Long Term Care in British Columbia

GOVERNMENT-SUBSIDIZED NURSING HOMES

How Nursing Homes are organized and administered

Nursing homes/long term care facilities provide 24-hour professional nursing care and supervision in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes.

Admissions to subsidized nursing homes or beds (subsidized beds within a private nursing home) are managed by the Health Authority. A client can apply for admission through the local Health Authority. British Columbia's residential access policy ensures seniors and people with disabilities with the highest need and urgency have priority for the first available, appropriate care facility bed. Clients who have been assessed as needing facility care are expected to take the first room that becomes available. Once in a nursing home, clients may request a transfer to a preferred care facility when there is an opening.

Eligibility/Requirements for Admission

To be eligible for subsidized care services clients must be:

• 19 years of age or older,
• a resident of British Columbia and have a valid provincial Health Card,
• a Canadian Citizen or have permanent resident status and unable to function independently because of chronic, health-related problems or have been diagnosed by a doctor with an end-stage illness.

An assessment by a case manager from the Health Authority will determine the client's eligibility for services, the client's health care needs and whether the client will be required to pay anything toward the cost of the service.

Income/Asset Test

During the assessment, the case manager from the Health Authority may ask to see war veteran and pension cheque stubs as well as the client's most recent income tax return or notice of assessment as the fee for subsidized nursing homes is based on income level.

• If the client's after tax income is less than $19,500 per year, the monthly rate is calculated as their after tax income less $3,900 and divided by 12. Note: The $3,900 deduction ($325 per month X 12 months) is set to ensure that most clients have at least $325 of income remaining per month after paying their monthly rate.
• If the client's after tax income is equal to or greater than $19,500 per year, the monthly rate is calculated as their after tax income multiplied by 80 per cent and divided by 12.

Costs for Nursing Homes

If a married couple receives GIS (Guaranteed Income Supplement) and shares the same room in a nursing home, then the couple is eligible to pay $27.62 per day or $840.16 per month per person. Clients receiving respite care pay the lowest client rate. The respite care rate applies to all beds used for respite care in government-subsidized nursing homes.

Subsidized Nursing Home fees include:

• an assisted meal service,
• medication supervision,
• personal assistance with daily living activities, such as bathing, dressing or grooming, and
• a planned program of social and recreational activities.

PRIVATE NURSING HOMES

A senior may choose to live in a private nursing home and pay the full fees charged by the individual nursing home. Each individual private nursing home is in charge of its own admissions procedure, waiting lists and fees. Fees cited here include room, board and basic care.

Costs for Private Nursing Homes

RETIREMENT HOMES / RESIDENCES

How Retirement Homes are Organized and Administered

A retirement home in British Columbia is a multi-residence housing facility that provides accommodation and services such as meals and cleaning services for older people. Retirement homes in the province are privately owned and operated and not administered by the provincial government. Each facility usually provides a private or semi-private room or complete living suite and then also provides common living quarters, including a lounge area, a common dining room, recreation rooms, cleaning services, social and/or religious programs and some basic health care services. The unit can be paid for on a monthly fee basis, like an apartment, or can in some instances be bought the same way as a condominium.

Admission, fees and waiting lists for retirement homes are controlled by the homes themselves, not by the government. Admission usually depends on the ability to pay and absence of serious medical conditions that require professional nursing care. Residents are responsible for paying their own fees and government subsidies are not available for accommodation in a retirement residence.

Costs for Retirement Homes

GOVERNMENT-SUBSIDIZED HOME CARE

How Government-subsidized home care is organized and administered

Home support services are designed to help clients remain independent and in their own home as long as possible. Home care services include professional health care services as well as personal care services such as bathing, dressing, grooming and light household tasks that help to maintain a safe and supportive home.

To apply for subsidized home care a senior must contact his/her local Health Authority. The Health Authority will conduct an assessment. If home support assistance is recommended, a case manager will help the client determine the assistance that will best suit their needs and will make the necessary arrangements.

Eligibility/Requirements for Admission

To be eligible for services such as home care nursing, occupational therapy and physiotherapy, clients must:

• be a resident of British Columbia,
• be a Canadian Citizen or have permanent resident status and
• require care following discharge from an acute care hospital, care at home rather than hospitalization or care because of a life-threatening illness.

To be eligible for subsidized services such as home support and adult day care centres, clients must:

• be 19 years of age or older,
• be a resident of British Columbia,
• be a Canadian Citizen or have permanent resident status, and
• be unable to function independently because of chronic, health-related problems or have been diagnosed by a doctor with a life-threatening illness.

Income/Asset Test

During the assessment, the case manager from the Health Authority may ask to see war veteran and pension cheque stubs as well as the client's most recent income tax return or notice of assessment as there may be a daily charge, depending on income.

Costs

Case management, nursing and rehabilitation services are provided free of charge. There may be a daily charge for home support services, depending on income (for most clients, there is no charge).

PRIVATE HOME CARE

Health Authority resources are limited and go to the neediest. As a result, many seniors get inadequate amounts of Health Authority services and have to rely on private home care services to receive the appropriate amount of care.

Costs of Private Home Care

Scenario 1: Low level of care (early in the crisis management stage of care)

Mrs. Williams is an 85 year old widow living in her own home. She has osteoarthritis and leg edema. She must wear support stockings to relieve her edema and because her fingers and back are arthritic, she needs help getting dressed. To get around her home, she uses a walking support device or rollator. Both of Mrs. Williams' daughters help her out regularly on weekends and evenings while her son-in-law helps maintain the house and takes care of the lawn.

After fracturing her femur in a significant fall 9 months ago, Mrs. Williams' mobility has been severely decreased and she lost 9 kg or almost 20 lbs as a result. She tells her daughters that she forgets to eat and the food in her refrigerator is spoiled. During their visits, her daughters notice she eats very little and sometimes chokes on her food.

To help her eat safely and address her other needs, Mrs. Williams and her daughters agree it's time for some formal care. She needs her meals delivered to her home, someone to supervise her meals and assistance with dressing and bathing. She would also benefit from a home safety assessment.

Care plan to assist family caregivers part-time

• Meal delivery - 2 meals a day on weekdays provided by Meals on Wheels or another meal delivery program
• Meal supervision - 1 hour a day on weekdays (to include a record of food intake and assistance if patient chokes)
• Personal Care (bathing, dressing) - 1 hour a day on weekdays
• Occupational therapist: to provide initial home safety assessment and recommendations

IIn addition, there will be expenses for two visits of an occupational therapist including a 1 hr. initial assessment and 45 min. follow up after equipment has been installed. The two visits will cost $218.75 altogether.

Scenario 2: Intermediate Level of Care (late in the crisis management stage of care)

Mr. Leung is a 72 year old widower. He lives with his daughter and her husband in a small community outside the city. Mr. Leung has cataracts in both eyes. He also has dementia which has progressed to the point where he requires continual supervision. He forgets to take his medication, does not eat properly and cannot safely prepare meals. He needs cues for dressing and bathing.

Mr. Leung's daughter and her husband assist him mornings, evenings and weekends but aren't available on weekdays. For weekdays, they enrolled him in an adult day program 2 days per week and hired someone to accompany him to and from the program. For the remaining 3 days of the week they've hired someone to supervise him and keep him company. They've also arranged help for laundry and house cleaning.

Care Plan to assist family caregiver full days, during the week

• Companionship/Supervision: 3 times a week, 8 hrs a day
• Adult Day Program: 2 days a week
• Safety Supervision: to and from the Adult Day Program - 2 times a week, 30 minutes each way
• Laundry/House cleaning: 3 hrs a week

Scenario 3: High level of care (in the dependence stage of care)

Mr. and Mrs. Jensen live in a two-bedroom condominium. Mr. Jensen is 93 years old, alert and aware but physically frail. Mrs. Jensen is 88 years old, diabetic and recently had a stroke. Her balance is poor and she's at high risk for falling. She can only walk short distances and needs help to get around. She also has heel ulcers that make walking even more difficult. For longer distances, she uses a wheelchair.

Her family doctor recommends Mrs. Jensen move to a nursing home. But because Mr. and Mrs. Jensen's daughter promised she wouldn't send her parents to a nursing home, she needs to make alternate arrangements. Options include a caregiver to assist Mrs. Jensen with bathing, dressing, toileting, walking, meal preparation, household chores and transportation to and from appointments. A nurse could monitor and chart her medicine use and blood sugar levels, clean her heel ulcers and change her bandages. Mr. and Mrs. Jensen would also benefit from a home safety assessment by an occupational therapist who may recommend safety bars, raised toilet seats, better lighting, removing clutter and securing loose rugs.

Care plan to assist family caregivers full-time, every day

• In-home meal preparation - 7 days a week, 2 hours daily
• Private caregiver - 7 days a week, 8 hours daily to assist with bathing, dressing, toileting and walking and relieve spouse of caregiver duties
• Private Registered Nurse - 4 times a week for 30 minutes to monitor and chart medicine use and blood sugar levels and monitor and change dressing on heel ulcers
• Laundry - 2 hours every other week
• House cleaning - once a week for 90 minutes
• Occupational therapist: to provide initial home safety assessment, recommendations and a 45 minute follow-up after equipment installation