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Seniors face reduced help at home

Government cutbacks blamed; big home-care firm to leave B.C. because of 'inadequate funding'

Tuesday, October 29, 2002

The sick, elderly and disabled in the Greater Vancouver area received a double dose of bad news Monday.

First, the Vancouver Coastal Health Authority -- which covers the North Shore, Squamish, Vancouver and Richmond --announced it will reduce cleaning, laundry and shopping services to an estimated 5,600 residents living in their own homes.

Second, a company that provides home-care services to 3,000 B.C. residents -- many in the Greater Vancouver area -- announced it is shutting its operations in B.C. because of "inadequate and out-dated funding" from Victoria.

The impact of these changes will be crippling to senior citizens, says Joyce Jones, co-chair of Seniors Network B.C.

"I don't think this is what seniors expected out of their aging, frail years," Jones said.

She says it's just one of many broken health promises. The government said it wouldn't touch things and we'd have better health care. Then they cut back on the services, she complained.

The Vancouver Coastal Health Authority is the last health authority in B.C. to reduce shopping and cleaning services so it can increase home-care medical services while staying within its budget.

"Right now we can't meet the demand," said health authority representative Clay Adams. "We just don't have enough resources and enough staff to be able to meet what needs to be done because [home-care workers] are spending a lot of time doing things that are nice for people, but aren't necessarily truly part of their day-to-day health need.

"Should we be using our employee time to help someone shop when that time could be best spent providing hands-on care to another client?"

He said most elderly and sick people will need to rely on a friend, neighbour or relative to help with errands and household chores.

Each of the authority's 7,000 clients in the Vancouver area will be assessed to determine if they desperately need those non-medical services. Adams estimated about 80 per cent will experience a reduction in service.

He said the decision by ParaMed Home Health Care to cease B.C. operations will affect about 1,200 clients in Vancouver, who mainly live in the West End.

Adams said the authority is planning how three other agencies that provide home care in the region -- one private company and two non-profit agencies -- will absorb the work done by ParaMed.

He said there is no guarantee ParaMed workers will be re-hired, and acknowledged that clients may not have the same home-care worker in the future.

"These are fairly intimate relationships, given what they do, but unfortunately, we can give no assurance that those existing employees of ParaMed will [all be re-hired]," he said.

The province, in an effort to restructure health care in B.C., is moving seniors out of institutions and has said it will provide support for them to live in their own homes.

Provincial Health Services Minister Colin Hansen announced in April that 3,000 extended-care beds would close, but said they would be replaced with 4,200 assisted-living spaces and that "no patient will go without care they would have had otherwise."

On Monday, Hansen said the cutting of services in the Coastal Vancouver Health Authority was a matter of allocating scarce health-care dollars to medical necessities.

"It really comes down to priorities. If we had the money to do everything, we'd do everything," Hansen said.

Regarding ParaMed, Hansen said it is up to health authorities to reach contracts with service providers that are within their budget, and noted is often difficult to do in B.C. given the high cost of labour compared with other provinces.

"We don't have the dollars to fund everybody at the level they would like to be funded at, so we may need to find other organizations that can provide that service," Hansen said.

Ethel Lambert, ParaMed B.C. regional manager said the company will no longer operate in B.C. because of insufficient funding, a problem that began under the NDP government and has increased under the Liberals.

"ParaMed's withdrawal comes after years in an environment of decisions beyond the control of home-care agencies. No business can continue to operate indefinitely while losing money, and the inadequate and outdated funding formulas that exist in B.C. simply don't cover the cost of providing home care," she said in a letter to her staff announcing the company will no longer provide services in B.C., effective March 31, 2003.

Lambert said the costs of wages, benefits and overhead have increased, but there hasn't been a change in the funding formula for 10 years. In the 1998-99 fiscal year, ParaMed, which has operated in B.C. for 21 years, received almost $5 million from the provincial government.

ParaMed's parent company, Extendicare, provides home-care services across Canada, and Lambert said there are not similar funding problems in any other province.

The layoffs will affect about 900 employees, most of those working in the Lower Mainland, and about 3,000 clients scattered across B.C.

"It's a systemic problem. We're not the only agency experiencing these difficulties," Lambert said. "We've clearly identified that funding for home care isn't adequate to sustain the true costs."

Within the Vancouver Coastal Health Authority, there are two non-profit agencies and another for-profit company -- Drake Medox -- that provide home care to patients.

Drake manager Barbara Fry would not comment on whether her company has similar concerns or whether it plans to withdraw services in B.C.

"We're quite shocked at the ParaMed situation, but we're not prepared to speak to how that affects us at this point in time," Fry said.

Drake and ParaMed each perform about 20 per cent of home care services in Vancouver, but the health authority says Drake has not expressed similar funding concerns.

About half the ParaMed employees are members of the B.C. Government and Service Employees' Union, which says the workers are "devastated" by the loss of their jobs and the uncertainty of whether they'll be re-hired by the other agencies.

"Their clients are scared, wondering what is going to happen to them," said Ann Chambers, secretary treasurer of the BCGEU's health service division.

Chambers, who is a community health worker, says shopping, cleaning and laundry are as important to many seniors as the medical services performed by workers, such as bed baths, emptying catheter bags or washing hair.

"You may have someone who is totally capable of doing their personal care, but is not capable of driving a vacuum or cleaning out a fridge," Chambers said.

Housekeeping work can keep someone from eating food that has gone bad or living in unclean conditions. "They're going to end up sick and up in emergency, which is not going to save the system money," Chambers said.

"[The government] is not focusing on the preventive care, and it certainly isn't looking after our seniors, our disabled and our sick. What hours they will be getting will be very limited."

The government says the Vancouver health authority will still provide housework to clients if it makes the difference between keeping people in their homes or going into a care facility.

"The government should be the provider of last resort and that, as has been the case for decades, families should be there for their family members as a first priority," Hansen said.

He said there is enough time before ParaMed withdraws its services March 31 to reassign the work being being done by that company.

The Coastal Vancouver Health Authority will now start assessing its 7,000 clients to determine who will lose housekeeping services. The process involves a personal visit by a health authority worker going through extensive paperwork, and Adams estimated it would take several weeks to complete.

He said the changes could enable more people to stay at home because the new system will provide more medical services to more clients.

The Fraser Health Authority has made similar housekeeping cuts to its clients, said representative Helen Carkner. That began in 1997 in the Fraser Valley, and concluded in early 2002 in South Fraser.

Jones promised to be "in the face" of Premier Gordon Campbell to fight the cuts to service. She encouraged people affected by the changes to leave their stories on a special line: 1-877-600-1180.

"We think that's a way of keeping the government aware that they're just not going to do this without hearing about it," Jones said. "It's up to organizations such as ourselves to be an advocate for these people and say 'This is one of things where you are really hurting people and it's going to cost you more money in the end.' "

Home care cutbacks make no sense

The B.C. Liberals evidently prefer hypocrisy to Hippocrates. Two recent health-care developments are proof enough of that.

First, the Vancouver Coastal Health Authority announced Monday that it would reduce shopping, cleaning and laundry services to about 5,600 residents of the Lower Mainland.

Also on Monday, a company that provides home-care services to 3,000 B.C. residents announced it was closing its B.C. operations because of inadequate government funding. ParaMed officials noted that their parent company has not had similar difficulties in any other province.

The elimination of home care is enough to stain the Liberals' reputation, but when we view Monday's twin developments through the prism of the government's stated health-care plans, the Liberals' reputation is left blackened by the penumbra of hypocrisy.

In April, Health Services Minister Colin Hansen announced a plan to deinstitutionalize as many frail seniors as possible. However, Mr. Hansen assured British Columbians, "no patients [would] go without the care they would have had otherwise" because B.C. would replace 3,000 extended care beds with 4,200 assisted-living spaces. Without adequate home-care services, those assisted-living spaces are now jeopardy.

Aside from the obvious hypocrisy, the decision to eliminate home care seems ill-advised from almost any perspective you'd care to take.

As a public relations matter, the Liberals' decision is beyond us. It comes on the heels of the census, that found more seniors are living alone than ever before. And while measures to cut government costs are both necessary and overdue, the decision to target the most physically, psychologically and financially vulnerable segments of the population looks like political suicide. What's next -- telling heart attack victims to hitch a ride to the hospital?

On a moral level, the plan to move seniors out of institutions could have been commendable. Most seniors prefer the sense of independence that comes with living in their own homes; research suggests that people who waste away in institutions can thrive at home, provided they receive the proper supports.

But by eliminating those crucial supports, the Liberals are threatening to foist on to seniors the disaster that successive governments have visited upon the mentally ill. The deadly equation that has long governed our experiments with mental health -- deinstitutionalization plus very little support equals sadness and sorrow, disease and death -- could easily come to permeate our entire health care system.

And somewhere between disease and death come the lengthy hospital stays, which inevitably cost the government much more than hiring people to run a few errands for the elderly.

So the Liberals' seeming ignorance of preventive health care makes no economic sense either. Preventive medicine? Never heard of it.

Even those "non-essential" home-care services the government has slated for extinction -- shopping, laundry and cleaning -- can well prove to be preventive measures that reduce future hospital visits.

The inability to keep a clean house can obviously lead to the spread of disease, and those seniors who are unable to shop for themselves face significant risks of malnutrition. Add to that the fact that visits from home home-care personnel often improve the mental health of seniors and the "non-essential" services start looking indispensable.

But when the only thing you can see is the cash right in front of your eyes, everything else is dispensable.

Care home residents face fee hike

Gov't to raise top monthly bill up to $3,875

Some nursing home residents will soon be paying more than double for their care as a result of last Wednesday's provincial budget.

The government wants long-term care home residents to pay a greater share of the actual cost of their care -- based on their income -- up to a new maximum of $3,875 per month.

The current maximum fee is $1,561 per month.

"Even with people in the higher income bracket, it's going to be a pretty tough hit," said Wes Ashwin, vice-chair of the Provincial Advisory Committee for Seniors.

"For seniors it could be a serious matter, because we tend to be on a fixed income, so any increase affects our budgeting."

Beginning Oct. 1, monthly fees will rise for about 6,000 of the province's 8,900 nursing home residents, depending on their income. About 16 per cent of long-term care home residents will see increases from $202 to $2,314 per month, while about 53 per cent will see increases of less than $202.

About 120 residents -- or those with an income of more than $52,000 a year -- will pay the new maximum monthly fee of $3,875, said assistant deputy minister of Health Duncan Fisher.

The government will continue to shelter lower-income residents, so about 2,800 residents won't be affected by the increase and will continue to pay the minimum fee of $828 per month.

"It's a difficult choice, as I'm sure you can appreciate, because no one likes to pay more," Fisher said.

"There are a number of services we have to pay for fully under the Canada Health Act. Long-term care is not one of those services, so we are asking folks that can afford to pay a little bit more towards care to do that."

Fisher said the fee changes will bring the government an extra $7.4 million in revenue this year.

By making this change, Saskatchewan will have the third-highest maximum monthly fee for long-term care among the provinces, behind Nova Scotia ($5,085.60) and New Brunswick ($4,020).

But Fisher said the government will continue to subsidize 74 per cent of the overall cost of long-term care in the province. He said no resident will have less than $166 in disposable income each month.

"The thing to keep in mind is it is an income-tested resident charge for long-term care," he said.

"We will still be heavily subsidizing long-term care."

According to a Saskatchewan Health document, the cost of providing long-term care to an individual is more than $48,000 per year. The document states that in Saskatchewan, health costs have grown by about 50 per cent since the mid-1990s, which is "well above our rate of economic growth."

Frances Farness-Petit, secretary-treasurer of the Senior Citizens Action Now Association, said she's concerned about how policy changes impact low-income seniors.

"I think if any senior's getting more than $5,000 a month, they likely can afford some increase," she said.

"But any seniors who may be living on just their pension would have a hard time.

"If I had to go into a nursing home, my income is about $1,100 a month. I wouldn't be able to pay for one."

© Copyright 2002 Saskatoon StarPhoenix

Coping with cuts: a tale of two seniors

A North Vancouver woman gets help to take a shower once a week, and do her laundry every two weeks

Friday, November 01, 2002

Although she is severely arthritic and 87 years old, Kitsy Crichton sat down on the kitchen floor last week and wiggled her buttocks across it to clean the floor, which was so dirty she couldn't stand the sight of it.

This is what you do, she says, if you want to stay in your own home and health authorities have cut your home care to such a meagre amount that all it gets you is assistance to take a shower once a week and help with laundry once every two weeks.

"My house isn't clean. I can do a bit of dusting but I can't vacuum, I don't dare do that. I'm full of arthritis. My back is just unreal.

"Every once in a while I have to phone an ambulance to get me to Lion's Gate Hospital so I can get a shot of demerol in the emergency department," says Crichton, who lives on a $17,000 pension at the Zajac Norgate House in North Vancouver, an apartment building for seniors who are still trying to maintain their independence.

Crichton's neighbour, Marjorie Hammond, is affected by arthritis to an even greater extent. She gets one hour of home care per week. Both women were victims of a reassessment process conducted a few months ago by North Shore community home support, which determined that hundreds of seniors would have to make do with less personal assistance such as housekeeping, cooking, shopping and errands.

Not for cost-cutting purposes, health authorities maintain, but because the program needs to shift its priorities to focus more on the purely medical care needs of shut-ins.

Now that Richmond and North Shore seniors have seen their home care services cut, the Vancouver Coastal Health Authority (VCHA) is turning its attention to thousands of Vancouver seniors who will undergo the same review.

Clay Adams, spokesman for the VCHA, said 7,000 seniors who receive home care services will be reassessed and about 80 per cent of them can expect to see services reduced.

Seniors in Vancouver can look at the examples of Crichton and Hammond to see what's on the horizon for them.

In Crichton's case, what was once fours hours a week of free home care is now an alternating two hours one week and three the next. When her home care provider comes, there is only enough time to help Crichton get a shower and do the laundry.

"I guess I should be satisfied with this because so many others are getting less. I'm scared they'll take it all away from me if I complain," says the twice-widowed woman who raised four children, including a schizophrenic son who depended on her completely until his death at the age of 46 a few years ago.

"I want to make a pie so badly but I can't because of my arthritic wrist. I shouldn't complain because I'm still living on my own. I've got a young mind and an old body. It helps that I got an electric scooter on loan from the Red Cross so I can do my own shopping on my good days.

"I do plan to be around a lot longer, you know," Crichton says. "I'm planning on getting a letter from the Queen when I'm 100."

At 73, Hammond's letter from the Queen is still a distant dream. When her home care was cut from three hours to one, it meant she could only shower once a week and that was upsetting to her.

"It's not like we want to have to ask for assistance. We'd rather do it all ourselves. And it seemed like they wanted us staying at home because then we wouldn't be cluttering up the extended care facilities," she says, referring to provincial government health planners.

Although Adams said this week that health authorities are expecting seniors' families, neighbours and friends to pitch in with more help, Hammond and Crichton both say it is an unrealistic request.

"In theory, it sounds good, but in today's society young people today work long hours at their jobs and then they go home to their children and their own messy homes," says Hammond. who worked as a licensed practical nurse in three B.C. hospitals before being forced to retire at the age to 60 when arthritis got the best of her.

Crichton says the only child she has living in Vancouver is a single mother with pressures of her own so she doesn't want to add to them. As an accomplished seamstress, she has sewn clothes for a woman who later came to her apartment a few times to clean it in exchange.

Not one for self-pity, Crichton says she watches in wonder as Hammond somehow manages to get herself transferred from her bed to her wheelchair all on her own.

Hammond says she takes advantage of her pain-free moments to do her errands and she's resigned herself to her limitations.

"You do what you have to do. If it means going without bras and panties because it's an easier way to get yourself dressed, then that's what you do."

pfayerman@pacpress.southam.ca  

Home care workers threaten to strike

Friday, January 09, 2004

Home care will be thrown into disarray if hundreds of workers walk off the job January 19.

Union spokesman Peter Olfert says more than 500 home care and other workers are set to walk out if there is no resolution to their contract demands.

That means patients needing home care would be backed up in hospital.

The Winnipeg Regional Health Authority admits if the workers do go on strike, the families of 13,000 people receiving home care may have to step into the breach to help look after them at times.

The main issues in the dispute are wage parity with their counterparts at other regional health authorities in the province and more pay for ever greater job responsibilities.

The union also says there are cases where supervisors are earning less than the people they're supervising.

Olfert says the workers have been working without a contract since March 31.

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