Govt review of AB's continuing care system simply changes who pays, who benefits

June 1, 2021

Government review of Alberta's continuing care system simply changes who pays, and who benefits

Yesterday, the Minister of Health and MLA Richard Gotfried announced the release of the final report of the Facility Based Continuing (FBCC) Review Panel. This 15 member panel was appointed by the health minister to discuss issues relating to the FBCC Review, being conducted by MNP LLP, a chartered accountancy and business advisory firm. This review is intended to serve as a reference for the impending legislative review which will see the consolidation of 15 pieces of current legislation that oversee our current continuing care system.
Notably, panel chair Richard Gotfried is the same MLA who introduced Bill 70: COVID Related Measures Act, which will ensure legal protection for health services facilities-including continuing care operators who are facing lawsuits over illness or death due to exposure to COVID-19. If passed this bill will prevent families from being able to seek answers and hold care homes responsible for negligence of their loved ones.
The FBCC review's final report was released without allowing the media the opportunity to receive a technical briefing that would have enabled them to ask critical questions about its contents, rather than merely regurgitate the government’s narrative. The report was completed over a month prior to releasing it to the public. 
Throughout this pandemic, seniors have consistently made up over 60% of all COVID-related deaths in Alberta, and we have seen the deaths of 6 front line workers. But little action has been taken by the Alberta government to remedy the long-standing problems in our continuing care system that have been exacerbated by this pandemic, except to put over $200 million in the hands of private continuing care operators to offset their loss of ‘revenue.’
"This has been a harrowing year for our seniors. Albertans have been anxiously waiting to see if the grim lessons of this pandemic will actually have been learned by this government," says Sandra Azocar, Executive Director of Friends of Medicare. "But regrettably, the primary strategy we see offered by this report is the further offloading of care costs and responsibilities onto residents and their families."
The report provides 12 policy directions with 42 total recommendations, and the final implementation plan is expected this fall. As for immediate steps, as of July 1st, continuing care residents will no longer be admitted into shared rooms, and ‘ward rooms' will be phased out. This is a positive, albeit overdue step to finally mitigating infection in residential facilities. They also plan to, “where possible,” stop the separation of couples in continuing care facilities—another long awaited change in the current continuing care system.
Albertans can also expect expanded public reporting on facility performance, as reports are to be made available via online access in the AHS facility directory. These are all good steps to alleviate some of the immediate concerns for seniors and their families. However, as one might expect from an accounting company tasked with reviewing public health policy, the report’s focus is on ways in which savings could be achieved, with little consideration as to the impact these recommendations will have on the care and lives of the people who actually live in these facilities.
"It's disappointing, though unsurprising, that this government has opted to ignore so many of the meaningful responses they gathered from residents and caregivers, even after all they've been through," says Azocar. "Once again they're putting monetary concerns ahead of the needs and wellbeing of vulnerable Albertans and their families." 
A few other notable recommendations made in the report:
  • Shift change in the delivery of continuing care services: The panel recommends that a “significant shift is required such that a greater portion of continuing care services are delivered in the home/community through long-term home care (LTHC) services rather than through FBCC”. Rather than increasing actual care to meet what seniors require in FBCC, they are instead sending seniors with complex health care needs into the community, potentially without additional supports, thereby setting the stage to potentially ultimately reduce the number of beds in the province. This recommendation goes hand in hand with the EY AHS review recommendation that AHS convert Long-Term Care beds into Designated Supportive Living beds, meaning individuals requiring 24-hour care for unscheduled medical needs would be considered to have lower staffing needs. Any ‘savings’ found via the implementation of either of these recommendations would come directly at the cost of unfilled care needs for seniors. 
  • Self-directed care as part of long-term home care: Under the guise of “choice,” self-directed care will be extended, provided on the basis of income testing. Currently, self-directed care is often capped, delivered as a task based service that is often not reflective of the needs of the individual, so any ‘extra’ services not covered by the subsidy would have to be paid residents.
  • Accommodation fees: 
    • Recommendation #32: While respondents were clear that they did not want to see an increase to accommodation fees, the review recommends care operators to not only be allowed to make annual fee increases, but that they should be allowed to increase fees beyond the core inflation rate for Alberta. 
    • Recommendation #35: Respondents reported cost barriers to accessing facility based care, but rather than addressing reasons for barriers, the panel recommended services be aligned with income testing for self-directed care, further offloading the costs for things like ambulance, medical transfers, medications, and medical equipment onto vulnerable residents and families. 
  • Primary caregiver role expanded: An estimated 30-40% of care in FBCC is provided by family members. Respondents reported various negative impacts on primary caregivers, but the panel still saw it appropriate to increase their role, mitigated only by providing mental health and social supports as needed to help “alleviate caregiver distress.”
  • Staffing hours and consistency of staffing: Though they recommend an increase to staffing hours and more consistency of staffing, there is no proposal for legislative mandate to ensure that these changes are actually implemented. They recommend Alberta establish a full-time employment benchmarks in FBCC sites, though as we have seen, care operators tend to pursue low wage strategies to reduce costs and increase profit margins, by providing only part-time and casual employment to avoid paying benefits like holidays and sick pay.
  • Ownership: Respondents indicated that they did not want to see public funds provided to private, for-profit facilities, yet the report made no recommendations that would see the removal of for-profit delivery. Further, they recommend "providing opportunities to attract more private development."
More to come from Friends of Medicare in the coming days.
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