Alberta’s Continuing Care System Organization and Priorities

Presentation to BC Care Provider’s Conference

Tyler James, Executive DirectorContinuing Care

Alberta Health

May 6, 2013

Continuing Care SystemGovernance

• Alberta Health Services (AHS) created as single health authority on April 1, 2009.

• Alberta Health, accountable to the Minister of Health sets directional policy, legislation, regulations and standards, and provides funding to AHS for the delivery of continuing care health services.

• AHS is accountable to the Minister of Health, and is responsible for developing and implementing operational policies, delivering continuing care health services, and assessing and placing continuing care clients.

Continuing Care SystemSystem and Standards

• Continuing Care Health Service Standards– Apply to all publicly-funded continuing care health services.– Currently under review; revisions expected to focus on areas of risk and

quality of life.• Supportive Living and Long-Term Care Accommodation Standards

– Apply to all supportive living and long-term care accommodations.– Last updated April 2010.

Home Living Designated Supportive Living (DSL)

Long-Term Care (LTC)

95,975 Unique Clients 7,985 DSL Spaces* 14,565 LTC Spaces*

Cumulative total to December 31, 2012

Point-in-time information as of March 31, 2013

Point-in-time information as of March 31, 2013

Continuing Care SystemCapacity Planning

• Capacity Planning – Provincial Capacity Planning Model– Commitment to add 1,000 continuing care spaces per year between 2010

and 2015. • Affordable Supportive Living Initiative (ASLI)

– Capital funding provided to operators to support the development of affordable supportive living spaces in the province.

– Since 1999, almost $600 million in funding has been provided to develop, renovate or renew approximately 10,000 supportive living spaces.

– Work in collaboration with AHS to increased the continuing care capacity in priority areas of the province.

Continuing Care SystemPolicy Priorities

• Shift to the Community

90% of Albertans want to live in their own homes during their senior years; 59% of individuals over 95 years of age still live at home.

– Growth in Home Care• Home Care Redesign and Directional Policy Development

– Supportive Living Capacity Growth• Quality and Innovation

– Policy Review– Standards– Innovation Grants– Information Resources

Continuing Care SystemPolicy Priorities

• Accommodation Charges– Long-Term Care Maximum Accommodation Charge increased in January

2013.• Private Room Rate: $58.70/day (~$1785.00/month)• Semi-Private Room Rate: $50.80/day (~$1545.00/month)• Standard Room Rate: $48.15/day (~$1465.00/month)

• Business Model review– Alberta recognises increasing pressures related to cost on the

accommodation and the health side– Upcoming work will look at the funding/revenue and expense issues

review options to develop a model that is more sustainable.

AHS Seniors Health

The Right Care in the Right Place

Presentation to Members

of

BC Care Providers Association

By

David O’Brien

SVP, Primary and Community Care, AHS

May 6th, 2013

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Familiar Challenges with the Numbers

• Number of older adults in Alberta will grow from 375,000 to 880,000 by 2030

• As cognitive impairment is associated with age, the number of individuals living with dementia will also grow

• Of concern – Alberta has the highest proportion of early onset dementia – 17% (e.g. 1,693 individuals under 65 with a primary diagnosis of dementia were seen by physicians in 2008)

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Familiar Challenges with Public Expectations

• Higher levels of education and income• Greater interest in being partners in their

own health – autonomy and choice• Expect a higher level and quality of services• Younger, disabled adults want to stay in

community• Older adults want to stay in community or as

close to home as possible

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Principle Driven Service Delivery

Client based care• Coordinated and trained case manager staff –

increasing integration within community• Acting from a position of wellness and independence;

enhancing individual and community capacity– Caregiver respite; education– Common Home Care services– Adult day programs – Self managed care funding – Testing technology

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Principle Driven Service Delivery

Aging Closest to Home – Aging in Place

• 90% of Albertans want to live in their own homes during their senior years - 59% of individuals over 95 years of age still live at home

• Increase the services provided through home care– Increase number of clients by 3,000/year for 3 years– Increase the variety of home care services– Provide for assessed extra-ordinary funding

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Principle Driven Service Delivery

Right Care – Right Place – Shift to Community• Provide home care, and continue to support individuals

who are unable to remain in their own home in living options close to home

• Increasing the range of congregate living options• Increasing supports within current environments, such

as lodges, to accommodate unscheduled health needs• Increase the number of living options

– Add 5,000 new spaces over 5 years – Align living option with right mix of staffing– Provide added care option for episodic care

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Community Health and Pre-Hospital Supports (CHAPS)

Right patient to the right place at the right time to be cared for by the right practitioner

• CHAPS is an EMS referral program• Connects patients to community and home based services• Helps patients stay at home longer and stay healthier with

additional home services Connect more patients to community services Reduce calls to EMS Reduce Emergency Department presentations Reduce acute care admissions

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ED To Home (E2H)• Connects Seniors visiting the ED with services in the

community, ensuring access to the right care in the right place

• Currently there are 13 EDs across Alberta with E2H program in-place

• The E2H program is a model of integration between Community and Acute Care

• 5,003 additional Home Care referrals generated, enhancing client knowledge of Home Care and increased communication among service providers

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Destination Home• Represents philosophical shift in how Health System

currently responds to seniors with complex needs, and those at risk for admission to supportive living, long-term care and/or ED/acute care

• Mirrors similar approaches in other provinces (Home is Best in BC and Home First in Ontario)

• Transfers to congregate living settings will not be considered until all community-based options have been exhausted. Moving to a residential care facility is a life-changing decision that optimally should be made from home.

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Path to Home• Is an AHS discharge model to effectively and consistently

discharge patients in a standardized method from in-patient beds• Coordinates teams within Acute and Transition care, enabling

completion of activities required prior to discharge in a timely manner, to allow return to home with appropriate community supports

• Model developed on 5 best practices:– Anticipated date of discharge upon admission– Estimated day and time of departure– Readiness for discharge– Complex discharge targeting – flagged and proactive on admission to

acute care– Right time to diagnostics and timeliness of reports

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Home Care Redesign

• 3-year plan to address provincial inconsistencies around– Home Care Service Guidelines (hours of care

available): developed and implemented across AB– Integration of Home Care with Community & Primary

Care supports– Types of services provided– Rates of pay for Home Care services– Service effectiveness and quality outcomes

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Responding to the Needs

Patient Care Based Funding – Case Mix Indexing• Started with Long Term Care Facilities; then Supportive

Living; then home care services • Systematic equitable way of dividing available resources

based on client needs• Based in RAI assessments

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Capacity Changes since 2010

• Added >3,000 new beds• All of them in Supportive Living• Services designed for client need• 24X7 Home Care in retirement homes/lodges• Cost per client reduction• Placement options increasing

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Outcomes - Making Progress

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Wait Time for Living Options

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Seniors ED Utilization

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Seniors ED Utilization

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Questions?

Alberta’s Continuing Care System from a Provider’s Perspective

Presentation to BC Care Providers Association

Bruce West, Executive DirectorAlberta Continuing Care Association

May 6, 2013

About the ACCARepresent the owners and operators of publicly funded long term care and supportive living facilities and the providers of publicly funded home care and home support services.

• 26 facility-based members operating over 11,000 beds/spaces in 110 facilities• 26 home care and home support members providing over 5 million hours of care

annually to over 40,000 clients

Vision: The recognized voice for advancing excellence in continuing care

Mission: We advance the continuing care system by:• Advocating for effective public policy;• Assisting members in networking, education and pursuit of best practices;• Promoting a sustainable and innovative continuing care system; and• Championing quality care and quality of life for individuals receiving

continuing care.

Values: As ACCA members our actions are guided by a commitment toexcellence, professionalism, integrity and accountability.

Challenges for Providers in 2010 Health System Restructuring

Loss of corporate memory Revisions to contracts and regional programs and policies Changing roles and responsibilities

Communication and Consultation Lack of consultation on policy and program development Inconsistent and contradictory messages (Gov’t and AHS)

Operating Funding – Health and Accommodation Continuing care underfunded Regional funding and accountability differences No acuity adjustments since 2005 Introduction of Activity Based Funding No accommodation fee adjustment mechanism Taxation inconsistencies

Capital Funding Capital funding available for supportive living but not LTC No capital component (debt servicing or upgrading) in

accommodation fees

Aging LTC Inventory No action on 2008 strategy to replace 7,000 aging long term

care beds by 2015

Standards and Monitoring Regional accountability differences Impact of standards on operating costs Introduction of new health and accommodation standards Multiple, uncoordinated inspections

Workforce Labour shortages Aging workforce Higher expectations and standards Injury and lost time rates

Challenges for Providers in 2010

Challenge Industry Rating Trend

Health System Restructuring B

Communication and Consultation BOperating Funding – Health and Accommodation C

Capital Funding B

Aging LTC Inventory D

Standards and Monitoring B

Workforce B

Challenges – 2013 Status Report