Presentation - BC Care Providers

Alberta’s Continuing Care System
Organization and Priorities
Presentation to BC Care Provider’s Conference
Tyler James, Executive Director
Continuing Care
Alberta Health
May 6, 2013
Continuing Care System
• Alberta Health Services (AHS) created as single health authority on
April 1, 2009.
• Alberta Health, accountable to the Minister of Health sets directional
policy, legislation, regulations and standards, and provides funding to
AHS for the delivery of continuing care health services.
• AHS is accountable to the Minister of Health, and is responsible for
developing and implementing operational policies, delivering
continuing care health services, and assessing and placing
continuing care clients.
Continuing Care System
System and Standards
Home Living
Designated Supportive
Living (DSL)
Long-Term Care
95,975 Unique Clients
7,985 DSL Spaces*
14,565 LTC Spaces*
Cumulative total to
December 31, 2012
Point-in-time information as of
March 31, 2013
Point-in-time information as of
March 31, 2013
• Continuing Care Health Service Standards
– Apply to all publicly-funded continuing care health services.
– Currently under review; revisions expected to focus on areas of risk and
quality of life.
• Supportive Living and Long-Term Care Accommodation Standards
– Apply to all supportive living and long-term care accommodations.
– Last updated April 2010.
Continuing Care System
Capacity Planning
• Capacity Planning
– Provincial Capacity Planning Model
– Commitment to add 1,000 continuing care spaces per year between 2010
and 2015.
• Affordable Supportive Living Initiative (ASLI)
– Capital funding provided to operators to support the development of
affordable supportive living spaces in the province.
– Since 1999, almost $600 million in funding has been provided to develop,
renovate or renew approximately 10,000 supportive living spaces.
– Work in collaboration with AHS to increased the continuing care capacity
in priority areas of the province.
Continuing Care System
Policy Priorities
• Shift to the Community
90% of Albertans want to live in their own homes during their senior
years; 59% of individuals over 95 years of age still live at home.
– Growth in Home Care
• Home Care Redesign and Directional Policy Development
– Supportive Living Capacity Growth
• Quality and Innovation
Policy Review
Innovation Grants
Information Resources
Continuing Care System
Policy Priorities
• Accommodation Charges
– Long-Term Care Maximum Accommodation Charge increased in January
• Private Room Rate: $58.70/day (~$1785.00/month)
• Semi-Private Room Rate: $50.80/day (~$1545.00/month)
• Standard Room Rate: $48.15/day (~$1465.00/month)
• Business Model review
– Alberta recognises increasing pressures related to cost on the
accommodation and the health side
– Upcoming work will look at the funding/revenue and expense issues
review options to develop a model that is more sustainable.
AHS Seniors Health
The Right Care in the Right Place
Presentation to Members
BC Care Providers Association
David O’Brien
SVP, Primary and Community Care, AHS
May 6th, 2013
Familiar Challenges with the Numbers
Number of older adults in Alberta will
grow from 375,000 to 880,000 by
As cognitive impairment is
associated with age, the number of
individuals living with dementia will
also grow
Of concern – Alberta has the highest
proportion of early onset dementia –
17% (e.g. 1,693 individuals under 65 with a
primary diagnosis of dementia were seen by
physicians in 2008)
Familiar Challenges with Public Expectations
Higher levels of education and income
Greater interest in being partners in their
own health – autonomy and choice
Expect a higher level and quality of services
Younger, disabled adults want to stay in
Older adults want to stay in community or as
close to home as possible
Principle Driven Service Delivery
Client based care
Coordinated and trained case manager staff –
increasing integration within community
Acting from a position of wellness and independence;
enhancing individual and community capacity
Caregiver respite; education
Common Home Care services
Adult day programs
Self managed care funding
Testing technology
Principle Driven Service Delivery
Aging Closest to Home – Aging in Place
90% of Albertans want to live in their own homes during
their senior years - 59% of individuals over 95 years of
age still live at home
Increase the services provided through home care
Increase number of clients by 3,000/year for 3 years
Increase the variety of home care services
Provide for assessed extra-ordinary funding
Principle Driven Service Delivery
Right Care – Right Place – Shift to Community
• Provide home care, and continue to support individuals
who are unable to remain in their own home in living
options close to home
• Increasing the range of congregate living options
• Increasing supports within current environments, such
as lodges, to accommodate unscheduled health needs
• Increase the number of living options
Add 5,000 new spaces over 5 years
Align living option with right mix of staffing
Provide added care option for episodic care
Community Health and Pre-Hospital Supports (CHAPS)
Right patient to the right place at the right time to be cared for by
the right practitioner
• CHAPS is an EMS referral program
• Connects patients to community and home based services
• Helps patients stay at home longer and stay healthier with
additional home services
 Connect more patients to community services
 Reduce calls to EMS
 Reduce Emergency Department presentations
 Reduce acute care admissions
ED To Home (E2H)
Connects Seniors visiting the ED with services in the
community, ensuring access to the right care in the right
Currently there are 13 EDs across Alberta with E2H
program in-place
The E2H program is a model of integration between
Community and Acute Care
5,003 additional Home Care referrals generated,
enhancing client knowledge of Home Care and
increased communication among service providers
Destination Home
Represents philosophical shift in how Health System
currently responds to seniors with complex needs, and
those at risk for admission to supportive living, longterm care and/or ED/acute care
Mirrors similar approaches in other provinces (Home is
Best in BC and Home First in Ontario)
Transfers to congregate living settings will not be
considered until all community-based options have
been exhausted. Moving to a residential care facility is a
life-changing decision that optimally should be made
from home.
Path to Home
Is an AHS discharge model to effectively and consistently
discharge patients in a standardized method from in-patient beds
Coordinates teams within Acute and Transition care, enabling
completion of activities required prior to discharge in a timely
manner, to allow return to home with appropriate community
Model developed on 5 best practices:
Anticipated date of discharge upon admission
Estimated day and time of departure
Readiness for discharge
Complex discharge targeting – flagged and proactive on admission to
acute care
Right time to diagnostics and timeliness of reports
Home Care Redesign
• 3-year plan to address provincial inconsistencies
– Home Care Service Guidelines (hours of care
available): developed and implemented across AB
– Integration of Home Care with Community & Primary
Care supports
– Types of services provided
– Rates of pay for Home Care services
– Service effectiveness and quality outcomes
Responding to the Needs
Patient Care Based Funding – Case Mix Indexing
• Started with Long Term Care Facilities; then Supportive
Living; then home care services
• Systematic equitable way of dividing available resources
based on client needs
• Based in RAI assessments
Capacity Changes since 2010
Added >3,000 new beds
All of them in Supportive Living
Services designed for client need
24X7 Home Care in retirement homes/lodges
Cost per client reduction
Placement options increasing
Outcomes - Making Progress
Wait Time for Living Options
Seniors ED Utilization
Seniors ED Utilization
Bruce West, Executive Director
Alberta Continuing Care Association
May 6, 2013
Represent the owners and operators of publicly funded long term care and
supportive living facilities and the providers of publicly funded home care and
home support services.
• 26 facility-based members operating over 11,000 beds/spaces in 110 facilities
• 26 home care and home support members providing over 5 million hours of care
annually to over 40,000 clients
Vision: The recognized voice for advancing excellence in continuing care
Mission: We advance the continuing care system by:
Advocating for effective public policy;
Assisting members in networking, education and pursuit of best practices;
Promoting a sustainable and innovative continuing care system; and
Championing quality care and quality of life for individuals receiving
continuing care.
Values: As ACCA members our actions are guided by a commitment to
excellence, professionalism, integrity and accountability.
 Health System Restructuring
Loss of corporate memory
Revisions to contracts and regional programs and policies
Changing roles and responsibilities
 Communication and Consultation
Lack of consultation on policy and program development
Inconsistent and contradictory messages (Gov’t and AHS)
 Operating Funding – Health and Accommodation
Continuing care underfunded
Regional funding and accountability differences
No acuity adjustments since 2005
Introduction of Activity Based Funding
No accommodation fee adjustment mechanism
Taxation inconsistencies
 Capital Funding
Capital funding available for supportive living but not LTC
No capital component (debt servicing or upgrading) in
accommodation fees
 Aging LTC Inventory
No action on 2008 strategy to replace 7,000 aging long term
care beds by 2015
 Standards and Monitoring
Regional accountability differences
Impact of standards on operating costs
Introduction of new health and accommodation standards
Multiple, uncoordinated inspections
 Workforce
Labour shortages
Aging workforce
Higher expectations and standards
Injury and lost time rates
Health System Restructuring
Communication and Consultation
Operating Funding – Health and
Capital Funding
Aging LTC Inventory
Standards and Monitoring

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