January 2003
Introduction
Thank you for once again
inviting the Ontario Association of Non-Profit Homes and Services for Seniors
(OANHSS), to speak to you about the very real issue of appropriate and adequate
care and services for Ontario’s seniors.
OANHSS is a provincial
association that has represented not-for-profit providers of long term care, services
and housing for seniors for over 80 years. Members, which include municipal and
charitable homes for the aged, non-profit nursing homes, seniors’ housing
projects and community service agencies, operate over 25,000 long term care beds
and close to 5,000 seniors' housing units.
I’m sure most of us in this
room know someone who is living the reality of caring for, or finding care for,
an aging parent, relative, friend or neighbour. This is no easy task. It is an
emotionally difficult and draining experience for everyone involved. There is no
shortage of research pointing to the guilt, stress, confusion and anxiety
families and their elderly loved ones feel when it comes time to make decisions
regarding care.
At the very least, those going
through this process should be able to take comfort in knowing that they will
get the care they need.
Right now, in Ontario, this is
not the case.
But this can be fixed. The
purpose of my presentation today is to leave you with our suggestions and
recommendations for alleviating the funding crisis in long term care to ensure
that seniors in our province receive the care and services that they deserve.
Meeting the Need
Looking specifically at long
term care facilities -- homes for the aged and nursing homes -- funding has not
kept pace with the changing needs of residents. The average age is now 86,
compared to 73 two decades ago. Residents often have multiple chronic illnesses
and require special care. More than
half suffer from dementia and other mental health illnesses, and over
three-quarters require rehabilitation to maintain their level of functioning.
The reality is that, since 1993, the acuity levels in long term care facilities
have risen by
almost 20%.
Simply put, residents no
longer “walk in the door” of our facilities as they did years ago. They are
coming from hospitals, psychiatric facilities and crisis situations in the
community. Intravenous treatments, gastric feeding tubes and oxygen are regular
parts of the care that is given. Residents suffering from dementia require a
high staff ratio to meet their very complex and challenging needs. This is not
reflected in the funding facilities receive to the extent that these people
deserve, but to their credit, the staff in our homes do a remarkable job in
difficult circumstances.
You are not doubt familiar
with the Level of Service Study, commissioned by the Ministry of Health and
Long-Term Care, which found that Ontario ranked dead last out of 10
jurisdictions in meeting the needs of long term care residents. Conducted in
2001 by PricewaterhouseCoopers, the study concluded that residents in Ontario
receive the least amount of nursing and therapy services.
This is very damning evidence
of the crisis in our sector.
In his 2002 Annual Report, the
Provincial Auditor included the Level of Service Study in his review of long
term care. He stated that they had found no evidence to indicate that the
Ministry had addressed the results and he outlined recommendations for ensuring
that, and I quote, “…the funding provided to long term care facilities is
sufficient to provide the level of care required by residents and that the
assessed needs of residents are being met.”
A Good First Step
Last summer’s announcement
of $100 million in new operating funding for facilities was a much-needed
infusion and a good first step in addressing the funding shortfalls that have
plagued our sector for years.
We fear, however, that the
perception at Queen’s Park is that long term care is now “okay”. Things
are not okay – not by a long shot.
Long term care remains
underfunded by $430 million a year. What is needed is an $18 per day increase --
from $70 to $88 -- in the government’s share of the per diem for each long
term care resident. This is keeping with our long-standing request for a $25 per
diem increase - the $100 million investment represents $7.00 of the $25 – a
further $18 is still desperately needed.
We recommend that this be
spread over two years with an investment of $215 million, or $9.35 per resident,
in the upcoming fiscal year and the same in 2004-05.
This funding will make a very
real difference in the lives of residents. More dollars will mean trained staff
who understand the struggles of someone living with dementia. More dollars will
mean that residents who can benefit from therapy can get it. More dollars will
mean residents get more than 15 minutes of care a day from a registered nurse.
More dollars will mean that staff have the time to give people more than
briefest attention.
Let me share with you some
startling realities:
On average there is one registered nurse looking
after up to 100 residents – and we have heard as high as 200.
Despite the enormous number of residents with dementia and behavioural problems less than 6% receive any professional intervention.
Only
10% of residents with the potential to benefit from rehabilitation actually
receive physical therapy.
And isn’t it a sad day when
a member of the Legislature feels it necessary to introduce a motion to ensure
residents receive a minimum of at least one bath a week.
But perhaps the most telling
example of the need for increased funding, and something we can all relate to,
is the food allowance. Facilities are expected to feed residents on a budget of
$4.49 a day -- and this amount has increased by only 23 cents or 5.4% since
1993.
Put aside for a moment the
fact that for three meals a day plus snacks, this is unconscionable, and
consider that for this paltry amount, providers are expected to produce ground,
minced and pureed versions of each meal, and numerous special diets such as
diabetic, weight loss, weight gain, lactose intolerant, wheat-free, reduced salt
and so on. They must also offer a second choice for each meal and each diet. And
after all is said and done, the hope is that the meal is enjoyable for the
resident, because for many, eating is quite simply the highlight of the day.
I challenge any of us to feed
our families on $4.49 a day.
Funding Equity Critical
A financial crisis of another
sort has had a slow and insidious impact on homes for the aged.
Funding for long term care
facilities is not equitable. A succession of government policy decisions has
created funding inequity within the sector. Our analysis has revealed that
nursing homes receive on average 10 per cent more government subsidies through
supplemental funding initiatives than the typical charitable home for the aged.
The estimated additional amount going to nursing homes can be as high as $6.00
per resident day, which represents about $70 million per year.
The provider associations,
OANHSS, OLTCA and AMO, have come together and reached agreement on a solution,
which we presented to government in December. We are anxiously awaiting a
response.
It is critical that the
province take immediate steps to rectify this inequity and level the playing
field to ensure that residents are funded at the same level of care regardless
of which type of facility they live in.
A Healthy, Sustainable
Continuum
Long term care facilities are
but one part of an entire network of services for seniors in Ontario, all of
which are sagging under the weight of an aging population that has increasingly
more complex care and service needs.
Substantial investments are
needed at all points along the continuum – home care, community services,
supportive housing and facility care. The effectiveness of any one of these
components is dependent upon the strength of the system as a whole.
We urge the government to make
good on its 1998 commitment of $551.8 million for home and community care, which
includes important services such as homemaking, respite care, adult day
programs, visiting health services, meal programs, supportive housing and
others.
Based on a recent calculation
there is $257 million that has not yet been allocated. This is money that is
desperately needed by a sector that, if properly funded, will go a long way in
taking the pressure off more costly components of the health sector.
Conclusion
It has been said by some that
long term care is the “Cinderella” of the health sector. We work hard to
provide care, but we do not have adequate resources.
This can and should be fixed.
In summary, our recommendations are:
1.
An $18 increase in the per diem paid by the
province to address the $430 million funding shortfall and bring long term care
facilities to more appropriate levels of care and services. We recommend $215
million (or $9.35 per resident) in 2003-04 and a further $215 million in the
2004-05 fiscal year.
2.
Implement recommendations from provider
associations to address funding inequities. Funding for long term care
facilities needs to be equalized to ensure a level playing field for providers
and consumers.
3.
Address the significant underfunding of the
community sector by flowing the $257 million remaining in the government’s
1998 commitment of $551.8 million for home and community care - $170 million in
2003-04 and the balance in 2004-05.
Achievement of these
recommendations will ensure that the entire network of services for seniors in
Ontario remains healthy and sustainable. We urge you to take this message
forward when you are advising the Legislature.
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Ontario Association of Non-Profit Homes & Services for Seniors
7050 Weston Road, Suite 700, Woodbridge, Ontario L4L 8G7
(P) 905-851-8821
(F) 905-851-0744
Comments or questions about our site?
Contact
Debbie Humphreys
at 905-851-8821 ext. 233
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© Copyright 2008 OANHSS
OANHSS members include not-for-profit providers of long term care, services and
housing for seniors in Ontario.
Members include municipal and charitable long term care homes, non-profit
nursing homes,
seniors' housing projects and community
service agencies.