+ RMA Rural Municipalities
of Alberta

Resolution 10-23F

Enhancing Home Care Services for Rural Residents in Alberta

Date:
November 8, 2023
Expiry Date:
December 1, 2026
Active Status:
Active
Sponsors:
Wheatland County
District:
2 - Central
Year:
2023
Convention:
Fall
Category:
Seniors
Status:
Accepted in Principle
Vote Results:
Carried
Preamble:

WHEREAS rural Alberta’s population is aging, and the demand for healthcare services is growing correspondingly; and

WHEREAS rural residents face unique challenges in accessing home care services, including geographical barriers, limited availability of healthcare professionals, and lack of specialized care; and

WHEREAS Alberta Health Services (AHS), through the Resident Assessment Instrument for Home Care (RAI-HC), designates individuals needing home care into one of six categories: acute, rehabilitation, long-term supportive, end of life, maintenance, and wellness; and

WHEREAS home care services may be provided by AHS or contracted providers; and

WHEREAS many Alberta home care patients have unmet care plans and service needs, especially concerning housekeeping, grocery assistance, bathing, and therapies, indicating that more comprehensive services are needed beyond traditional health supports; and

WHEREAS there is an increasing reliance on for-profit providers in Alberta’s rural areas, which deviates the standard set for quality of care; and

WHEREAS the current funding model for home care services in rural Alberta is insufficient to meet the needs of the aging population, leading to a gap in healthcare provision and impacting the quality of life;

Operative Clause:

THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta advocate to the Government of Alberta to enhance home care services for rural residents by increasing funding, improving accessibility, implementing innovative care models such as community-based care tailored for rural settings, and other means.

Member Background:

Rural Alberta is witnessing a significant increase in its aging population, resulting in a rising demand for home care services. As this demographic trend continues, the urgency to address the issue becomes inevitable. Rural residents face a distinct set of challenges when accessing these services, such as geographical barriers, a scarcity of healthcare professionals, and a shortage of specialized care.

The foundation of the problem lies in the fact that home care is not entirely insured under the Canada Health Care Act (CHA). Depending on the province’s commitment, the eligibility for publicly provided home care services varies. In recent history, the annual budget increments for Alberta’s home care barely kept pace with inflation or population growth, increasing at a rate of just 1.4% per year. Although the 2023 budget has seen a 15% uplift, a significant portion is directed towards capital projects.

A 2019 MNP report titled Including Quality of Life for Residents in Facility-Based Care emphasized the inefficiencies in the current system, pointing out Albertans’ prolonged stays in higher levels of care while awaiting transfer to an appropriate care facility. Such inefficiencies result in higher hospitalization rates for conditions treatable outside hospital settings. Much of this challenge arises from a lack of suitable home or community care facilities outside of the primary hospital establishments.

A concerning trend in Alberta is the increasing reliance on for-profit providers, especially in many rural areas. Such providers often prioritize profitability by catering to clients with less complex needs, sidelining communities with high service costs, paying lower wages, resisting unionization, and under-investing in worker training. As a result, seniors, who constitute roughly 70% of home care patients, are often left with compromised care plans that include late or missed appointments and rushed care.

Further emphasizing the gravity of the situation, the MNP Senior’s Housing Study of 2021, Improving Quality of Life for Residents in Facility-Based Continuing Care, developed an integrated financial model to estimate the cost implications of the current care system. With care spaces anticipated to grow from 69,732 in 2020 to 112,960 by 2030, operating costs could skyrocket to $1.8 billion annually by 2030, with capital costs reaching $4.9 billion. Significant savings could be realized by enhancing home care service hours, thereby reducing the dependency on long-term care facilities.

Given the projections, it is evident that the present provincial model for home care services is falling short, especially for rural Alberta. The Rural Health Services Review by the Canadian Mental Health Association (CMHA) Alberta Division reiterated the necessity for enhanced home care supports for the elderly in these areas. A particularly poignant challenge is the separation of elderly couples due to care requirements, leading to emotional distress during times when familial support is of utmost importance.

Considering the escalating demands, there is a pressing need to revisit and revamp the current model, placing a higher emphasis on home care services. This would allow seniors to remain in their familiar environments, respecting their wishes to age in their homes, while also addressing the heartbreaking issue of couples being separated.

The ramifications of this issue extend beyond the immediate need for enhanced care. Stakeholders, ranging from healthcare providers to senior advocacy groups and families, are deeply affected. Rural municipalities, in particular, are feeling the pressure as they fund housing management bodies in their regions. A failure to innovate could place a heavier burden on municipal resources. However, by proactively addressing these challenges, not only can seniors receive better care, but potential financial savings could also benefit municipal ratepayers.

RMA Background:

RMA has no active resolutions directly related to this issue.

Government Response:

Alberta Health Services

As announced in the Government of Alberta’s 2023-26 Budget and Fiscal Plan, Alberta Health provided Alberta Health Services (AHS) with funding to begin transformation of the continuing care system, which includes enhancement projects in rural home care services.

AHS is taking action to:

  • Innovate to improve care in rural communities by: Expanding Adult Day Programs (ADP) for respite services to assess outcomes related to the needs within rural communities for extended hours, caregiver distress, and client satisfaction, and implementing an Intensive Home Care program to assist clients to return home earlier after an acute care stay with increased supports in the home and allow a client to continue to receive restorative services to improve function with the comfort and security of being at home. For those clients who require a higher level of care, the enhanced in-home care supports the client until the most appropriate place is available.
  • Expand Client Directed Care funding models in rural communities by: Bringing Client Directed Home Care Invoicing programs to rural communities so that clients can select an eligible Care Provider Agency to provide these services up to a maximum number of pre-approved hours per month. Alberta Blue Cross® has partnered with Alberta Health Services to administer the benefits for this exciting new service delivery option, and offering Self-managed care (SMC) as an alternate method of service provision. SMC provides resources so home care clients can directly pay for and manage personal care and home care support services.
  • Provide additional supports for rural home care service provision by: Supplementing services in rural areas with contracted providers that will be held to common standards of service delivery. All AHS home care clients are assessed by AHS Case Managers utilizing standardized comprehensive needs assessment tools and the provincial service guidelines providing consistent and fair service delivery, and expanding virtual care options to augment services to rural and remote clients. This may include remote patient monitoring or involve professional to professional consultation allowing for improved specialized care.
  • Ensure Palliative End-of-Life Care (PEOLC) home care support services are available for patients who choose to remain in their homes in rural communities by: Supporting patients with palliative conditions through the Rural Palliative Care In-home Funding Program (RPIHFP), who live in rural areas of Alberta, to stay at home when desired and when they require additional care beyond existing home care services. In collaboration with patients and their families, the rural palliative and home care teams identify the amount and level of additional care that is needed.

The AHS Home Care program is preparing to meet increased demands for rural home care service. Growth in the number of Albertans over the age of 65 will steadily increase to one in five by 2046. Capacity and service plans must align with government and organizational principles while creatively delivering equitable, high quality and safe care to Albertans of all ages in their homes and communities.

AHS strives to improve access and services to all Albertans including those living in rural communities.

AHS is working to align home care services by developing a standardized home care delivery service framework for use across Alberta and improving equity in home care service delivery for rural clients. In 2023, AHS implemented a provincially standardized contract for home care agencies, which includes updated quality & safety compliance reporting and metrics for all contracted home care service providers.

AHS home care programs strive to achieve the following client outcomes:

  • Equitable services regardless of residence location in the province.
  • Increased satisfaction with the quality of care.
  • Increased confidence in the health system.
  • Improved quality of life.
  • Greater self-management and support.
  • Better access – getting the right service at the right time and place.
  • Improved understanding and transparency of what can be expected from Home Care providers and Home Care services.
  • Remaining at home for as long as possible.

Alberta Health

Through the recommendations outlined in the Facility-Based Continuing Care Review, we are initiating a multi-year transformation of the continuing care system. As part of Budget 2023, we invested an historic $1 billion over three years to begin this transformation. This strategic investment is supporting initiatives that will help shift to care in the community, enhance workforce capacity, increase choice and innovation, and improve the quality of care within the continuing care sector.

One of the first steps to transforming the sector was the introduction of the Continuing Care Act, which received Royal Assent on May 31, 2022. The Act introduces a new legislative framework that will support and enable transformational shifts to improve the continuing care system in the short term and over the years to come. This includes enabling more innovative approaches to home and community care.

I am pleased to report that we are making progress in the first year of the continuing care transformation. This includes enhancements to home care, including increasing funded rates to home care operators, and putting out an Expression of Interest and Qualifications for innovative models of home care delivery. This open call has resulted. in ten new contracts with providers of community home care services.

Further, we are providing supports to caregivers through several initiatives, by:

  • Expanding client directed care models that provide choice and flexibility to clients and caregivers in selecting their care providers and directing how their care is provided;
  • Increasing access to non-medical community supports for community-based clients and their caregivers;
  • Funding Caregivers Alberta to expand programs, grow their volunteer ambassador program, establish pathways and supports for caregivers to navigate the system and easily connect with help, and implement their Work & Care curriculum for employers; and
  • Providing support to Indigenous post-secondary institutions to develop Health Care Aide training for Indigenous Albertans.
Development:

RMA appreciates the measures being taken for continuing care services across the province. The initiatives proposed for rural Albertans to receive more equitable access to care are a step in the right direction and will be monitored closely.

However, the response from Alberta Health does not acknowledge the unique needs and challenges of people requiring care in rural and remote areas. There are a variety of unmet service needs that are not accounted for in the response from Alberta Health, and there is no clear increase in funding for how these needs will be met. While the commitments to programming enhancements are encouraging, and, if properly implemented, should meet the intent of the resolution, RMA plans to monitor their progress in the coming months.

RMA assigns this resolution as “Accepted in Principle” and will continue advocacy efforts on this issue.

Provincial Ministries:
Health,
Seniors
Provincial Boards and Organizations:
Alberta Health Services
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