Monday, March 20, 2017

#GOASPIN--Reducing costs by rebalancing the system from acute care to community care has been a talking point for the last several years among Alberta health leaders, but progress has been slower than some hoped.------Monday’s news conference was held in the Ramsay Heights house of Jaye Fredrickson, who receives home care to cope with amyotrophic lateral sclerosis.--Much of the home care in Edmonton is provided by private companies such as CBI Health Group and Bayshore, along with a number of non-profit agencies.----“I don’t think there are any specific plans right now,” Todd said. “However we move forward is going to be in partnership with a lot of community providers.”----------Julie Ali · University of Alberta It is doubtful that this investment will save any money for the acute care system since the range of home care services are limited and the clients being serviced are usually not complex care patients. The emphasis on home care does not exempt the folks at Alberta Health from the needs of seniors for placements in the continuing care system which also includes long term care placements. No sort of effort has been made by the government of Alberta to keep the promise of the 2,000 long term care beds. Creation of a long term care facility in Calgary and increasing beds at Norwood in Edmonton does little to meet the demand for long term care placements which has been kept artificially low by the GOA for ages. In fact, it appears to me that the long term care beds are being transformed into lower level of care placements such as SL4 (supportive living) placements which do not have the same level of trained staff (no requirement for RNs 24/7) and are not appropriate for long term care status residents. But of course these placements are cheaper to provide than the more expensive long term care placements. With the downgrading of long term care residents to SL4 placements there are lower costs for providers that are increasingly in the private sector. The lack of adequate oversight or interest by the GOA ensures that care will be less of a concern than profits-at least in my opinion. But of course in the front window of Alberta Health we have this mannequin wearing the home care fashion of the season. The buyers of continuing care services will be fooled. There will be great sales. No indications of how the government at all levels is preparing for the complex care customers, the dementia crowd and the other hard to service seniors -the very old.


While it is nice to have chatter about home care, we have no sort of advertisements at the house of spin about the problems in the continuing care system that home care will not solve. It is doubtful to me that this advertisement campaign for home care will even reduce the costs of the acute care system. Why do I not believe the current GOASPIN?
Well let me think.
1) We have those pesky bed blockers. These are hard to place residents. No one wants them because they require more care. They are stuck in hospitals and ALC places. The ALC (Alternate Level of Care) places are not meant to be real placements but sort of train stop places so the patient isn't in a real home but in some sort of no man's land where the patient health and quality of life is impaired.
The home care plan does not address these cases. What is required for hard to place complex cases (i.e. more expensive care placements) is facilities in the public realm since private businesses in continuing care won't do the work of taking care of these folks as it might impact their profits. The Michener Centre could be repurposed for such hard to place folks and an integrated care team could be developed there.

2) Dementia cases are increasing. The system is not ready for them. The GOA has no clue about dealing with these cases and has it's head up its ass. But they are here and increasing so how will home care help these folks? I guess they will have private care providers going to the homes of families who have family members with dementia to do what? I don't know. Nor does the GOA.
3) Staff are overworked, poorly trained and there is no mandated staff: resident ratio at the continuing care facilities so it is up to every organization. What this means is that you get what the organization decides is necessary. In the end the families have no possible way to get what might be required for family members because we have no sort of power. If we get too troublesome, the organization just dumps the resident out (eviction) and AHS looks around for an AHS facility to put the resident because government has set up the system so that the continuing care provider is not inconvenienced. The GOA is not interested in the destabilization of the resident or the resident rights because the resident is powerless, the destabilization is something to be accepted and there are no resident rights.
4) More money alone won't solve the culture in the GOA, the health authorities and the continuing care industry. What will change the poor culture of entitlement, power driven decisions and disrespect is for families to speak out about the problems. We have a false free market established by the GOA for our family members. We are forced to accept placements. The continuing care industry has a safe and continuous supply of customers no matter what because supply outstrips demand in this artificial market that has been deliberately set by government to ensure that there are too few placements for the number of customers. Customer satisfaction is impossible when you can always tell unhappy customers--if you don't like it here-find somewhere else. In a normal free market you could find somewhere else. In the rigged "free" market of continuing care in Alberta all you have are forced placements, no choice, and no plain language document to explain evictions, transfers, transition, placements because guess what? This is the way government has set it up for us-to make us the game pieces of a game where outcomes are assured for the private sector.
5) Nice game. But what if we stop playing it?

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While I understand that "rebalancing the system" to put the emphasis in the community is useful it does not negate the need for more funding for the continuing care system. The funding should go to the public sector facilities that treat residents with dignity.
In addition to funding there needs to be legislative upgrades to protect residents which are not present because government doesn't give a darn about citizens. We need to have visitation rights, an independent appeal process for the Trespass to Premises legislation that allows banning without any good reasons that I can determine other than the care organizations get fed up of dealing with families and get rid of them in this way.

I also believe we need a shift in the culture of all the partners in the system--from the GOA down to the front line workers. The current culture of entitlement at the GOA and the health authorities where the payers of the entire system are treated disrespectfully as game pieces to be moved here and there needs to end. We need to have clear plain language documents to explain placements, downgrades, evictions and transitions. We need an end to the retribution responses of the partners and more of the resolution business. We need families and patients being allowed visitation rights. We need basically the rights in the health care and continuing care system that are denied to us. Instead of rights to visitation, to fair independent appeal process or really any sort of chance at justice in the system we get placebo solutions such as an internal to AHS appeal process that took decades for the system to install, a moving forward process that even considers installing a Public Guardian for a citizen to remove her rights, and forced eviction from a hospital to a lower level of care using the Hospital Act. All of these matters are very disrespectful and harmful. They are especially harmful to handicapped citizens who have no one in their corner. Sure the government tells us to go to the health advocates but when I did this they told me they can't do anything for my sister-they are basically there to be yet more window dressing for the house of spin.

Meanwhile the problems of underfunding of the continuing care system, lack of trained workers, and the lack of oversight by the GOA are all ignored so that the refurbished window dressing for the house of spin can be put up in the form of home care.  So how will home care cut the costs of demands on the acute care system?  How will home care remove the problems and costs of bed blockers who are usually hard to fit patients who can't find a placement because the private continuing care providers don't want costly residents? How will home care solve the problems of the patients stuck in limbo land--the alternate level of care places where their quality of life and health are compromised? How does all this spin solve the problems that government is ignoring for mysterious reasons? Or does government not want to address the problems of the continuing care system in Alberta or the major boom in customers coming down the pipe in terms of dementia patients?  How will home care meet the demands of dementia cases that will be a major cost that increased home care delivery will not reduce? Where is the strategy for all the non-home care cases in Alberta?

There is no strategy. There is no plan. But the window dressing for the house of spin is always being refurbished.


http://www.calgaryherald.com/health/alberta+health+minister+hopes+transform+system+with+investment/13160488/story.html



Alberta health minister hopes to transform system with big investment in home care

KEITH GEREIN, EDMONTON JOURNAL  03.20.2017
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NDP invest in Healthcare
Health Minister Sarah Hoffman says her government will be pushing hard this year on a major health system transformation that will see more people treated at home or in community settings than an expensive hospital bed.
The health ministry’s latest budget features a $57-million cut to acute care services, while funding for home and community care is set to rise $200 million to more than $2 billion.
A portion of the increase is funding from the federal government, which recently reached a transfer deal with Alberta to provide $703 million over 10 years for home care.
“Instead of living their lives in a hospital bed, people can stay in their homes and neighbourhoods, with dignity and independence and the security of familiar surroundings,” Hoffman said at a news conference Monday.
While improving lives is one of the goals, the move is also a key part of the province’s strategy to make the health system more efficient. As the theory goes, if more people are treated at home or in community facilities, that should relieve pressure on overcrowded hospitals.
Statistics show Alberta is one of Canada’s biggest per-capita spenders on health care, largely due to a heavy reliance on care delivered through the hospital.
“The key here is that we must reorient our health system with the (right) social infrastructure,” said Kathryn Todd, vice-president of research, innovation and analytics for Alberta Health Services.
Reducing costs by rebalancing the system from acute care to community care has been a talking point for the last several years among Alberta health leaders, but progress has been slower than some hoped.
For the current 2016-17 fiscal year, the province had budgeted $3.7 billion for acute care, but is currently on track to spend nearly $4 billion.
Monday’s news conference was held in the Ramsay Heights house of Jaye Fredrickson, who receives home care to cope with amyotrophic lateral sclerosis.
Fredrickson said she was diagnosed in 2008. Home care initially allowed her to continue her vice-president job at NorQuest College, but the condition eventually worsened to the point where she needed help with most daily tasks, including feeding, dressing and turning over in bed at night.
Fredrickson, 66, said there was the option of moving to a care facility, but she and her husband wanted to stay home.
“For us, (home care) has really meant that we can continue to have what some days feels like a normal life,” she said. “It’s really important to us to be able to stay at home, next to our neighbours, with our son, and being able to keep the family together. And it keeps me healthier.”
Much of the home care in Edmonton is provided by private companies such as CBI Health Group and Bayshore, along with a number of non-profit agencies.
It is unclear if the province plans to continue with this model once the contracts expire in March next year, or whether AHS will take over a larger share of providing care. All of the contracts have extension options.
The NDP government has taken steps to minimize the role of private providers in other areas of the health system, including laboratory and linen services.
“I don’t think there are any specific plans right now,” Todd said. “However we move forward is going to be in partnership with a lot of community providers.”
The number of home-care recipients in Alberta has increased about 20 per cent in the last six years from 97,000 to 116,000. That number is expected to grow in coming years as more of the province’s population become senior citizens.
kgerein@postmedia.com
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Julie Ali ·
It is doubtful that this investment will save any money for the acute care system since the range of home care services are limited and the clients being serviced are usually not complex care patients.

The emphasis on home care does not exempt the folks at Alberta Health from the needs of seniors for placements in the continuing care system which also includes long term care placements.

No sort of effort has been made by the government of Alberta to keep the promise of the 2,000 long term care beds. Creation of a long term care facility in Calgary and increasing beds at Norwood in Edmonton does little to meet the demand for long term care placements which has been kept artificially low by the GOA for ages. In fact, it appears to me that the long term care beds are being transformed into lower level of care placements such as SL4 (supportive living) placements which do not have the same level of trained staff (no requirement for RNs 24/7) and are not appropriate for long term care status residents. But of course these placements are cheaper to provide than the more expensive long term care placements.

With the downgrading of long term care residents to SL4 placements there are lower costs for providers that are increasingly in the private sector. The lack of adequate oversight or interest by the GOA ensures that care will be less of a concern than profits-at least in my opinion.

But of course in the front window of Alberta Health we have this mannequin wearing the home care fashion of the season. The buyers of continuing care services will be fooled. There will be great sales.

No indications of how the government at all levels is preparing for the complex care customers, the dementia crowd and the other hard to service seniors -the very old.
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