Our Recommendations to Improve Continuing Care

Our Recommendations to Improve Continuing Care

The Alberta Government has invited public input on their review of three pieces of regulation on continuing care: 

We felt that the survey did not focus on important challenges we’ve identified in the system and instead have prepared a submission that we have sent via email and posted online for everyone to read. You are encouraged to repeat any of our recommendations that you agree with, and send your own feedback on these regulations to continuingcare@gov.ab.ca before the July 31 deadline.

We have included these recommendations below but also encourage you to read our full submission for background information on the issues facing the system.

Our Recommendations

Albertans value an improved and expanded public health care system and this regulatory review is a chance to make good on those values.

Our recommendations recognize the unfortunate existing reality of privatization in continuing care, but with a goal of improving care for all providers, and a focus on holding the private sector accountable. There should be an end to new approvals for private providers, and the end goal for our continuing care system should be to phase out private operation of such a critical component of Albertans health needs while improving patient outcomes and experiences in the public system.

Recommendations for the Nursing Homes Operation Regulations:

1. Transparent Wait List Data.

Albertans value transparency in health care delivery, and deserve to know that adequate resources are being targeted to communities needing long-term care services.

The regulations should mandate reporting on long-term care wait lists including:

A public listing that includes the number of people on wait lists for long-term care by encatchment area, which specifies those that are waiting in their home for placement, and those that are occupying other health care beds such as acute care or even emergency care that require long-term care placement. This listing should also include the number of people on wait lists to be assessed for possible long-term care placement. The listing should be updated monthly on a publicly accessible website.

2. Support residents and families by mandating Resident & Family Councils.

Some facilities in Alberta provide valued Resident & Family Councils to provide peer support and a venue for discussing and taking action on issues with care and services. Many facilities lack this support as there is currently no obligation to do so.

Regulations should be added that mandate all operators to support the establishment and continued function of Resident and Family Councils who are independent of facility or AHS management.

3. Improve patient input in assessment processes.

The assessment committee as established in Section 6 does not mandate patient or family involvement in the process. Regulations should be amended to ensure the transparent engagement of patients and family in the assessment process.

4. Improve care by increasing mandated care hours.

Section 14 mandates a mere 1.9 paid hours of combined nursing and personal care services per resident per day (hprd). Paid hours are an inadequate standard as it is broad enough to include sick time, holidays and other time off. Research published suggests 4.1 nursing hours worked per resident day[1], and some going as high as 4.5 to 4.8 worked hprd to improve care[2].

Regulations should mandate a minimum of 4.1 hprd. and should specify care provided or worked, not care paid.

5. End the expansion of private care and service delivery. Phase out private providers.

Albertans deserve consistent quality continuing care that is under full democratic accountability in the public sector. While it may not be financially or logistically feasible to terminate existing private contracts, no new contracts should be entered into, and all new beds should be run by Alberta Health Services or its subsidiaries such as Capital Health and CareWest. As private contracts expire the public sector should become the operator of those facilities.

Section 4 – Application for Contract should be renamed Amendments to Grandfathered Contracts and have section 4(1) removed to reflect that no new applications will be considered.

Regulations should be added specifying that private contracts will not be renewed and the public will assume responsibility for operations when those contracts expire.

6. End the expansion of contracted out care and service work.

When patients choose care homes there is an expectation of having services maintained as is or improved. The practice of contracting out care and services is often to for-profit providers, adding unnecessary third party profits to health care costs, and contracting out to either for-profit or not-for-profit providers creates an unnecessary duplication of administration.

Regulation should be added to prohibit the practice of contracting out care and support services. Regulations should also be added to specify that where contracting out currently exists, the operator will bring the services in-house at the expiration of the contract or sooner where allowed for.

7. Keep Registered Nursing as a component of care delivery in long-term care.

Registered Nurses are an important part of the care and service team in long-term care and should remain mandatory as specified in current regulations.

 

Recommendations for Nursing Homes General Regulations:

1. Transparency and accountability for contracts with private providers.

The public deserves to know the details of contracts for long-term care awarded to all private providers. The public, residents, and especially the staff of long-term care facilities deserve not only a transparent funding system, but an accountable one in which funds provided for providing care hours have strings attached that ensure they go to the staff providing that care.

Regulations should be added that gives the Minister the authority to disclose details of all grants and contracts with private providers, and requires the Ministry to disclose those details on a publicly accessible website.

Regulations should also be added to specify that funding is to be assigned specifically for care staff and that 100% of that funding should go towards that staff.

2. End the practice of providing public funds towards building private facilities.

All new facilities should be operated publicly. Even if private care were desirable or necessary, it is unacceptable that public funds be used to subsidize the building of a private business.

Section 10 – Grants should be amended to remove the ability for private operators to receive capital grants to establish new facilities.

Recommendations for Co-Ordinated Home Care Program Regulations:

1. Transparency and accountability for contracts with private providers.

Regulations should be added that gives the Minister the authority to disclose details of all grants and contracts with private providers, and requires the Ministry to disclose those details on a publicly accessible website.

Regulations should also be added to specify that funding is to be assigned specifically for care staff and that 100% of that funding should go towards that staff.

2. Transparent Wait List Data.

Regulations should mandate disclosure of the number of people on wait lists for home care assessment and home care services by AHS Zone, to be published on a publicly accessible website and updated monthly.

3. End the expansion of private care contracts and new providers.

All new home care services should be provided by the public sector, to avoid duplication of administration, unnecessary cost cutting in the name of competition, and to ensure equal treatment of staff.

Section 5 – Provision of services in the regulations should be amended to reflect that the public sector will provide services, except where existing private contracts remain. Upon expiration of existing private contracts, the public sector will assume responsibility for delivery of home care services.



[1] Harrington et al. The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes. Health

Services Insights 2016:9 13–19 doi:10.4137/HSI.S38994. (“Harrington (2016)”) Retrieved July 21,2016

from http://www.la-press.com/the- need-for- higher-minimum- staffing-standards- in-us- nursing-homes-

article-a5529

[2] U.S. Centers for Medicare and Medicaid Services, Abt Associates Inc. Appropriateness of Minimum

Nurse Staffing Ratios in Nursing Homes. Report to Congress: Phase II Final. Volumes I-III. Baltimore,

MD: CMS; 2001. (“CMS (2001)”) Retrieved July 21, 2016 from

http://www.allhealth.org/briefingmaterials/abt-nursestaffingratios(12- 01)-999.pdf.

 


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