Dismantling AHS: continuing care in Alberta

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The perennial complaint is two fold: there aren’t enough continuing care beds, and the ones that do exist are understaffed.

It means families are waiting months, if not years, to get elders a room in a long-term care facility, and it’s affecting bed space in hospitals, which in turn lead to longer wait times for other patients.

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The system across the country is being squeezed.

“And it has been for a long time.”

To fix the system, leaders need to be strategic and integrated in their planning, said Rachlis.

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There are several arms of continuing care, from home care, to supportive living, to facility-based long-term care.

When it comes to continuing care, Rachlis said “the best models have integrated funding and integrated governance.” 

The danger is that decision-making becomes even more siloed. 

“That will make things worse. Things are already bad, but this will make things worse.”

“You can’t run continuing care without family doctors and nurse practitioners.”

The devil will be in the details of how that governance structure will work. He’ll be watching to see if the system will support models of care like The Good Samaritan Society’s Comprehensive Home Option for Integrated Care for the Elderly (CHOICE) program.

“Those are the kinds of programs that one would want.”

As in Ontario, Alberta could look to contract out more services to private for-profit facilities out than ever before.

“So you’re going to get a race to the bottom,” when what is needed is wage parity between the community sector, acute care, and long term care.

“The business interests in health care are very well positioned,” said Rachlis.

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Much stronger primary health care that is integrated COMPLETELY with the other care they need.

GO TO ORGANIZATIONS TO SEE IF THEY”LL BE SUPPORTED. If they’re not going to do well, then it’s not going to work any where.

“You dont need doctors all the time, but when you need them they need to be under the progrmam completely.” Cant use independent physicians.

“We know if you put more resources into primary and community care you save money on acute care hospitals and also nursing homes. And if you put more resources into nursing homes, e.g. the nurse practitioner program in Ontario TC facilities, you save on hospitalization (and death!). 

“What would happen to a patient in CHOICE with a urinary tract infection under the new model?”

Look at vulnerable patients…start asking – if they’re 

“If you’re completely changing the processes of governance and finance of your health care system, and you’re not running them with patient experience test cases, then you’re doing something really dangerous.”

Feisal Keshavjee, chair of Alberta Continuing Care Association, representing most of the continuing care, home care, and palliative care sector in Alberta, expressed optimism that the new provincial organization will help the sector add more spaces, attract workers.

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“alberta always at the forefront of health care reform.”

“That’s the biggest issue we have right now – it’s the staffing” he said, adding that the association is in talks with the government on addressing training and recruitment, an issue that isn’t unique to Alberta.

“In the past, our system was very acute care focused, and hospitals are very expensive,” he said in an interview with Postmedia.

on equal footing with a champion for your issues. – acute care tended to take up most of the oxygen..

Keshavjee said he doesn’t see the restructuring “I don’t see how a structure like this would encourage contracting out.

“It’s not going to make it easier.”

“I think you’re going to see way more primary care integration into the community.”

“These restructuring efforts are iterative,” he said, expressing optimism that province-wide procurement and purchasing – one thing often touted as a big benefit of Alberta Health Services – will remain in place.

Integration council will make sure things don’t fall through the cracks.

Confident that the governmetn is still on the same page – with facility based continuing care review MNT report – it focuses and accentuates quality of life. #1 recommendation was ending divorce by nursing home.

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2030 % of Albertans will be over 65 years old.

Bill 11, The Continuing Care Act, which aimed to better enforce compliance with care standards, was passed by the legislature in May 2022, and on Friday, the government finally put those standards into force with a cabinet order.

The legislation came after government reviews of the continuing care system, including a facility-based review, and a palliative and end-of-life care engagement process.

“With more than 33,000 supportive living spaces (including almost 12,000 designated supportive living spaces), 15,000 long-term care spaces and 127,000 Albertans receiving home care each year, continuing care impacts the lives of many Albertans.”

Under the previous Alberta Health Services structure, a continuing care committee reported recommendations to the Board of Directors.

According to an analysis from Senior Care Access, a senior housing and services directory, average wait times can range from six months to two years. That’s comparable to estimated wait times in British Columbia, but better than in Ontario, where average wait times can be between one to three years.

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Kesavjee noted those numbers are a general snapshot in time.

“There’s going to be highs and lows, I think we are middle of the pack in certain areas. In others, we excel,” he said – like when it comes to home care assessments.

Jackie:

Budget stuff:

AHS eliminated the use of ward rooms in Continuing
Care and will continue to fully eliminate shared
accommodations by 2027 as per the recommendation
from the Facility-Based Continuing Care Review.

Budget 2024 includes
$654 million for the Continuing Care Capital Program, and saw an increase of $107 million for continuing care operating expenses, boosting it from $1.5 billion the previous year, to $1.6 billion.

Home care costs are expected to go up from $836 million to $921 million.

$654 million for the Continuing Care Capital Program to develop four
streams of continuing care capacity, including modernizing continuing
care facilities, establishing innovative small homes, delivering culturally
appropriate care for Indigenous residents located both on and off the
reserves and Metis settlements, and creating additional spaces in priority
communities with the greatest need.

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There are a variety of continuing care services and supports available to
Albertans, depending on an individual’s health and personal care needs.
Budget 2024 includes a forecast of $140 million per year over three years under
the yet-to-be-signed Aging with Dignity federal bi-lateral agreement, allocated:
• $70 million per year for Long-Term Care initiatives, including hiring
Personal Support Workers and other health workers, wage increases or
top-ups, improvements to workplace conditions, training, and compliance
and enforcement of quality and safety.
• $70 million per year for Home and Community Care initiatives, including
activities / programs to enhance access to palliative and end of life care at
home or in hospice, increased support for caregivers, and enhancements to
home care infrastructure.
Budget 2024 honours government’s commitment to invest $1 billion over
three years to transform the continuing care system in response to the
Facility-Based Continuing Care Review. This strategic investment will shift care
to the community, enhance workforce capacity, increase choice and innovation,
and improve the quality of care.

lijohnson@postmedia.com

X: @reportrix

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