Supportive living for seniors

New government regulations try to encourage options to long-term care.
CYNTHIA RAMSAY SPECIAL TO THE JEWISH BULLETIN

Don't think that because you're first on the waiting list for long-term care that you are going to be the next person admitted. Announced in April, the B.C. government's new regulations restrict access to public long-term care facilities by need. Seniors who don't meet the government's criteria must remain in their own homes, apply for assisted living housing or pay for residential care or housing privately. The changes are already being implemented and you should prepare for the choices ahead.

What are the changes?

"The current government direction in this is that only people with complex medical needs, be they cognitive or physical needs, would gain admission to a long-term care organization such as Louis Brier," said Nick Braithwaite, administrator of the Louis Brier Home and Hospital, in an interview with the Bulletin.

"All other people, and that would include a lot of people who traditionally have made it into long-term care facilities, would be supported in the community," he continued, meaning in a supported or assisted living environment.

As currently defined by the government, supportive living is the early stages of ill health and assisted living is when the person needs more nursing care (IC2 to early IC3, which is dementia), according to Gillian Watson-Donald of the Pacific Development Advisory Group, which specializes in housing for seniors.

IC1, IC2 and IC3 refer to intermediate care levels and a person's classification relates to the number of hours they need of nursing care, said Watson-Donald. For IC1 people, no nursing care is required and IC1 is now called supported or assisted living; supportive living was, and still is by some, called congregate living.

Facilities that provide IC1, and even some IC2, do not have to be licensed by the government. Institutions providing IC2, IC3 and/or extended care (these three levels together comprise multi-level or complex care), such as Louis Brier, must be licensed. However, with its new policy, the government wants IC2 people to be cared for in supportive living, said Watson-Donald.

Supportive Living B.C.

The Supportive Living B.C. program will create 3,500 supportive housing units for seniors and people with disabilities who have low or modest incomes. The belief is that supportive living can provide a better quality of life by allowing people to stay in their communities.

Through the program, by 2006, 1,500 new housing units will be built, 1,000 existing housing units will be converted and 1,000 rent supplements will be provided to enable seniors and people with disabilities to live in assisted living facilities provided by the private sector. Support services such as meals, housekeeping, laundry, recreational activities and emergency response will be provided and personal care services will be available.

Another point of view

According to A Dramatic Reversal of Policy on Long-Term Care, a paper prepared by the Hospital Employees' Union (HEU) for the Canadian Centre for Policy Alternatives, the government's new policies represent a broken election promise.

"Prior to the election, the Liberal's committed to build 5,000 new not-for-profit, long-term beds.... Then, in the fall, it was 1,500 new long-term care beds and 3,500 assisted living units. On April 23, when the regions presented their three-year [health] plans, the numbers changed once again," states the HEU, adding that now the number of long-term beds is going to be reduced.

In addition, the HEU claims that the experience with supportive living in Alberta and the United States shows it to be a positive model only for those seniors with limited care needs, that it is not an effective subsitute for long-term care and that it is largely unaffordable for moderate and low-income seniors. For these and other reasons, 19 seniors, health, housing and union groups, including the HEU, have come out in opposition to the government's plan.

In the community

The Louis Brier Home and Hospital is classified as a public facility. People wanting admission into the Louis Brier have to approach the health authority.

With the recent policy changes, said Braithwaite, potential residents have to be classified as a priority admission, which means that they have complex care needs, they aren't being supported in the community and they need to be admitted somewhere within three months. If they meet those qualifications and if they are Jewish, then the first place the health authority would look is to the Louis Brier, he said. The home has a waitlist of approximately two years.

"What is going to happen now," said Braithwaite, "is those people on that waitlist ... if they are not qualified as priority admissions because of their needs, won't gain admission to Louis Brier. And people who are not on the waitlist or who are lower down on the waitlist, if they are classified as having need, will go to the top."

The result will be that people who are first on the list may be there indefinitely, until their condition is such that they qualify for long-term care.

Some housing options

The Louis Brier's new Harry and Jeanette Weinberg Residence will be a private facility that potential residents can access through Louis Brier directly. It will consist of 40 assisted living apartments for about 50 people, because there is room for couples, and 20 multi-level care beds. The rental rate will vary, said Braithwaite, but the Louis Brier is committed to providing rooms in the new residence that are subsidized by the community.

Of the more than 150 government-subsidized housing complexes for seniors in the Vancouver/Richmond region (this excludes care facilities such as Louis Brier), two have a Jewish connection: B'nai B'rith Manor on Howe Street and Haro Park Centre on Haro Street. B'nai B'rith Manor offers suites for low-income seniors, while Haro Park offers independent apartment living for low-income seniors as well as units for seniors who meet the Ministry of Health's criteria for intermediate care.

Most private sector options are not subsidized and residents have to bear the full costs. Supportive living rents generally include a set number of meals per month, 24-hour security, emergency response, weekly housekeeping and laundry service, recreation and social activities and transportation. Condos charge a monthly fee for these services.

At Cavell Gardens, located on Sophia Street at 12th Avenue, rents range from $1,400-$2,500 (293 to 476 square feet). In addition to the aforementioned services, it includes a wellness centre that will be run in co-operation with the Vancouver Coastal Health Region.

This arrangement will allow caregiver- resident relationships to develop, said Kellie Lawson, principal of Kellie Lawson Associates, the marketing consultant for Balmoral House and Cavell Gardens. It will also enable more people to access smaller increments of service: If they only need 30 minutes of attention, they will get it, rather than waiting or paying for the minimum two hours of service, which they would have to do if they were trying to access care from their own home.

The Balmoral House condos on Lynn Valley Road sell for $159,900 to $239,900 (629 to 925 square feet) plus a lifestyle services package for $525 a month. As well, Balmoral House has a relationship with neighboring Sunrise Assisted Living. On a fee-for-service basis, Balmoral residents can join in Sunrise activities and have priority access to suites at Sunrise, which is more care-oriented and includes reminiscence care for elderly with Alzheimer's or other dementia.

At the higher-end of the retirement living spectrum is Terraces on 7th.

"One of the big [things] that is missing in residential care and retirement living is hospitality. While most places emphasize care, we are going to emphasize hospitality," said Ken Levitt, Terraces' general manager.

There are 20 condos for sale and 83 for lease at Terraces (at 7th and Fir). Condos range from $270,000 to $550,000 (700 to 1,200 square feet) plus a monthly service fee of $635 to $735. For an additional cost, residents can purchase additional meals, spa services, etc. Monthly rents range from $2,700 to $5,220.

For more information, call Supportive Living B.C., 604-433-2218 or 800-257-7756; Balmoral House, 604-982-0228; B'nai B'rith Manor, 604-683-0596; Cavell Gardens, 604-637-1207; Haro Park, 604-687-5584; Louis Brier Home and Hospital, 604-261-5550; Sunrise, 604-904-1226; Terraces on 7th, 604-738-8380.

Prepare, ask questions

The B.C. Ministry of Health has published a booklet called Choosing a Care Facility or Home. Intended as a guide when selecting a licensed care facility (one that provides complex care), it can also be helpful for people looking at moving into a supportive living environment. The entire booklet is 35 pages long and can be found at www.healthservices.gov.bc.ca/ccf/adult/.

The questions to ask and things to observe and jot down include your first impressions, the design of the resident rooms, dining arrangements, special care programming, lounges, activity and outdoors areas, recreational and spiritual activities, laundry, facility policies, staffing, financial arrangements, security and emergency management.

Here is a sample of the specific questions you should be prepared to think about or ask when visiting a facility with the intention of buying or renting a suite:

• Is the facility or home clean, tidy and well maintained?
• Do the residents look clean and well groomed?
• If there are double or shared rooms, can you choose your roommate?
• How is the waitlist, if there is one, managed?
• Are telephone, electricity, water, cable and suite taxes included in the quoted price?
• Are meal times flexible?
• What types of personal care (nursing, dentistry, hairdressing, massage, etc.) are provided? At what cost?
• What is the procedure if
you or a family member has a complaint?
• How will your private information be protected?
• Who is responsible if any of your valuables disappear or
are broken?
• When was the most recent fire drill? Are emergency exits well marked?

If you are having trouble managing your current accommodation because of health reasons, call your local health authority or call Enquiry B.C. during regular office hours at 604-660-2421 in the Lower Mainland, 250-387-6121 in Victoria or 800-663-7867 elsewhere in the province.

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