Group items tagged

Our report shows that while demand for seniors' housing in B.C. is outpacing supply as more seniors opt for homes in independent living communities , not enough is being done to understand their longer-term health and housing needs. In the next 25 years, seniors will make up 25 per cent of B.C.'s population. We think it's time for the provincial and municipal governments to sit down with us and come up with a new plan to support the development of more independent housing and assisted living as a cost-effective alternative to residential care.

We also need improved planning and implementation of home health services provided by the Ministry of Health and the health authorities to residents of independent living communities to allow them to remain in the communities for as long as possible. There are approximately 355,700 people in B.C. over the age of 75, of which 8.2 per cent live in seniors' residences. Improved utilization and expansion of B.C.'s independent living and assisted living sectors to accommodate residents with a broader range of health and social needs could reduce reliance on residential care.

In the past, residential care was the primary option for people who needed additional care and support, but increasing costs and a shortage of publicly subsidized residential care facilities led to the development of publicly subsidized assisted living facilities. Since 2004, there has been a dramatic increase in the number of both independent living and assisted living units, which are often located in the same development and provide many benefits for their residents. But the time has come to take a fresh look at the services available to seniors and how we provide them. For example, the Ministry of Health could explore options to allow registered assisted living facilities to offer a more flexible approach to what and how services are provided to residents. Expanding the range of services could allow residents to return from hospital sooner and free up beds for other patients, or delay their admission to residential care facilities .

Not everyone has the resources to look after their own care and housing needs in their senior years, but the public resources to help are not unlimited. That means we have to be smart how we develop and implement policies for our seniors. Carole Holmes is president of the B.C. Seniors Living Association. Elder care in B.C.

Private-pay and publicly subsidized housing and care options for seniors in B.C. include: Independent living: A combination of housing and hospitality services for functionally independent seniors. Assisted living: A semiindependent type of housing regulated under the Community Care and Assisted Living Act and includes housing, hospitality services and at least one, but not more than two prescribed services for people who require regular help with daily activities. Residential care: 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence.

House calls are starting to make a comeback amid a rapidly greying population, although they're still rare. The idea: A doctor or nurse-practitioner, sometimes bringing along a social worker, makes regular visits to frail or homebound patients whose needs are too complex for a typical 15-minute office visit - and who have a hard time even getting to a physician's office. "It helps you avoid the emergency situations," said Naomi Rasmussen, whose 83-year-old father in Portland, Oregon, is part of Medicare's Independence at Home study.

Her father, stroke survivor Teodor Mal, is prone to frequent infections and unable to tell his wife or daughter whenever he starts to feel ill. Visits to multiple doctors left him so agitated that a good exam was difficult, and just getting him and his wheelchair there took several hours and a special van. Then Mal began getting his primary care from Portland-based Housecall Providers Inc. When family members see any worrisome changes in his behaviour or appearance, providers can make a quick visit to see if another urinary tract infection or case of pneumonia is beginning, in time to give at-home antibiotics a chance.

It took extra primary care visits, but "he went from bouncing in and out of the hospital to one hospitalization in an entire year," said Housecall Providers nurse Mary Sayre. But this kind of care is hard to find, in part because of reimbursement. Medicare did pay for more than 2.6 million house call visits in 2013. But add in the travel time, and doctors can see - and get paid for - many more patients in a day in the office than they can see on the road. Enter Medicare's Independent at Home demonstration project, now in its third year of testing how well a house call approach really works and how to pay for it. About 8,400 frail seniors with multiple chronic conditions - Medicare's most expensive type of patient - are receiving customized home-based primary care from 17 programs around the country. The incentive for doctors: They could share in any government savings if they also meet enough quality-care goals.

On Thursday, Medicare released its long-awaited analysis of the study's first year and said the project saved an average of $3,070 per participating beneficiary; Conway said all but five practices generated savings. Medicare will divide $11.7 million in incentive payments among the nine practices that met enough of the quality requirements for that financial bonus, including Portland's Housecall Providers. "We need to shift costs to this kind of intervention," said Dr. Pamela Miner of Housecall Providers.

The Affordable Care Act created the Medicare study, and legislation is pending in Congress to extend the project another two years. The program is "bringing the house calls of yesteryear into the 21st century," said Sen. Edward J. Markey, D-Mass. He said Thursday's pilot results are promising enough to make the project permanent so that many more Medicare patients eventually could seek this kind of care.

We need to stabilize the situation in Attawapiskat in terms of making sure they have the health support they need,” Mr. Angus (Timmins-James-Bay, Ont.) told The Hill Times last week. “We need a plan to get people who are needing help in any of the communities to get that help.”

A rash of attempted suicides prompted Mr. Angus, who’s also the NDP critic for indigenous and northern affairs, to call for an emergency debate on the ongoing suicide crisis in the James Bay community of about 2,000. As a result, the House of Commons convened until midnight last Tuesday for an emotionally charged discussion on mental health services following a string of incidents in northern reserves in recent months. Several MPs choked up during their statements, recounting suicide incidents in their ridings and personal lives.

Sometimes partisan politics need to be put aside and members need to come together to find solutions to prevent another unnecessary loss of life,” Conservative MP Todd Doherty (Cariboo-Prince George, B.C.) said during the debate. NDP MP Georgina Jolibois (Desnethé-Missinippi-Churchill River, Sask.) said the suicide rate went up in her home community of La Loche in northern Saskatchewan after a shooting spree that killed four people last January.

Liberal MP Robert-Falcon Ouellette (Winnipeg Centre, Man.) recalled visiting the northern Manitoba Pimicikamak Cree Nation, which declared a state of emergency over a series of suicide attempts last month.

Mr. Angus made an emotional appeal to action in his opening remarks during the emergency debate. “We have to end the culture of deniability whereby children and young people are denied mental health services on a routine basis, as a matter of course, by the federal government,” he said. Eleven people attempted to take their lives in Attawapiskat two Saturdays ago, prompting the First Nation to declare a state of emergency—the fourth one since 2006. There has been more than 100 suicide attempts in the reserve since the month of September, many of which involved children. The community has been plagued by flooding and several housing crises in recent years.

Eighteen mental health workers were dispatched to Attawapiskat on Tuesday, including two counsellors, one crisis worker, two youth support workers, and one psychologist. While there is no set timeline, they’re not expected to leave for at least two weeks, said Health Canada assistant deputy minister Keith Conn during a teleconference last week.

Some of the people treated for mental health problems last week had previously been airlifted out of the community for assessment before being sent back after their examination, according to Mr. Conn. This past Tuesday, at least 13 people, including a nine-year-old child, had made plans to overdose on prescription pills as part of a suicide pact. The Nishnawbe-Aski Police Service apprehended them before sending them to the local hospital for a mental health assessment.

Mr. Conn said he’s heard criticism of the mental health assessment process from Attawapiskat First Nation Chief Bruce Shisheesh. Individuals who are identified as likely to commit suicide are typically sent to a hospital in Moose Factory, Ont., to be psychologically evaluated by a psychologist or psychiatrist. They are then discharged and sent back to the community, where some try to take their life again. Mr. Conn said Health Canada does not “control the process,” but he personally committed to review the mental health assessment effectiveness.

No federally funded psychiatrists were present in the region prior to the crisis, despite reserve health-care falling under the purview of the federal government. Mr. Conn said the Weeneebayko Area Health Authority (WAHA), a provincial health unit servicing communities on the James Bay coastline, is usually responsible for the Attawapiskat First Nation following an agreement struck with the federal government about 10 years ago.

A mental health worker position for the reserve has been vacant since last summer, in part because there’s a lack of housing for such staff. The community has been left without permanent, on-site mental health care services. Since then, the position has been filled by someone already living on reserve. During the emergency debate in the House last week, Health Minister Jane Philpott (Markham-Stouffville, Ont.) emphasized the need for short- and long-term responses to the crisis.

We need to address the socio-economic conditions that will improve indigenous people’s wellness in addition to ensuring that First Nations and Inuit have the health care they need and deserve,” she said. Ms. Philpott pointed to the Liberal government’s budget, which includes $8.4-billion for “better schools and housing, cleaner water, and improvements for nursing stations.”

“Our department and our government are ensuring that all the necessary services and programs are in place,” she said during the debate. “We are currently investing over $300-million per year in mental wellness programs in these communities.” Yet, Mr. Angus said the budget includes “no new mental health dollars” for First Nations communities. In addition to allocating more funds for mental health services to indigenous communities, Mr. Angus said there needs to be a concerted effort to bring in the aboriginal youth in the conversation.

We need to bring a special youth council together,” he told The Hill Times on Wednesday. “We need to have them be able to come and talk to Parliament about their concerns, so we’re looking at those options now.” Emotion was audible in Mr. Angus’ voice when he read letters he received from Aboriginal youth during the emergency debate, which expressed a desire to work with the federal government to solve the crisis.

The greatest resource we have in this country is not the gold and it is not the oil; it is the children,” he said. “The day we recognize that is the day that we will be the nation we were meant to be.” Mr. Angus met with Indigenous and Northern Affairs Minister Carolyn Bennett (Toronto—St. Paul’s, Ont.) earlier in the week to discuss potential long-term solutions to the suicide crisis. “I’ve always had an excellent relationship with Carolyn Bennett, and as minister we’re trying to find ways to work together on this, to take the tension down, to start finding solutions,” Mr. Angus said. Mr. Angus criticized “Band-Aid” solutions that have been thrown at First Nations issues over the years and said there needs to be a “transformative change” this time.

That’s where we have to move beyond the positive language to actually the brass tacks,” he said. During the emergency debate, Mr. Angus supported the idea of giving more resources to frontline workers such as on-reserve police, and health and treatment centres. 0eMr. Angus’ riding sprawls from shores of the Hudson Bay to the Timiskaming district on the border with Quebec, an area roughly equivalent in land size to that of Guinea. He holds two constituency offices in Timmins and Kirkland Lake.

The average person over 55 enjoys more than $165,000 additional wealth in their homes after inflation compared to 1977. I'm glad my mom accumulated this wealth. But she and I wonder why the federal government prioritized cutting taxes for the aging population. Income splitting for seniors costs $1.1 billion annually. The pension income credit costs $1.1 billion. The "age" tax break for anyone over 65 costs $3 billion.

Then, we must carry larger mortgages, working an extra month to make annual payments compared to a generation ago - even though interest rates are low compared to the 1980s. For many, this crushes dreams of home ownership, while imposing rents driven by higher property prices. The housing market that frustrates younger Canadians has been good for my mom's demographic.

The average cost of housing is up $116,000 after inflation compared to 2005. Housing costs more even as apartments get smaller in our bigger cities. This squeezes younger generations for space, time and money just when we want to start our families. Compared to when Harper began as PM, we must work an extra two to three years to save a 20 per cent down payment.

Not done there, Harper doubled the contribution limit for tax free savings accounts in his election budget. Canadians over 60 are three to five times more likely to max out their TFSAs compared to those 18 to 49. TFSAs shelter deposits from further taxation no matter how well investments pay off.

He also cut $168 million per year in taxes for affluent seniors by changing rules governing registered retirement income funds - at a cost that is greater in one year than the total Harper added to student grants over the next three. Ironically, the opposition accuses Harper of cutting government spending because of his tax cuts. But this isn't accurate. Annual spending on old age security increased by $8 billion after inflation over Harper's decade, and the Canada Health Transfer increased $10 billion. Forty-seven per cent of health-care spending goes to the 16 per cent of the population over 65.

What Harper didn't increase substantially is spending on younger generations. Ottawa contributes to a federal/provincial spending pattern that invests more than $33,000 per person over 65 compared to less than $12,000 per person under 45. This calculation includes the PM's universal child care benefit, and income splitting for one in three families with kids.

Harper's main rivals promise to do better, but don't always budget enough. The NDP talks about $15/day child care. But the $1.9 billion they budget isn't a quarter of what is required. The Liberal platform so far budgets the most of the big three parties for families raising kids. But their promise to extend parental leave by six months is backed by too little money to make a meaningful difference.

By the platform numbers, the national party last in the polls is currently first for proposing more for younger Canadians. The Greens would eliminate tuition for a first post-secondary degree, and reallocate three times more money for child care services than the NDP. The Greens promise more money than other parties for a national housing strategy.

And the Greens are concrete about pricing pollution so that markets ensure younger Canadians aren't primarily left the costs of keeping our air, water, and land clean, while mitigating climate change. No matter which party you prefer, it's time all parties commit Ottawa to reporting how spending breaks down by age, and whether we are leaving at least as much as we inherited.

Although such reporting would cost Ottawa only a little staff time, it is a prerequisite for Canada to work for all generations. Dr. Paul Kershaw is a policy professor at the University of B.C., and Founder of Generation Squeeze (gensqueeze.ca).

Canada's youth faces a precarious financial future thanks to the actions of the federal government, Paul Kershaw writes. • Melissa Renwick/Toronto Star file photo

Today, for example, there is one home each in Red Deer, Portage la Prairie and Moose Jaw, and the latter one is slated to close.

an enormous price tag that is only partly offset by government

73 per cent of working-age adults with an intellectual disability who live on their own live in poverty.

estimates there are 686,000 intellectually disabled people across the country

In Ontario, 12,000 people are in the queue for residential housing.

152 residents

A compact, self-contained model village on a four-acre site on the outskirts of town, half of it is open space: wide boulevards, cosy side-streets, squares, sheltered courtyards, well-tended gardens with ponds, reeds and a profusion of wild flowers. The rest is neat, two-storey, brick-built houses, as well as a cafe, restaurant, theatre, minimarket and hairdressing salon.

low, brick-built complex, completed in early 2010

suffering from severe or extreme dementia

250-odd full- and part-time staff

six or seven to a house, plus one or two carers, in 23 different homes. Residents have their own spacious bedroom, but share the kitchen, lounge and dining room.

25 clubs, from folksong to baking, literature to bingo, painting to cycling

encourages residents to keep up the day-to-day tasks they have always done: gardening, shopping, peeling potatoes, shelling the peas, doing the washing, folding the laundry, going to the hairdresser, popping to the cafe

seven different "lifestyle categories"

One is gooise, or Dutch upper class

a house in ambachtelijke style, for people who were once in trades and crafts: farmers, plumbers, carpenters

Huiselijke is for homemakers: neat, spotlessly clean, walls hung with wooden display cabinets for dozens of brass and porcelain ornaments

No doors – apart from the main entrance, with its hotel-like reception area – are locked in Hogewey; there are no cars or buses to worry about (just the occasional, sometimes rather erratically-ridden, bicycle) and residents are free to wander where they choose and visit whom they please. There's always someone to lead them home if needed.

Other houses are designated christelijke, for the more religious residents; culturele, for those who enjoy art, music, theatre (and, says Van Zuthem, "getting up late in the morning"); and indische, for residents from the former colony of Indonesia (rattan furniture, Indonesian stick puppets on the walls, heating two degrees higher in winter, and authentic cuisine).

urban, for residents who once led a somewhat livelier lifestyle

By the time Hogewey was finished, it had cost ¤19.3m (£15.1m). The Dutch state funded ¤17.8m, and the rest came from sponsors and local fundraising.

anyone can come and eat in the restaurant, local artists hold displays of their work in the gallery, schools use the theatre, businesses hire assorted rooms for client presentations

Nor is the cost per resident of this radically different approach to dementia care much higher than most regular care homes in Britain: ¤5,000 a month, paid directly to Hogewey by the Dutch public health insurance scheme

Some residents also pay a means-tested sum to their insurer. There is a very long waiting list.

You don't see people lying in their beds here. They're up and about, doing things. They're fitter. And they take less medication.

we've shown that even if it is cheaper to build the kind of care home neither you or I would ever want to live in, the kind of place where we've looked after people with dementia for the past 30 years or more, we perhaps shouldn't be doing that any more."

According to Critchlow, evidence suggests that seniors who live in co- housing arrangements often remain for up to a decade longer in their own homes. She calculates that means a saving of about $50,000 per year per person.

Although outsourcing has grown steadily since the 1990s, expectations of an austerity-induced boom have so far disappointed, with some local authorities even deciding to insource services to address concerns that privatisation was not proving the best value for taxpayers’ money.

Cumbria council has recently agreed to repatriate 300 staff outsourced to Amey after its seven-year contract to provide highways maintenance comes to an end in April, while Rotherham and Ealing councils both insourced highways services last year.

Last year, Edinburgh council also decided against privatising the city’s bin collection and street cleaning services.

The SNP government has ruled out any privatisation of the National Health Service, but local authorities are free to consider outsourcing if they believed that would improve delivery of services, added the SNP government

According to the Open Public Services white paper published last year, at least 40 per cent of local authority spending goes on contracts to the private and voluntary sectors; almost half of all councils have outsourced refuse collection while 55 per cent of social housing is provided by housing associations.

Insists she is not opening the door to privitization A typical visit to see Sinnicks-House is between $20 and $30 per visit.

Combined with other savings and income, that amount might provide some retirees with all they need for decades. But everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Plans that looked solid on paper are no match for their bills. "Within the first year most people are tapped out," said Joe Caldwell, director of long-term services at the National Council on Aging. "Middle-class families just aren't prepared for these costs." Many who can afford it buy insurance to help pay for long-term care years in advance, when insurers are less likely to reject them. But even those with insurance, like Ranzman, come up short. Forced to improvise, they sell the house and lean on family. They move in with their adult children, or arrange for their children to move in with them.

Some can save money by switching to different facilities. On average, a shared room in a nursing home runs nearly $11,000 a year less than a private room, and a room in an adult-family home runs cheaper still. Still, there's not a lot of room for creativity, said Liz Taylor, a self-employed geriatric care manager in Lopez Island, Washington. "The amount of care you need dictates the price," she said, "and there aren't that many ways around it." Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid $20 an hour in some parts of the country. But hiring them to work around the clock is often the most expensive, Taylor said. "Needing help to get out of bed to use the bathroom in the middle of the night means you need a nursing home," she said.

EVICTED To Roslyn Duffy, it seemed that her mother, Evelyn Nappa, had everything she needed. After a stroke made it difficult to live alone, Nappa moved from Arizona to Seattle to be near her daughter and soon settled into The Stratford, an assisted-living facility, where she quickly made friends of fellow residents and the staff. "The care was great," Duffy said. "We loved that facility." With the sale of the house in Arizona, Nappa's savings appeared sufficient to cover 10 years at The Stratford, enough to last until she reached 100. Duffy said that the home's directors told her not to worry about her mother running out of money and winding up on Medicaid, even though the government program pays just a portion of what many facilities charge. After all, many of the same homes that refuse to admit seniors on Medicaid will keep those who spend all their savings and wind up on the program. "'We will keep her here' - that's what they said," Duffy recalls. "But I didn't get that in writing." A representative from the nursing home declined to comment.

As Nappa's dementia progressed, she needed more attention. That meant moving her from an independent unit that cost $3,000 a month, to a dementia unit that cost $6,000. Trips to the emergency room, hearing aids and other costs that Medicare didn't cover added up. Soon enough, the money that was supposed to last 10 years was gone in two. Duffy enrolled her mother in Medicaid, confident that The Stratford's management would keep its promises. Two months later, she received a letter saying her mother had 30 days to find a new home. Duffy protested, writing letters to the management and local newspapers, and succeeded in keeping her mother at the Stratford for two months until social workers helped line up an adult family home willing to take Medicaid payments.

But the stress and the change of surroundings strained her mother's health, Duffy said. Six weeks after moving, she was dead. "She declined so quickly," Duffy said. "Being in familiar surroundings is hugely important for dementia patients. There's no doubt in my mind that the move hastened her death. It was devastating, just devastating." NEW HOME Ranzman's story has a happier ending. Her daughter pulled her out of the Amsterdam Nursing Home and rented a house in Smithtown, Long Island, with a patio and a backyard full of azaleas and trees. It was Ranzman's own space. She had round-the-clock aides, a large window and plenty of sunlight. Her daughter, Goldblum, noticed that Ranzman's memory improved quickly. Her mother seemed happier and more alert. "It was less than half the cost of a nursing home and a million times nicer," Goldblum said. "She showed such improvement." Goldblum paid $36,000 a year for the house and her mother's long-term care insurance paid the home-health aides. The move saved around $250,000 a year in expenses. What's more important to Goldblum is that her mother seemed content when she died in April at age 86, lying in bed and surrounded by family. "It was a wonderful ending," she said.

The third way is to provide the evidence governments need to design effective policies. They sometimes — in fact frequently — ignore it, Hwang acknowledged ruefully. “The victories are small and few. We have to be determined and persistent.”

He is the fourth director of CRICH. Over its 17-year history it has grown from a handful of doctor-scientists into a multi-disciplinary team of physicians and researchers housed in the Li Ka Shing Knowledge Institute, a modern facility attached to St. Michael’s Hospital. “

We think preventing poverty and illness is a highly effective way to invest in health.”

After an intensive initiation in management, administration and strategic planning, he hopes to spend one day a week running the centre and split the rest of his time between his clinical work (he is a physician at Seaton House, Toronto’s largest homeless shelter for men and an internist at St. Michael’s) and his research. His colleagues don’t know how he’ll keep up that pace. He isn’t sure either. What he can say with certain