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Pan-Canadian standards on elder care would allow people to age with dignity

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Canadians should be worried about themselves and their aging family members. Canada has no pan-Canadian aging strategy, and with the federal Conservatives' refusal to negotiate a new Health Accord, there's not likely to be one anytime soon.

The first week of December was national medicare week in Canada. The Canadian Health Coalition organized a one-day elder care conference in Ottawa with guest speakers from across the country. They painted a picture of what elder care is like across Canada, and it doesn't take more than a few studies, reports and stories to realize that we have a real problem on our hands.

Elders deserve to live with dignity, but that's something being robbed from them in Canada's current state of affairs. Elders are stuck in hospitals because home or community care is unavailable; they're in for-profit care homes that have inadequate staffing levels and no minimum care standards.

Hospital occupancy rates across Canada are far higher than recommended levels. Both England and Australia consider the safe upper limit of hospital bed occupancy to be 85 per cent. Canada's bed occupancy rate as of 2009, was 93 per cent -- the second highest in the OECD (Silverside and Sullivan, 2003).

High hospital occupancy rates often mean patients are rushed out the door. Stories have surfaced of illegal hospital discharge practices where seniors are being sent home while still sick and with little or no support at home. Many of these seniors end up back in hospital a short time later.

Hospitals are also charging patients daily fees for being in a hospital instead of a retirement home or a long-term care facility. In Ontario, those who are admitted to the hospital in need of palliative care are given a three-month time period in which they are expected to die. Judith Wahl, a lawyer and the Executive Director of the Advocacy Centre for the Elderly (ACE), says that some of her clients have received bills for living past the three-month expected period -- in other words, they're being charged for not dying (see the 36:50 mark of this video).

Many patients don't want to have to stay in the hospital for an extended period of time, but home or long-term care facilities are often full and wait-lists can be long. Retirement homes operate outside of the public health-care system and so they may not have nurses, minimum staffing levels or care standards. Retirement homes are also a way to ask Canadians to pay for services that should be considered medically necessary and provided in a public care facility.

Ontario now has the highest hospital occupancy rate in Canada. In less than two decades it has closed 18,000 hospital beds. Complex care patients, who used to remain in hospital with higher staffing levels, are now being sent to long-term care facilities (many of which are private and for-profit) or retirement homes.

Wait-lists are especially long for preferred facilities. Some facilities today are in terrible shape and elders simply don't want to live in them. Instead of updating and modernizing these homes, provinces have sought to enact first-bed legislation, meaning people are forced to take the first bed that becomes available. This legislation has resulted in couples being separated, elders being moved out of their communities, and family and friends being at too great a distance to visit regularly.

For those who are willing and able to pay private fees, private residential facilities are more frequently available. However, governments such as Alberta are looking at eliminating price caps on residential care, meaning private care homes could be priced at up to $6,000 a month ($72,000 a year). This will leave elders stuck in the hospital with alternative care bills to pay or paying exorbitant fees for residential care.

Not only can few Canadians afford $6,000 a month, private care facilities have proven to be lacking in safety and care. In private, for-profit long-term care facilities staff-to-patient ratios are much lower than in public care facilities and have 30 per cent lower Registered Nursing hours than the recommended minimum in North America. Rates of pressure ulcers and bed sores are higher in for-profit than public facilities. Concerns have been raised about the hygiene needs of private long-term care patients. Patients have been left in soiled diapers and with unchanged and dirty bandages on open wounds. Despite these concerns, in most provinces there are more for-profit long-term care beds being built than public beds.

Canada is also experiencing a change in the care needs of long-term care residents. Over 75 per cent of residents in Ontario's nursing homes have some level of cognitive impairment. More than one in four residents suffers from severe dementia. Yet while chronic and mental care needs are expanding, provinces like Alberta are reducing the number of high-level care beds and shifting to for-profit and lesser care facilities.

Canada needs to address these issues immediately. The Council of Canadians and our allies have been calling on the federal government to hold a 2014 Health Accord meeting where the first ministers can work together to create a pan-Canadian strategy for elder care. We're calling on the government to create a continuing care plan that would integrate home, facility-based, long-term, respite and palliative care. We need pan-Canadian standards that will ensure no matter where you live, or what your income, you're able to access the care you need in a safe and appropriate home or facility. Elders and all people living in Canada need to know that they can get the appropriate level of care when they need it and with their dignity intact.

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