Alberta has been noted as one of the leading provinces in healthcare reform, often piloting innovative healthcare policies and spearheading healthcare reform [e.g., Mazankowski Report (2)]. Alberta has also been a leader in examining the role of AL within the Canadian
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context (4). In 2008, Alberta amended healthcare policies resulting in a shift from nursing home to AL care (33,88,113). This shift was in response to resource constraints and the desire among older adults (and their caregivers) to age-in-place in a more home-like setting (33,88,90). Some proponents of this shift argued that nursing home facilities often overcompensate for the physical and cognitive impairments of their residents. For example, it was stated that about 15% of people residing in nursing homes (90,114) could be adequately cared for in facilities offering less care, such as AL facilities (102).
At the time ACCES was underway (2006-2009), there was a commonly held view across several health regions in Alberta that AL could provide a suitable substitute for LTC. Although many residents did not need 24/7 nursing care, many residents were complex enough to warrant this amount and level of care. However, many were transitioned to AL facilities where the level, mix, and amount of health professional oversight were greatly reduced. AL facilities in Alberta3 were not required to employ 24/7 onsite licensed practical nurses and/or registered nurses. They were, however, mandated to have at least one staff member on-site at all times who was
proficient in emergency first aid (33). Concerns regarding delayed detection of health issues, poorer outcomes, and higher healthcare service use have been raised due to this relatively low staffing level and mix (14,115). Further, with lower staffing levels and the characteristically complex nature of residents in AL facilities (14,37,87,92,103), the suitability of these facilities for persons with psychiatric and physical conditions was questioned (92,100,108,116).
Within Alberta, there were also two broad AL designations: public and private. Facilities that were publicly funded were termed “designated facilities.” The designated facilities were named designated supportive living (DSL), enhanced lodge (EL), designated supportive housing
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(DSH), designated assisted living (DAL) and enhanced designated assisted living (E-DAL) (109). At the time of the ACCES study, designated spaces that existed within Supportive Living facilities were contracted by a regional health authority (RHA). Both parties collaboratively established admission and discharge criteria4, as well as the specific health and supportive services offered. In return for signing a contract with a RHA, the RHA provided funds to the facility (109) and access to skilled care via the local Home Care Program (102). In sum, admission and discharge criteria, and health and supportive services offered, differed considerably by residence and region during the time of ACCES.
Supportive services were provided through three domains: health and wellness,
hospitality, and physical and social. Health and wellness services included access to a healthcare professional (personal care aide, licensed practical nurse and/or registered nurse; physician; podiatrist; physiotherapist; occupational therapist; speech/language therapist). Hospitality services included meal preparation; housekeeping; laundry; social, leisure and recreational opportunities; safety and security; activities of daily living (ADL) support; medication
management; and coordination and referral to community services. Lastly, physical and social services offered included access to private rooms, ability to personalize rooms, and stipulations on pets, visiting hours and suites (109). Every facility had discretion over which services were provided, by which method (109), and the staffing level and mix that supported those services.
AL facilities in Alberta have evolved since the time of ACCES. Facilities that were included in ACCES are now termed Supportive Living Level 3 or 4 (88,117). Supportive Living Level 3 facilities are for individuals who are medically stable but need some support, and are not
4 Details concerning admission and discharge criteria can be found in “Designated assisted living (DAL) and long- term care (LTC) in Alberta: Selected highlights from the Alberta Continuing Care Epidemiological Studies (ACCES)” (109).
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a risk to themselves or others. Level 3 facilities have 24-hour onsite access to healthcare aides and access to nursing services. Level 4 facilities provide a care option for those with more
complex health conditions, who require ADL assistance, and who may have dementia. Like level 3 facilities, level 4 facilities have 24-hour access to healthcare aides, but additionally have onsite nursing (117). Moreover, Supportive Living Levels 1 and 2 are termed “Residential Living” and “Lodge Living” respectively. Supportive Living Levels 1 and 2 are composed of facilities that supply the least amount and intensive services, and therefore house persons with the lowest needs (33). All Supportive Living facilities provide housing, hospitality, and support services that are either supplied by the facility or coordinated by an outside party. The services provided by the facility and that are included in the monthly rental fee vary by institution (33).
Not only has the terminology used for designating AL spaces changed across Alberta, but more notably, the former Health Regions were dissolved. AL facilities are now governed
provincially, and publicly funded personal and health care services are administered by Alberta Health Services rather than the RHA (102). This regulatory change aimed to increase the cohesiveness among AL facilities. Whether this goal was obtained is unknown.