1

• Office of the Seniors Advocate: Isobel Mackenzie • Relationships with commercial interests: - Grants/Research Support: not applicable - Speakers Bureau/Honoraria: not applicable - Consulting Fees: not applicable - Other: not applicable

Managing Potential Bias

Faculty/Presenter Disclosure

• Not applicable

B.C. Quality Forum March 2, 2017

U[ www.seniorsadvocatebc.ca 1-877-952-3181

Office of the Seniors Advocate created March 2014 Legislated office with statutory duties, obligations and authority Independent office within government reporting to the Minister Responsible for Seniors, currently Minister of Health, the Hon. Terry Lake

Formation of the Office

3 3

Legislative Mandate & Scope

Monitors the provision of seniors’ services

Analyzes systemic issues

Provides information and referral to seniors and their family members

Reports to Minister and to the public on issues affecting seniors, and provides recommendations to the Minister and other service providers

5 mandated areas

• Health care

• Housing

• Income support

• Personal Support

• Transportation

4

Question 1

What percentage of seniors 85 and older live in residential care?

A. 25%

B. 35%

C. 15%

D. 50%

E. 10%

5

Where and How B.C. Seniors 85+ Live

6

74% of seniors live independently

41% live in a single family dwelling (house)

13% live in a townhouse

17% live in an apartment

2% live in mobile homes

11% live in assisted living facilities

15% live in residential care

What triggers a move to residential care?

Moving into residential care is a major decision, so need to ensure it is:

The right place for the resident

Resident wants to live there and, if not, ensure all alternatives have been exhausted

7

Is Residential Care the Right Place?

28,000 BC seniors call residential care home

300 facilities

Designation is “complex care”

MAPLe 4 or 5

24-hour unscheduled care

Need for a secure environment

Can no longer function in the community with supports such as home support, adult day programs, community bathing, HandyDART

8

Question 2

What percentage of people, at age 85 plus still have an active driver’s licence?

A. 12% B. 22% C. 34% D. 45% E. 52%

9

Question 3

At any given time in BC, how many people over the age of 85 have a diagnosis of dementia?

A. 10%

B. 50%

C. 30%

D. 20%

E. 60%

10

Question 4

At age 85, what % of people live alone?

A. 33%

B. 46%

C. 63%

D. 21%

E. 75%

11

Seniors at 85

At age 85, we know that:

66% do not hold a driver’s license

46% live alone

20% have dementia

Median income is $25,000 for singles

29% live on less than $20,000 per year

15% percent live in residential care

12

Who is living in residential care?

Married 24%

Average age 85

Over 85 years of age 56%

Female 65%

Diagnosis of Alzheimer's or other dementia 61%

Diagnosis of psychiatric condition or mood disorder 30%

Moderate to severe cognitive/memory impairment 62%

Combination of complex conditions indicating high or very high need for facility level care (MAPLe 4 or 5)

82%

Exhibits aggressive behaviour 33%

Primarily uses wheelchair 53%

Exhibits wandering 17%

Bladder incontinence 57%

Income of $18,000 per year or less 34%

13

Who is coming into residential care?

Half of new admissions into residential care did not receive publicly subsidized home support prior to entry

Of those who did receive home support, only one quarter received 3 or more hours per day of service

14

Potentially inappropriate placements

What pushes someone into residential care, when they might otherwise be able to live in the community?

Over 10% of clients currently in residential care fit a “light care” profile and could potentially be cared for in the community

Light care profiles include (percentages overlap): “Light care needs” (low cognitive and physical impairment) – 5.4%

“Dementia care” (dementia only with no physical impairment) – 5.4%

“Assisted Living Plus” (mild physical impairment; no dementia) – 4.2%

15

Who is in the community on home support?

Average age 81

Female 66%

Married 28%

Widowed 42%

Lives with primary caregiver 43%

Caregiver distress 30%

Dementia diagnosis 30%

Wandering 3%

Aggressive behaviours 11%

MAPLe 4 or 5 50%

Bladder incontinence 24%

Primarily uses wheelchair 11%

16

Question 5

What percentage of seniors live on less than $15,000 per year

A. 46%

B. 8%

C. 23%

D. 17%

17

Does cost dictate the choice?

Home support in B.C. carries a client contribution

The poorest seniors (those on Guaranteed Income Supplement) pay nothing, but what about moderate income seniors?

A single senior with an income of $25,000 per year pays a client contribution of around $6,800 per year for daily home support

Same senior would pay around $19,000 per year for residential care

18

Yearly Expenses Income: $25,000 Income: $40,000

Living at home with daily home support

Home support $6,800 $12,800

Rental $13,200 $13,200

Food $3,000 $3,000

Utilities $2,000 $2,000

Drugs and medical expenses $750 $1,600

Total $25,750 $32,600

Residential care cost $19,200 $27,600

Living expenses

Is the cost of home support driving people into residential care?

19

Are we providing enough home support?

Majority of home support clients receive one hour or less per day of home support service

Service per day % of clients

1 hour or less 60%

2 hours or less 25%

3 hours or less 7%

4 hours or less 3%

More than 4 hours 5%

20

Is it caregiver burnout?

Unpaid caregivers provide an average of 19 hours of care per week, ↑ to 30 hours per week for caregivers in distress

29% of caregivers are in distress, ↑ to 38% for those caring for complex care needs

54% of caregivers are caring for people with complex care needs

62% of distressed caregivers live with the care recipient

21 21

Is it risk aversion by the care community?

22 22

Current Challenges in Residential Care

Drugs

Staffing

Shortened length of stay

Complex care as a uniform designation

Physician support

Palliative care

Public accountability

Do quality indicators truly measure residents’ quality of life?

23 23

The Voice of Seniors in Residential Care

Province-wide survey wrapping up

Nearly 300 facilities, averaging 40% response rate

Matched sample with Most Frequent Visitor

Matched to RAI data

To be publicly reported at the provincial, health authority and facility level

Will reveal systematic issues and those related to particular subsets

All families and residents on the same page

Do quality indicators clinicians use match what residents value?

24 24

Work Ahead

Understand more about BC data on light care needs seniors in residential care

Better exhaust community supports

Listen to the voice of seniors in residential care about what they value

Shift from “best we can do with what we have” to “the best it can be”

25 25

Contact

www.seniorsadvocatebc.ca

Toll-free: 1-877-952-3181 In Victoria: 250-952-3181 Open Monday to Friday, 8:30am - 4:30pm Translation services available in more than 180 languages.

info@seniorsadvocatebc.ca facebook.com/SeniorsAdvocateBC @SrsAdvocateBC

26