The numbers say privately contracted long-term residential care facilities don’t perform well and it’s costing taxpayers, according to a report from the province’s seniors advocate released Wednesday.
In the report, Isobel Mackenzie said care facilities contracted by regional health authorities in B.C. are responsible for substantially more hospital visits and more than double the death rate in hospital when compared to publicly operated facilities.
“A consistent pattern emerges that shows a demonstrably greater use of the emergency department and hospital beds by residents from contracted long-term care facilities versus residents from publicly run facilities and a stunning 54% greater likelihood that you will die in the hospital if you live in a contracted care facility versus a publicly operated facility,” said Mackenzie in a press release.
The stats covered a four-year period from April 1, 2012 to March 31, 2016. The data pulled from the Canadian Institute for Health Information from 24 hospitals and 212 care facilities shows seniors living in a care home operated by a contracted provider are:
• 32% more likely to be sent to the emergency department;
* 34% more likely to be hospitalized;
• to have a 32% longer stay in hospital;
* a 47% higher chance of not returning to the care home;
• and 54% more likely to die in hospital.
“At every turn whether it is the decision to call the ambulance, the decision to admit the resident as in-patient, the decision on when or if to discharge the resident back to the care facility we see the contracted care facilities persistently failing relative to the health authority operated facilities,” said Mackenzie.
There are six long-term residential care facilities in Coquitlam and two in Port Coquitlam, all of which have publicly subsidized beds and are either operated by private firms or not-for-profit organizations. The Fraser Health Authority, however, operates Eagle Ridge Manor in Port Moody.
The report says if contracted facilities could match the performance of the public ones there would be a $16 million annual saving and create more than 15,000 additional bed days for an already congested hospital system.
Mackenzie believes it would also reduce the risk of hospitals getting hit by infections or delirium which the report estimates combines to affect half of frail elderly patients.
“Hospitals are not the best place for the frail elderly. Issues related to deconditioning and the anxiety of unfamiliar places and interrupted routines can have a significant impact on the health and well-being of the frail elderly population. We also know that most people want to die at home and for many of our frail and elderly seniors, ‘home’ is the residential care facility. With a rate more than double the public facilities we really need to ask why contracted care facilities are seeing their residents die in the hospital,” said Mackenzie.
The report notes the contracted facilities have fewer frail and complex residents than the public ones, yet they send more residents to hospital.
“This means we need to look at other issues related to the experience and continuity of the staff and the financial incentives for contracted care home operators,” said Mackenzie.
According to the report, private facilities pay lower wages than the public ones with only 54 of 184 private facilities paying the top wages and benefits of the master collective agreement. The lower wages, said the report, could mean less-experienced staff and more turnover which could be a problem in providing continuity of care that has proven to link with better health outcomes, including lower hospitalization rates.
But, said Mackenzie, there’s no provincial data on staff turnover in contracted facilities while there’s data to support public facilities having low staff turnover.
Her report questions whether the contractual relationship between health authorities and care homes are appropriate because most operators receive the same amount of money whether the resident is in the facility or the hospital and that facilities are funded to pay higher wages they they are actually paying.
BC Liberal seniors critic Joan Isaacs, MLA for Coquitlam-Burke Mountain, said while she appreciates Mackenzie highlighting issues that impact quality of care for elders, there should be options for seniors and their families.
“We have heard concerns from families who are being told there is a difference in the quality of care between public and privately operated care homes. This is irresponsible and adds needless concern for families,” said Isaacs in a release that points out the report notes for most quality indicators there’s no difference between operators.
“[Family members] are the best ones suited to make choices for their loved one, ensure that that location and type of home fits their lifestyle, whether it is a private, public, faith-based or not-for-profit care home.”
She agrees with the report’s suggestion that further studies are warranted before drawing conclusions and making recommendations. Isaacs said she will meet with Mackenzie later this summer.
A press release from the BC Care Providers Association (BCCPA) blasted the report’s methodology for not using independent data and said the advocate does not substantiate whether the emergency department visits were inappropriate or not.
“Unfortunately, this flawed report appears to have been produced at the last minute and is filled with questionable suppositions and political buzzwords, rather than independent research,” said BCCPA chief executive officer Daniel Fontaine in the release.
He also said it’s unfortunate the report can instill additional fear and uncertainty for seniors and families when transitioning into long-term care.
The release asserts while the report advocates for increasing wages and benefits for care home staff it doesn’t say what the cost would be or where the money would come from.
“The issue of wages and benefits for workers is something best dealt with through the collective bargaining process,” said Bob Breen, executive director of the Denominational Health Association, in the release. “Furthermore, we expect the [office of the seniors advocate] to speak with organizations like ours not only to verify her claims, but to work with care providers to seek solutions as well. This is something we have not seen to date.”
Long-term residential care facilities in the Tri-Cities:
Coquitlam
Dufferin Care Centre, 1131 Dufferin St.
Lakeshore Care Centre, 657 Gatensbury St.
The Madison, 1399 Foster Ave.
Cartier House, 1419 Cartier Ave.
Foyer Maillard, 1010 Alderson Ave.
Belvedere Care Centre, 739 Alderson Ave.
Port Coquitlam
Nicola Lodge, 2240 Hawkins St.
Hawthorne Care Center, 2111 Hawthorne AVe.
Port Moody
Eagle Ridge Manor, 475 Guildford Way*
*operated by Fraser Health
