Experts question Alberta's proposed plan to increase costs for seniors in care

Health Minister Tyler Shandro has paused part of an Alberta Health Services cost-cutting plan that would disproportionately impact seniors by increasing or introducing continuing care fees.

But some health policy experts say if Shandro decides to move forward with those initiatives, they may end up costing the health-care system more in the long run and result in fewer seniors accessing the care they need. 

On Tuesday, Shandro released an Alberta Health Services (AHS) plan that detailed how the health authority proposed to implement the cost-cutting measures outlined in an Ernst & Young external review.

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Included in the health authority's 100 recommendations were proposals to introduce a co-pay for certain home-care services, increase accommodation fees for continuing care, and shift more patients from long-term care to designated supportive living. 

Friends of Medicare executive director Sandra Azocar was critical of the proposed changes and the impact she believes they would have on seniors.

For example, she said home care "keeps people from being in hospital. It keeps people living healthier and longer at home," adding that a co-pay "doesn't make sense.

"It is also nonsensical to put people in a position where they're going to get sick because they can't afford a service and then end up costing [the system] more in the long term," Azocar said. "So the upstream thinking that this government has is almost nil."

The UCP government has directed AHS to proceed with some of its proposed changes, expected to cut up to 11,000 jobs and save the health-care system up to $600 million a year.

At a news conference Tuesday, Shandro said all continuing-care initiatives in the plan are paused pending the outcome of an Alberta Health review into continuing care services and legislation. UCP MLA Richard Gotfried is leading the review, which is expected to be completed in 2021.

"Any of the implementation plan items that deal with continuing care are going to be waiting for that review to come out to make sure that they are aligned with whatever that review comes back to us [with]," Shandro said. "And so those items are going to be put on hold."

An Alberta Health spokesperson clarified Wednesday that "no decision has been made" on whether these initiatives will move forward once the review is complete.

The AHS plan said lower-income Albertans would be exempt from, or subsidized for, the additional home care and continuing care fees.

Health policy consultant Steven Lewis said it makes no sense to charge people for home care because people with precarious incomes will forego home care when they run short of money, and end up back in the hospital or a nursing home.

"So they and the system have saved a couple of thousand bucks and then they end up costing fifty to a hundred thousand dollars a year because they ended up with a serious health problem that could have been deferred or perhaps entirely avoided," he said. 

"So I think that part of the strategy is actually contrary to what they should be doing. And it is short-term gain for very long-term pain." 

Shifting continuing care beds

The AHS plan also proposes to transition some long-term care beds to designated supportive living beds across the province. AHS estimated this initiative would save nearly $7 million a year.

"This service adjustment will better align service levels to population needs and prevent over-serving but maintain health outcomes," the plan states, adding that designated supportive living allows residents more independence and privacy while long-term care supports people with complex health needs.

"All residents will receive the care they need in a space that best meets their assessed care needs. This change will increase the choices and options available to seniors and their families."

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Carole Estabrooks, a University of Alberta nursing professor and elder care researcher, said this and the other AHS continuing care recommendations are scant on details that will be critical to assessing whether they might succeed.

"Many — most people, I might submit —  in nursing homes need to be there," Estabrooks said. "And so if we're going to shift people from long-term care to a lower level of care to save resources, we have to make sure that we are shifting people who can safely be shifted."

She said there are already many costs for seniors in long-term care such as dental or hearing care that are not covered. She said if the province shifts more patients to designated supportive living, where even fewer costs are covered, it will have to ensure that patients that afford the care they need.

The AHS plan doesn't specify how many seniors would be affected by the transition from long-term care. 

Proposal to explore selling long-term care facilities

Also paused is an AHS recommendation to explore selling some of the health authority's assets, including long-term care facilities.

Dr. Michael Rachlis is a public-health doctor and health policy expert who teaches at the University of Toronto. He said research — including during this year's pandemic — has consistently shown that for-profit long-term care facilities provide a lower quality of care than those owned by the government or non-profits.

Any plans to further commodify long-term care are misguided, he said.

"This action by the provincial government simply reinforces that health care, even for our most vulnerable, is actually a business opportunity; it is not a public service," Rachlis said.

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