We have been surprised, to say the least, at the lack of public discourse around health care during this election period. As a top-of-mind issue for British Columbians, you'd think it would be as central as the always large and looming economy. So what are the burning issues in health care, and how do the party platforms stack up? Here's our take, with a particular focus on seniors.
When we talk about "health care" we're talking about a large and complex system that includes three major areas: primary care (family doctors and health centres), acute care (hospitals and emergency services), and home and community-based care (services for seniors and others who require support in their homes, communities or residential facilities). There are also issues related to technology, drugs, education and training, funding models, integration across different parts of the system, patient rights, privatization … and more.
Health care is by far the largest expenditure in the provincial budget. Dire warnings in recent years about the financial "sustainability" of Medicare have prompted fears that aging baby boomers will soon overwhelm the system, leaving few resources for the needs of younger generations. The CCPA has published extensively on this issue, pointing out that it is the costs associated with new health technologies, such as new surgical techniques, diagnostics, prescription drugs, and end-of-life interventions that are key cost drivers, not the growing number of seniors. And our research has shown how we can improve access to surgical care and prescription drugs while also helping to contain costs.
But when it comes to seniors and the aging population, the home and community care system is particularly vital. Ask any community seniors' group in B.C. how this system is doing and you're likely to hear a similar story: it's more of a fragmented patchwork of services than a system, it is extremely confusing to navigate, and seniors and their families are ending up in impossible situations as a result. It is a story well-documented by B.C.'s Ombudsperson in her recent landmark systemic investigation into the crisis in seniors care.
Problems of underfunding and lack of coordination date back to the 1990s, but worsened significantly over the last decade due to reduced access to services and poorly planned restructuring. Between 2001/02 and 2009/10, for example, access to residential care dropped by 21 per cent, and access to home support dropped by 30 per cent. As the July 2012 CCPA study, Caring for BC Aging Population: Improving Health Care for All finds:
Restructuring in home and community care -- such as changes to policies that govern when seniors get access to what types of care -- has also undermined the vital prevention role these services can play. In both residential care and home support, eligibility criteria have become increasingly restrictive, to the point that seniors often have to wait until they are in crisis and admitted to hospital in order to get the community services they require. Even then, services can be difficult to access.
The impact of these changes can be seen in the 35 per cent increase since 2005/06 in hospital beds occupied by patients who couldn't be discharged because the appropriate residential or home health services were not available.
A more comprehensive and better-co-ordinated system of home and community care can help seniors stay healthy and independent, reduce pressure on hospitals (the most expensive part of health care), and make things easier for those caring for aging family members. Based on our research and extensive work with community seniors' groups, these are priority actions we hope the next provincial government will move forward over the coming two to four years:
- Increase access to public, not-for-profit home and community care, especially home support.
- Fully implement the B.C. Ombudsperson's comprehensive recommendations, which provide a roadmap for a more co-ordinated and accountable system of seniors' care.
- Establish an independent seniors advocate with a broad mandate that includes systemic advocacy.
- Create a more integrated system -- or a "one-stop-shop" approach -- so that seniors can access a continuum of services as their health needs change. Integration also means better co-ordination across the acute, primary and home and community systems.
It is important to note that seniors health is also supported by access to affordable housing, transportation, adequate income, and social supports that help prevent isolation and loneliness. Seniors may also be more likely to experience ill health and/or be marginalized depending on their gender, immigration status and number of years spent in Canada, level of education, sexual orientation, culture and ethnicity.
The platforms (in alphabetical order):
As the governing party for over a decade, the BC Liberal platform must be considered in the context of the current situation. There aren't any major departures in the platform, where the focus remains on funding health-care infrastructure ($2.4 billion over the next 3 years) and educating and retaining health-care providers. The platform boasts a 23 per cent increase in publically subsidized assisted living, residential care and group home beds since 2001 (combined). However, this figure doesn't account for the increase in the seniors population during that time. When we instead measure access to services (i.e., the number of beds relative to the number of seniors over 75), it turns out that access to residential care and assisted living combined dropped by 9 per cent between 2001/02 and 2009/10. For residential care alone the drop was a much steeper 21 per cent.
The Liberal platform does not make any commitments to enhance funding for home and community health care services, with the exception of a $5 million per year increase in funding as of 2014/15 for a United Way program that uses community volunteers to help seniors with home-based tasks. A Liberal government would also "partner with the health care community" to develop cost-effective and appropriate dementia care, and partner with hospice organizations to "encourage development" of new hospice spaces. Neither of these ideas come with financial commitments, despite a promise to double the number of hospice beds by 2020.
The Liberal government has already addressed the issue of a seniors' advocate, with legislation introduced earlier this spring. The new office's mandate includes a number of positive elements, but is created as a "within-government" position rather than as an independent office of the legislature (like the Ombudsperson, Auditor General, and Child and Youth Advocate). This is a vital distinction if the advocate is going to play a strong role in holding future governments accountable for their policies and actions. It is also what community seniors' groups and advocates across BC want to see -- which was communicated very strongly during a provincial consultation process held last year.
The platform is largely silent on the issue of better coordination and integration of health care. It also does not address the question of fully implementing the BC Ombudsperson's recommendations. The Ombudsperson says the provincial government has "made progress" on about one quarter of her recommendations. But according to a recent Province newspaper story, MLA Ralph Sultan, who served as the Minister of State for Seniors, says "his government's overhaul of the senior-care system is adequate and, about 'as done as it is going to be done'."
BC Conservative Party
The Conservative Party platform makes fairly general statements and is not fully costed (they describe it as an "intentionally incomplete," living document). There is no discussion of seniors in the Conservative pre-election party platform.
The Conservative Party does, however, have a policy document published in September, 2012 that provides more detail, and in which seniors' issues are addressed directly. In broad brushstrokes, it commits to "establishing programs to assist our seniors with access to lifestyle activities and services" to enable seniors to age in place. The document also speaks to the need for integration of the system by "coordinating, enhancing and improving accessibility to existing services." These sound positive but lack concrete policy actions or financial commitments to support them. The document also names a Seniors Advocate "at the Ministerial Level," meaning not independent.
In regards to health care in general, the Conservative pre-election platform and the more detailed policy document serve as a reminder of why the basic principles of the Canada Health Act -- universality, accessibility, comprehensiveness and portability -- are so important. These are the principles that mean our system provides care based on need rather than ability to pay. The Conservative platform suggests more "flexibility in the delivery of health services, including consideration of a balance of public and private options." Introducing more private, for-profit delivery into our system would undermine the Canada Health Act.
The Conservative platform does not speak to implementing the Ombudsperson's recommendations.
The NDP proposes new initiatives primarily focused on community-based services and integration. The platform commits to improving home support and community care for seniors and people with disabilities ($70 million over the next 3 years), enhanced standards of care in residential facilities for bathing, toileting, recreational activities and culturally appropriate care ($35 million in 2015/16), and promises to "establish an independent Seniors' Representative" ($11 million over the next 3 years). It also commits to "improve access to multi-disciplinary health clinics and teams" ($35 million over three years) -- a positive step towards reducing pressure on hospitals and creating a more patient-focused, integrated health system.
The NDP Platform does not mention the Ombudsperson's Report or commit to full implementation of her recommendations, though it does address some of the key issues identified in her investigation. In terms of improving quality and standards of care, the NDP propose renewing and redefining the Health Quality Council to support innovation and accountability in the system. They also plan to restore the Therapeutic Initiative's role as a B.C. drug watchdog (the current government officially ended its funding on April 22, 2013), which helps keep our provincial drug costs low and provides up to date prescription practice guidelines to B.C. physicians and pharmacists.
Finally, relevant to the CCPA's recent attention to the issue of affordable housing for seniors living in B.C., the NDP have said they will "strengthen and rebalance" the Residential Tenancy Act and Manufactured Home Act to "better protect tenants and landlords." At the moment, there is seriously inadequate protection for seniors living in Assisted Living facilities, manufactured homes, and Seniors Supportive Housing -- we hope such revisions will work in the favour of tenants living in these spaces.
Green Party of BC
The Green Book provides valuable insight on what we should be aiming for to build a just and healthy society, with a more holistic, less medicalized approach to health and health care. The platform reflects what health research shows -- that a focus on prevention, community-based care, and choice and dignity for patients leads to positive health outcomes and cost savings for a broader health system. The platform highlights the importance of addressing the inadequacies in seniors' health care today, and argues that it is not more funding but a "fundamental reallocation of existing resources" that is currently needed to address our health system woes -- especially the integration of home, community, and primary care services. This is an important point -- though it is an ambitious undertaking. Certainly in the short term, additional funding to build capacity in the home and community care system is needed to support a broader shift in how we organize and deliver health care.
The Green Book is not costed, though it highlights the importance of addressing inadequate staffing levels and funding for residential care units, improving social support and public reporting, and making a concerted effort to implement the recommendations from the B.C. Ombudspersons report, the Green Book hits many of the right notes. Finally, while they advocate for "independent review of all public reporting," the Greens make no direct comment on their position on an Independent Seniors Advocate.
Of course, platforms are not policies and this is all conjecture until the next government is elected. We encourage you to review the party platforms yourself and decide who you wish to vote for. Once the election is over, we also encourage you to remember what was promised, and hold the next government's feet to the fire to deliver -- and more.
Photo: Thompson Rivers/flickr
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