L A  U NIÓN  M ETAL ‐Ó XIDO ‐S EMICONDUCTOR

Community Care and Assisted Living Act 2004

1. regular assistance with activities of daily living, including eating, mobility, dressing, grooming, bathing or personal hygiene 2. Central storage of medication,

distribution of medication, administering medication or monitoring the taking of medication

3. Maintenance or management of the cash resources or other property of a resident or person in care

4. Monitoring of food intake or of adherence to therapeutic diets 5. Structured behaviour

management and intervention 6. Psychosocial rehabilitative

therapy or intensive physical rehabilitative therapy

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medications. If a resident needs one or more of the other four prescribed services, their care will be deemed as too complex for registered Assisted Living and a discharge plan will be implemented or, in the case of a senior attempting to move in, the move will not occur.

Additionally, if the senior requires two prescribed services or needs only one prescribed service, but it is not the prescribed service offered by that operator, then they will not be admitted to registered Assisted Living and will likely be referred directly to residential care. The decision is based not on what assistance the senior needs but on what two prescribed services the operator has selected to provide.

Those seniors whose needs and service requirements change will find themselves moved to residential care perhaps unnecessarily, especially if they require high-intensity care over a

prolonged period, such as palliative care. This hypothesis is supported by what we see in the data. One consequence of the B.C. approach of regulation of prescribed services is that, how a senior pays for their assisted living can be a determining factor in whether or not they need to move from assisted living to residential care, or whether they can even enjoy the greater independence offered in assisted living to begin with.

Those who can afford to purchase the supports and services needed to live in a non-registered assisted living residence do so on a “buy as needed” basis. The costs charged are irrespective of income and can range from $2,500 per month to $8,000 per month depending on location, size of unit and additional services purchased.

Conversely, those seniors who are subsidized and living in a registered Assisted Living unit pay a total fixed price of 70% of their net income up to a cap that varies depending on where they live in the province, but generally reflects the actual cost for basic assisted living in that community. The practical effect is that, for the 7,680 seniors in Registered Assisted Living, 58% of whom are subsidized, they will need to move to residential care if their care needs progress beyond the two prescribed services. However, the approximately 15,000 seniors living in private, non-registered assisted living can purchase private help and support when needed in order to continue to age in place, if they so choose. Other jurisdictions such as Alberta and Ontario do not have the prescribed services model of B.C. and allow for more flexibility in assisted living type residences. This may explain in part why we find that, based on comparative residential care assessments, there are seniors living in residential care in British Columbia who would be living either in the assisted living equivalent or the community if they lived in Alberta or Ontario.

In 2007, the Assisted Living registrar introduced a new policy, as opposed to regulation, to allow provision of two additional prescribed services at a lower level of intensity – called “the support level”. While this move was intended to be helpful, it did not address the critical issue of initial exclusion based on needing one of the prescribed services not offered in a setting. It also created ongoing confusion around the interpretation of prescribed versus support level services and policy versus regulation. Ultimately, there has been no tangible improvement in terms of the care level of seniors in assisted living.

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SenIOrS’ HOUSIng In B.C.

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To demonstrate the challenge of operating under the current legislative model, where assisted living operators can only provide up to two prescribed services, we offer the following typical scenarios.

Senior A has what can

be described as a fairly common range of needs and will need to use

two of the prescribed services allowed in registered Assisted Living (personal care assistance and medication management) as well as all the hospitality supports. This individual has no dementia, is able to make appropriate decisions for himself, and is able to direct his own care needs. Physically, however, he has a high need for assistance with daily activities like dressing and bathing, and has two medical conditions, congestive heart failure and osteoarthritis. These conditions require regular medications and cause this senior to have limited physical endurance, but he does not need oxygen support and is fully continent. Because of his failing eyesight, this senior needs physical assistance to properly

take his medications. Senior A experiences a fall that results in a compound fracture that has put him in a wheelchair and he will require on-going intensive physiotherapy. He is otherwise exactly the same, no change in cognitive function and no other medical changes. He can still eat meals with the people he has lived with for the past three years, play bridge and Skype with his grandchildren in Toronto. However, he is going to need to move from registered Assisted Living to residential care because his intense physiotherapy over a prolonged period inside the setting will trigger a third prescribed service.

Senior B has mild cognitive impairment

but is able to direct her care and able to independently make the necessary daily decisions which makes her eligible for

registered Assisted Living. She has some minor assistance needs in the area of personal care and bathing and she is well able to manage