residential Care Infrastructure Fund should also be provided tosupportthedevelopmentofsuchinitiativesincludingretrofittingexistingcarehomesaspartofanystrategytocreateDFCs.

30. BC work with other provinces to advance the development of a National Seniors Health Promotion

Strategy, which could outline various strategies to promote seniors physical and mental well-being,includingoutliningbestpracticesamongjurisdictions.

LOOK FORWARD TO SEEING YOU!40th Anniversary

Annual Conference.

Fairmont Chateau Whistler, May 28th-31st 2017.