+ RMA Rural Municipalities
of Alberta

Resolution 17-23F

Sustainable Community Hospice Funding Model

Date:
November 8, 2023
Expiry Date:
December 1, 2026
Active Status:
Active
Sponsors:
Clearwater County
District:
2 - Central
Year:
2023
Convention:
Fall
Category:
Community Services
Status:
Intent Not Met
Vote Results:
Carried
Preamble:

WHEREAS the demographic trend in Alberta suggests that, over the next 25 years, the population aged 80 and older will double, potentially constituting up to 7% of Alberta’s total population; and

WHEREAS the Government of Alberta recognizes that adopting a palliative care approach upon the diagnosis of life-limiting diseases not only enhances patients’ quality of life but also serves as a cost-effective strategy in managing healthcare expenditure; and

WHEREAS community providers, including non-profit hospice societies, are facing a growing demand to deliver palliative end-of-life care (PEOLC); and

WHEREAS the ability to meet the Alberta Health Services (AHS) accepted standard for PEOLC bed capacity is severely limited by the lack of a province-wide, sustainable funding model; and

WHEREAS the AHS Rural Palliative Care In-Home Funding Program can only be used to cover end-of life care received at home and cannot be utilized to cover end-of-life care provided by hospice societies in their facilities; and

WHEREAS the Government of Alberta’s former Palliative End-of-Life Care Grant Fund provided one-time funding and excluded operational costs for hospice societies;

Operative Clause:

THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta advocate for the Government of Alberta to implement a sustainable operational funding model for the provision of hospice services by community hospice societies across the province.

Member Background:

There has been ongoing engagement from the Government of Alberta regarding Palliative End-of-Life Care (PEOLC), highlighting the importance of these supports and services to Albertans. The need to develop the capacity of these community services, especially in rural settings, is clear; the following provincial frameworks and reports are all consistent in that message:

  • Government of Alberta – Advancing palliative and end-of-life care in Alberta – Palliative and End-of-Life Care Engagement Final Report November 2021
  • Alberta Health Services – Palliative and End of Life Care – Alberta Provincial Framework Addendum 2021
  • Alberta Health Services – Palliative and End of Life Care – Alberta Provincial Framework 2014

What remains is the question of continual operational funding for PEOLC hospice community providers.

The Government of Alberta identified the service gaps that exist for PEOLC needs in Alberta in the Advancing Palliative and End-of-Life Care in Alberta Final Report November 2021. The report included the following recommendation:

Government, AHS, and their partners, should grow and expand community-based PEOLC services via home and community care programs and facility-based continuing care…Stand-alone hospices face challenges in maintaining sustainable operational budgets and workforce.

The Government of Alberta committed $20 million over four years to improve PEOLC by shifting from hospital to community-based care; raising awareness of how and when to access PEOLC; developing effective caregiver supports; and establishing education, training and standards for health professionals. The funds were entirely allocated as of 2022 and were not eligible for hospice societies’ operational expenses.

Non-profit hospice societies who are already operating in communities and working towards expanding these important services in Alberta have been left in budget purgatory. They are actively working towards a priority identified by the Government of Alberta, but reliant on fundraising for operational funding.

Correcting the disparity between the funding available to patients who choose to receive PEOLC in-home versus in a hospice suite is an immediate solution that could address these challenges while the economic analysis of reallocating health care financial resources in accordance with the shift from hospital to community-based hospice care is completed.

Municipalities must advocate for the allocation of financial resources to these valuable supports and services provided in their communities.

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 has provided AHS with funding to begin transformation of the continuing care system, which includes the addition of 25 net new community hospice beds across the province over 3 years.

In 2023/24, AHS invested over $160 million in new operating funds to improve funding model sustainability for community residential and home care service providers across Alberta by increasing the funded hours of care and funded rates within the models.

  • By increasing the funded hours of care, AHS and Alberta Health aim to provide more care to clients requiring health care services in the community.
  • By increasing the funded rates within the models, AHS and Alberta Health aim to attract and retain health care staff to meet the needs of continuing care clients across the province.

Alberta Health and AHS continue to review the operating funding models for community residential continuing care programs, including; long-term care, designated supportive living, home care services provided in congregate living environments, hospice, small homes, and other rural and remote community residential care settings.

Current Community Hospice Funding Model:

Palliative end-of-life care (PEOLC) services are currently delivered by AHS and contracted health service providers at 25 facilities, that operate 261 designated community hospice beds across Alberta. Community hospice beds are located in standalone facilities, and in some cases, are co-located with other continuing care programs, such as long-term care (LTC) and designated supportive living (DSL).

AHS delivers care directly at AHS owned and operated community facilities or provides site operations funding through contracts with health service providers. Contracted hospice providers are accountable to provide the care service hours that are funded by AHS as per terms of the contract and service schedules. AHS also provides contracted hospice providers with client accommodation funding. Clients are not charged for their publicly funded care and accommodations while receiving PEOLC in community designated PEOLC/hospice beds.

Site operations funding provided by AHS may vary due to the unique settings, client characteristics, and infrastructure required to provide appropriate PEOLC care. For example, small standalone facilities that provide 24/7 nursing care coverage require more funded care per resident day than larger sites that share staff and efficiencies with other co-located programs in the building. Community hospice providers may fundraise and/or accept donations to cover other potential additional program costs as required.

Alberta Health

The Government of Alberta also recognizes the importance of providing Albertans who have life-limiting illness to appropriate and timely palliative and end-of-Iife care (PEOlC). This includes providing a peaceful, comfortable environment for patients, as they transition into the final stages of life. Since 2019, our government has provided an additional $20 million over four years to enhance and advance PEOlC initiatives in the province. Many of these initiatives resulted from consultations with Albertans, including feedback captured in the 2021 Advancing Palliative and End-of-Life Care in Alberta report. Highlights and areas of focus include expanding programs and services to address hospice capacity issues and the costs of integrating the palliative approach in acute and continuing care settings. As part of the Continuing Care Transformation and to address hospice capacity needs, Alberta Health has increased funding in fiscal years 2024/25 and 2025/26 to support new hospice spaces in the community. We are collaborating with AHS to determine how to allocate these additional funds, by comparing community needs assessments from across the province.

Development:

The response by Alberta Health Services shows promising commitments to enhancing hospice services for communities across the province. However, it is unclear whether it addresses the requests of the resolution and the extent to which the infusion of funding and additional beds will lead to “sustainable” operations, as requested in the resolution. The creation of a sustainable operational funding model for the provision of hospice services by community hospice societies across the province will ensure that sites are receiving the support that they need to succeed. RMA is committed to learning more about the transformation of the continuing care system and hopes that it will better address the needs of community hospice services in Alberta.

RMA is still awaiting a response from the Ministry of Seniors, Community and Social Services.

RMA assigns this resolution with a status of “Intent Not Met” and will work with Alberta Health and other relevant ministries to better understand the impacts of the support indicated in the responses.

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