International Federation on Ageing Conference Presentation
Transcription
International Federation on Ageing Conference Presentation
SENIOR HOUSING ACROSS CANADA Presented by BCSLA, ASCHA, ORCA and ARCPQ Expo Aging & Design Conference Montreal Sept 4 – 7, 2008 REGULATING RETIREMENT HOUSING ACROSS CANADA Gord White, CEO, Ontario Retirement Communities Association [email protected] Presentation Overview Get to know the Canadian retirement housing landscape Canadian Demographics – Briefly! Regulations – Where they are and where they aren’t. Terminology – Why do they call it that? Funding – Who pays. Restraints – It’s complicated. Tell us what you think. CANADIAN DEMOGRAPHICS A Brief Overview of Demographics Across Canada Briefly describe some of the key elements of Canadian demographics as it relates to the seniors’ housing and care sector How quickly will this sector grow? Where will there be the greatest demand? Will governments be able to keep pace? Will Changing Demographics in Canada = Demand for Seniors Housing and Care? Substantial growth expected Private pay care and accommodations will grow faster than government subsidized care The main contributing factors Age wave Capacity of government to provide subsidized care Income capacity of seniors Expectations of consumers Demand for Care and Accommodations Statistics Canada’s “Health and Limitations Surveys indicate that currently as many as 20% of those over 75 years have severe frailties that require some assistance with the activities of daily living Provincial governments currently only meet ½ of this demand with long-term care homes (nursing homes) – 100 beds per 1000 people over 75 (10%) Further, another 20% of seniors have moderate limitations Information collected by Care Planning Partners Generational Cohorts in Canada Descrip(on Grandparents of Boomers Parents of Boomers WW2 Babies Baby Boomers Baby Bust Baby Boom Echo Echo Kids Birth Years Age in 2006 Before 1921 1922 to 1938 1939 to 1946 1947 to 1966 1967 to 1979 1980 to 1995 1996 to 85 and older 68 to 84 60 to 67 40 to 59 27 to 39 11 to 26 under 10 Source: StaGsGcs Canada, 2006 Census Total 2006 520,605 3,039,480 2,365,045 9,672,980 5,404,775 6,710,345 3,899,680 75+ Population Doubles in 25 Years NFLD PEI NS NB QUE ONT Over 75 in 2006 306,000 92,000 63,800 50,800 491,000 774,100 81,800 77,600 162,300 289,400 2,030,600 Over 75 in 2031 69,600 18,600 126,600 102,900 979,700 1,566,600 134,500 113,200 396,400 612,600 4,120,700 Percentage Growth 127.5% 102.2% 98.4% 105.6% 64.4% 45.9% 144.2% 99.5% 102.4% MAN SASK ALTA Information collected by Care Planning Partners BC 111.7% Canada 102.9% Market Penetration Market penetration measures the percentage of 75+ participation Across Canada Nursing Homes 10.1% Low of 8.1% in New Brunswick, high of 12.0% in Saskatchewan Retirement Homes/Assisted Living 5.9% Low of 1.8% in BC, 2.0% in Nova Scotia, 5.8% in Ontario, 10% in Quebec Independent Low Living 2.1% of .9% in Nova Scotia, high of 5.2% in Alberta Income Capacity of Seniors The capacity of seniors to afford to purchase their own care and accommodations is an important variable in the growth of this sector Property ownership in an indicator of income capacity Next slide shows clearly that over 60% of seniors over the age of 75 own property without mortgages Seniors own property without mortgages Impact of More Seniors on Provincial Health Care Systems Seniors (over 65 years) use more than 3 times the allocation of health care than those under 65 – more seniors = much higher health costs Today in Ontario 13% of population will use 43% By 2025, 20% will use 66% of health care dollars Big diseases for seniors – cancer, diabetes, Alzheimer Shrinking workforce – less revenue Increasing difficulty managing maintaining health care services for all Canadians Based on current proportional usage, by 2025, we will need: CURRENT FUTURE % LTC 204,900 413,500 201.8% Retirement 120,800 245,500 203.2% Care Planning Partners and Statistics Canada What if provincial governments can’t keep pace with LTC? CURRENT FUTURE % LTC 204,900 309,200 150.9% Retirement 120,800 349,800 289.6% Based on provinces keeping pace with 50% of LTC demand What we expect will happen Governments will struggle with continuing to maintain current levels of health care Canada will need twice the number of spaces for seniors requiring care and accommodations by 2025 Long-term care growth will slow dramatically Private-pay care and accommodations will grow rapidly The public will demand quality and accountability REGULATIONS Regulations, what regulations? A common definition for retirement homes are seniors’ residences where care and accommodations are sold to residents. Care is considered to be assistance with activities of daily living Regulatory frameworks currently exist in five provinces – BC, Alberta, Saskatchewan, Quebec, Newfoundland and Labrador Ontario is moving towards introducing legislation governing care Provincial Descriptions Ontario – Private homes, mostly for-profit, range of services offered including meals, activities of daily living, nursing care, some dementia care Alberta – Public or private homes. Full range of services offered within 4 distinct levels of care BC – Private homes offering a full range of services with at least 1 but not more than 2 prescribed services Provincial Descriptions Nfld. & Labrador – Public or private homes with between 5 & 75 residents. No framework for 75+ residents. Full range of services. Quebec – Private homes which offer a full range of services Saskatchewan – Private homes which offer a full range of services Size of Sector Ontario – 40,202 Alberta – 22,000 BC – 4,050 (only assisted living) Newfoundland & Labrador – 2,676 Quebec – government is uncertain. Initiating a registration process Saskatchewan – 3,100 residents Applicable Legislation Ontario – Residential Tenancies Act, Building Code, Fire Code, some municipal by-laws Alberta – Social Care Facilities Act BC – Community Care and Assisted Living Act Nfld. & Labrador – Health and Community Services Act, Personal Care Homes Regulations Quebec- An Act Respecting Health Services and Social Services Saskatchewan – Personal Care Homes Act Regulatory Bodies Ontario – None Alberta – Ministry of Seniors and Community Supports BC – Assisted Living Registrar Nfld. & Lab. – Department of Health and Community Services – Regional Health Authorities Quebec – Ministry of The Elderly and Social Services Saskatchewan – Saskatchewan Health Admission Requirements Ontario – Determined by operator Alberta – Care needs-based determined through assessments by regional health authorities BC – Care needs-based determined through assessments by regional health authorities Nfld. & Lab – If subsidized, needs-based determined through assessments by regional health authorities Quebec – Determined by operator Saskatchewan – Determined by operator Key Regulation Issues Inconsistent regulations or lack of regulations from province to province Public confusion on what is regulated in seniors’ housing and what is not Lack of understanding of differences in seniors’ housing by key bureaucrats Some Questions to Consider Is regulation in seniors’ housing essential? Should a Canada-wide (federal) system of regulations for seniors’ housing be considered? Alternately, could provinces become more consistent as they move to regulate? What are the expectations of consumers? Where are the best examples of regulations for this sector world-wide? Terminology In Canadian Seniors Industry Marlene Williams, Executive Director, BC Seniors Living Association [email protected] Seniors Living Canadian Overview Many researchers and public agencies have noted the difficulty of distinguishing and drawing comparisons among the many types of facilities that provide assistance or care to older adults in Canada. Each province within Canada has various levels of care available which may or may not be classified or referred to as the same type of care as another province. Overview of Terminology We will attempt to explain the terminology used in senior care communities available within the private and government sectors within Canada. We will define seniors into 3 broad categories. The ‘young old’ who are healthy and fit The ‘middle old’ who are starting to slow down and need a little assistance with daily tasks The ‘frail old’ who are very elderly and are often no longer capable of directing their day to day activities The ‘Young Old’ Independent Living – includes a combination of housing and hospitality services for retired adults who are functionally independent seniors capable of directing their own care. This may also be referred to as Supportive, Retirement or Congregate Living These seniors choose to be free of the home management duties and prefer the convenience of service in a social atmosphere. Living space may vary from a studio apartment to a 2 bedroom or larger ‘Young Old’ Cont. Services provided are usually a menu of optional fee-forservices from a base rate which could include meals, housekeeping, monitoring and emergency support, social and recreational opportunities, transportation, etc. Building features include private space, and a safe secure environment with a home-like setting. The buildings are designed with common areas and features to allow seniors to ‘age in place’ These communities include privately owned, non-profit and subsidized housing options Provinces Overview Province British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Terms Independent, Supportive Independent & Supportive Living Enriched Retirement Living Independent Independent/Supportive Independent/Supportive Supportive Housing Provinces Overview Cont. Province Terms Nova Scotia Supportive Housing Prince Edward Island Community Care Facilities Newfoundland/Labrador Supportive Housing Northwest Territories Yukon Nunavut In the north seniors are generally continuing to live with their families The ‘Middle Old’ Assisted Living – offers housing, hospitality services and personal assistance to seniors who live independently but require help with some daily tasks Same type of communities as the independent living Provides additional services such as bathing, dressing or medication monitoring. Nursing care may be available Seniors may or may not be self directed and independently mobile depending on the criteria of the province Provinces Overview Province Terms British Columbia Assisted Living Alberta Supportive Living levels Saskatchewan Personal Care Homes Manitoba Special Care Homes Ontario Residential Assisted Care Quebec Private Residences non-profit and for profit Special Care Homes New Brunswick Provinces Overview cont. Province Terms Nova Scotia Prince Edward Island Assisted Living/Enriched Living/Residential Care Community Care Facilities Newfoundland/Labrador Personal Care Homes Northwest Territories Yukon Supportive Living Supportive Living group homes Elder Homes Residential Nunavut The ‘Frail Old’ Long Term Care/Complex Care – provides housing, hospitality, personal assistance and 24 hour professional nursing care is available for seniors unable to care for themselves. Also referred to as Nursing Homes Care is required on a regular basis in a facility setting but who are not in need of hospitalization This segment includes intermediate care, multi-level care, extended care hospitals, private hospitals, Palliative Care or Respite Care These must be licensed and may be private pay or government funded Provinces Overview Province British Columbia Saskatchewan Terms Residential Care/Complex Care Supportive Living or Long Term /Continuing Care Special Care Homes Manitoba Personal Care Homes Ontario Long Term Care Homes Quebec Residential/Long term Care Public or Private homes Nursing Homes Alberta New Brunswick Provinces Overview Cont. Province Nova Scotia Terms Nursing Homes Prince Edward Island Nursing Manors Newfoundland/Labrador Nursing Homes Northwest Territories Extended Care/Group Homes Extended/Complex/Special Care Elder Homes Residential Yukon Nunavut Additional Terminology Campus of Care – is a site that offers Independent Living, Assisted/Supportive Living and Complex Care in one location. May also be referred to as Evolutive Services This structure allows the senior to move from one care option to the next without having to move to a new community. In some provinces they do need to move to a new area within that community Additional Terminology Aging in Place - Canada Mortgage and Housing Corporation defines this ‘as a process which enables the elderly to grow older in familiar and comfortable surroundings while providing them with the necessary assistance to maintain a relatively independent lifestyle ‘ This could be applied to seniors living in their own home or housing community Additional Terminology Alzheimer Care – specialized care and supportive programs for persons with Alzheimer Disease or other forms of memory loss. Care may be provided in a Long Term Care home in a secure designated section or in the persons personal home. In some provinces this may be delivered in Supportive Living options as well. Respite Care (Répit dépannage) – this service provides relief for the care givers of seniors living in their own home. This program allows caregivers to have free time for themselves while their loved ones are supervised. Additional Terminology Hospice Care - also referred to as Palliative Care provides care and comfort to those with a terminal illness and to their families. It can include medical, counseling and social services Hospice care may be provide in the home or in a community or hospital setting Additional Terminology Home Support Services – help to support the seniors independence in their own home. Services are non-medical in nature and include meal preparation/delivery, homemaking, home maintenance, transportation, security checks and friendly visits among others Home Care Services – are provided to help seniors maintain health, well -being and personal independence in their own home. Professional services may include nursing, social work, physiotherapy, respiratory therapy and nutritional services. These services may be eligible for funding depending on the province Support services may include homemaking and personal care services however this varies again between provinces depending on their Provincial Health Act Terminology Synopsis Senior Living terminology can be confusing to the public when: The seniors industry and government do not use the same terms and definitions Individual provinces do not use the same terms and definitions for the same level or type of care One term is used to reflect many types of housing. An example is the word ‘Facilities’. This term is very clinical and does not effectively represent the senior living retirement community, however the government uses this term in all aspects of seniors information they produce which can be very confusing to the senior or the seniors families. It paints the independent, supportive, assisted, long term care and hospitals all with the same brush. Terminology Vision The seniors living industry and government need to work together towards developing common Terminology Definitions that better represent the types of services and communities available to: Make them less confusing to the public Ensure they do not vary between provinces Effectively represent the services and lifestyle within each level of care available based on the seniors needs Terminology Next Steps To set up a task force spearheaded by the four Provincial Associations on this panel today to address the issue of common terminologies. To work with both provincial and federal government to review and make recommendations for change within the industry that is beneficial for all concerned. We welcome comments from other countries if you have the same concerns or solutions to this issue. FUNDING SENIORS HOUSING ACROSS CANADA Irene Martin, Executive Director, Alberta Senior Citizens Housing Association [email protected] Funding in Independent Living In pure independent living where there are little or no support services, the only government program is for subsidized seniors housing. Tenants pay 25 – 30% of their income for rent and this program is cost shared by Federal and Provincial Government (typically 70 & 30% respectively). Eligibility for this program is determined by Core Need Income Thresholds (CNITs) determined by Canada Mortgage and Housing Corporation (CHMC). The majority of these seniors apartments are owned by the respective Provincial Governments. Funding in Supportive Living SUPPORTIVE/ASSISTED LIVING is not specifically funded by any level of the Federal Government in Canada. Seed Funding/home renovations funding available. Funding varies greatly between provinces. Includes ACCOMMODATION & ACCCOMODATION SERVICES: meals, housekeeping, linen, laundry, life enrichment, etc. Funding components – operational and capital May include HEALTH/PERSONAL CARE SERVICES: bathing, assistance with dressing and grooming, etc. and other professional health services – various levels. Funding components – operational and capital Supportive Living Sectors Public Sector - funded Owned and/or operated by government or an agency or body established by government. Subsidized and targeted to low income seniors. Not-for-profit Sector – if funded, it is limited Operated and owned mostly by faith based and cultural organizations. Private Sector - mostly not funded Accommodation & Accommodation Services Funding Public Sector British Columbia ASSISTED LIVING Tenant pays 70% net income to a maximum (approx $3000 for assisted living) & Provincial Government subsidizes accommodation and accommodation services. SUPPORTIVE HOUSING Provincial Government subsidizes up to $630/mo per resident. CAPITAL FUNDING Grants and mortgage financing available. For Supportive Housing capital is available to a maximum of $35 k/unit – subject to application process. Accommodation & Accommodation Services Funding Public Sector Alberta SUPPORTIVE LIVING – approximately 10,000 units Operating as the Senior Citizens Lodge Program Province pays $8.25 per eligible low income resident per day plus $3.50 per low income resident per day for a special services grant. Municipalities pay operational deficits – operated by Management Bodies established under Ministerial Order. CAPITAL FUNDING Currently the province has $50 million budget each year for 3 years in a maximum 50% in a capital grant program. All sectors eligible to apply. Accommodation & Accommodation Services Funding Public Sector Saskatchewan ASSISTED LIVING – Approximately 10,200 units Operating as Seniors Assisted Living Services Province pays for Coordinators to coordinate health and community based services with and for the tenant associations. Eligible residents pay 30% of income for rent and pay separately for additional support services (i.e. meals). Province also has a grant program for tenant associations. CAPITAL FUNDING All public sector housing is built, owned and maintained by the Province. Accommodation & Accommodation Services Funding Public Sector Ontario SUPPORTIVE HOUSING – Approximately 9,100 units Province funds a rent supplement program within seniors affordable housing. Eligibility for subsidy (rent 30% of income) is based on income – must sell home as well. Operated by municipalities and/or private not-for profit operations. CAPITAL FUNDING As of 2008, infrastructure funding is available for these groups only. Accommodation & Accommodation Services Funding Public Sector Newfoundland & Labrador PERSONAL CARE HOMES Province funds $1,600 per eligible “bed” per month targeted to low income seniors – also asset tested. Includes accommodation and health services. Access based on central health assessment, operated by all sectors. CAPITAL FUNDING None available. Accommodation & Accommodation Services Funding Public Sector SUMMARY Province British Columbia Alberta Saskatchewan Ontario Operating Funding Capital Funding yes - provincial grants and yes - provincial mortgage financing yes - provincial grants and yes - provincial and municipal some municipal assistance N/A - built and maintained by yes - provincial province Quebec yes - provincial and municipal yes – provincial yes - provincial to senior no for operator, yes for directly based on criteria home renovaGons Newfoundland & Labrador yes - provincial and municipal no Accommodation & Accommodation Services Funding Not-for-Profit Sector British Columbia ASSISTED LIVING Called Independent Living BC program (ILBC). Province provides subsidy of $475/month to cover debt servicing and accommodation services. SUPPORTIVE HOUSING Called Seniors Supportive Housing Program (SSH). Targets lower income seniors who are means tested to determine level of subsidy. CAPITAL FUNDING Grants available to a maximum of $35 k/unit and financing. Accommodation & Accommodation Services Funding Not-for-Profit Sector ALBERTA SUPPORTIVE LIVING No operational funding for accommodation or accommodation services. Some organizations have been granted property tax exemption. A few by the Province and some by the municipality. CAPITAL FUNDING Currently the province has $50 million budget each year for 3 years in a maximum 50% in a capital grant program. All sectors eligible to apply. Accommodation & Accommodation Services Funding Not-for-Profit Sector SASKATCHEWAN ASSISTED/RETIREMENT LIVING Can enter into a funding agreement with the province – details unavailable. Operator must maintain rents at an agreed to amount for a set period of time. CAPITAL FUNDING Subject to funding agreement with province – is available. Accommodation & Accommodation Services Funding Not-for-Profit Sector Ontario SUPPORTIVE HOUSING – Approximately 9,100 units Province funds a rent supplement program within seniors affordable housing. Eligibility for subsidy (rent 30% of income) is based on income – must sell home as well. Operated by municipalities and/or private not-for profit sector CAPITAL FUNDING As of 2008, infrastructure funding is available for these groups only. Accommodation & Accommodation Services Funding Not-for-Profit Sector Newfoundland & Labrador PERSONAL CARE HOMES Province funds $1,600 per eligible “bed” per month targeted to low income seniors – also asset tested. Includes accommodation and health services. Access based on central health assessment, operated by all sectors. CAPITAL FUNDING None available. Accommodation & Accommodation Services Funding Not-for-Profit Sector SUMMARY Province British Columbia Alberta Saskatchewan Ontario Operating Funding Capital Funding yes - provincial grants and yes - provincial mortgage financing no – may receive property tax yes – application to provincial exemption grant program yes – provincial, subject to yes - provincial funding agreement Quebec yes - provincial yes – provincial, mostly targeted to seniors 70+ yes - provincial Newfoundland & Labrador yes - provincial and municipal no Yes – provincial affordable housing Accommodation & Accommodation Services Funding Private Sector SUMMARY only as there is little or no funding for the Private Sector across Canada. Province Operating Funding Capital Funding British Columbia no Alberta no no yes – application to provincial grant program Saskatchewan no no Ontario no no Quebec yes no Newfoundland & Labrador no no Health/Personal Care Services Funding All Sectors Province British Columbia Alberta Operating Funding Health authority authorizes up to 1.5 hrs/tenant/day & subsidizes service delivery with daily per diem approx. $65 per day/tenant. 1. Funding for health care aide delivering personal care. 2. Funding for designated assisted living at daily flat rate ranging from $50 - $70 per day/tenant. Comments Some health authorities deliver the personal care directly. Each health authority is different. Some health authorities deliver the personal care directly. Each health authority is different and there are many funding arrangements based on health service requirements. If services are provided by the operator they must be paid for by the resident. If services are provided by the operator they must be paid for by the resident. Quebec no – health services are provided through regional health authorities. no – health services are provided through regional health authorities except in small public sector. yes – $82-$82 per day/client -2 hours/2 – ½ hours $95 per day, does not cover meds or prof. services. Newfoundland & Labrador yes - $1,600 per “bed” includes health Access based on central health and accommodation services. assessment. Saskatchewan Ontario Funding is blurred between accommodation and health/personal care services. short Long Term Care Accommodation Rates in Canada Province Alberta Accommodation rate (per day, maximum, private room) $54.25 Minimum disposable income (per month) $265.00 British Columbia $71.80 $236.00 Manitoba $67.60 $254.00 New Brunswick $70.00 $200.00 Newfoundland and Labrador $92.00 $125.00 Nova Scotia $79.00 $221.00 Ontario $69.88 $122.00 Prince Edward Island $65.00 $103.00 Quebec $51.99 $179.00 Saskatchewan $59.67 $200.00 Le financement accessible en matière de maintien à domicile et d’hébergement des personnes âgées au Québec Les types de milieux Réalisation (construction) Funding for Capital or Capital Grant Programs Résidences pour personnes âgées autonomes Résidences pour personnes en perte d’autonomie Exploitation de la résidence Funding received for Operations Contribution au bénéficiaire Funding received for supportive housing Logement abordable (SCHL) Logement abordable (SCHL) Programme projets novateurs Programme d’achat de place Programme de ressources intermédiaires Les OBNL d’habitation et Les COOP Ressources intermédiaires (permanent et long terme) Programme Accès-Logis (Québec) Logement abordable (Québec) CHSLD privés autofinancés Contrat signé entre le CSSS et l’établissement, est requise autorisation de l’agence régionale santé et services sociaux Un contrat à l’échelle du Québec Un per diem (selon une grille) 82 $ ou 86$ / client Un profil de groupe De 1994 à 2005 : programme d’achat de places, 2h à 21/2h soins, per diem 95 $, excluant les médicaments Pour clientèle de longue durée, per diem de 130 $ à145 Programme du crédit d’impôt pour le maintien à domicile 70 ans et plus Maintien à domicile CLSC (services) Crédit d’impôt foncier Allocation logement Programme du crédit d’impôt pour le maintien à domicile 70 ans et plus avec supplément pour personnes âgées en perte d’autonomie. Programme du crédit d’impôt pour soins de santé Maintien à domicile CLSC (services + $) Crédit d’impôt foncier Allocation logement Programme du crédit d’impôt pour le maintien à domicile 70 ans et plus Maintien à domicile CLSC (services) Organismes communautaires : initiatives locales ou régionales (ex : popotes roulantes) Client paie un maximum de 1 000 $ à 1 100 $ / mois Si revenu plus bas = plus bas RAMQ Le client paie ses médicaments Le client doit payer une contribution maximale de 1 590 $ / mois Si moins de 2 500 $ / mois, ajustement de la contribution Quebec Funding Model 1. Logement abordable (SCHL) Source : http://www.cmhc-schl.gc.ca/fr/prin/celoab/aifi/aifi_001.cfm 2. Programme Accès-Logis (Québec) Source : http://www.habitation.gouv.qc.ca/programmes/acceslogis.html#qui_adresse 3. Logement abordable (Québec) Source : http://www.habitation.gouv.qc.ca/programmes/volet_social.html 4. Programme projets novateurs Source : www.rqiiac.qc.ca/pub/MSSS/pj1-communiqué-2003-26.pdf 5. Programme d’achat de place Programme particulier aux CHSLD. Quebec Funding Model 6. Programme de ressources intermédiaires Source: http://msssa4.msss.gouv.qc.ca/fr/document/publication.nsf /4b1768b3f849519c852568fd0061480d/a3313d7fc61d188b85256a7e004ddaa8 ?OpenDocument 7. Programme du crédit d’impôt pour le maintien à domicile 70 ans et plus Source : http://www.revenu.gouv.qc.ca/fr/particulier/impots/impot/credit_remb/maintien_domicile /index.asp Quebec Funding Model Quebec Funding Model 8. Maintien à domicile CLSC (services) 9. Crédit d’impôt foncier Source : http://www.revenu.gouv.qc.ca/fr/particulier/impots/impot /credit_remb/rembours.asp 10. Allocation logement Source : http://www.habitation.gouv.qc.ca/programmes /allocation_logement.html Across Canada Funding Overview Tremendous variation in operational and capital funding for both accommodation/accommodation services and health services. Seniors across Canada do not have equitable access to affordable supportive/assisted living. Some provinces use income to assess eligibility for programs, more are also testing assets. Age of senior varies 65 – 70. Supportive living is often the preferred residential option to long term care for both residents and government yet funding doesn’t match philosophy. Health Care Aides are delivering most of the care who are not professional staff, low paid and require more training. Across Canada Funding Overview All provinces reported that funding is insufficient with rising costs and the increase needs of seniors. Biggest concern is that seniors may be living in a high risk situation without sufficient services. Limited incentives for private and the not-for-profit sectors to meet the rising demand. Private sector is where the seniors choose to pay their own way and this is misunderstood by public who don’t understand that government doesn’t contribute. Variations confusing for public, particularly adult children who often live in all parts of Canada and are seeking housing options for their families. Vision for Funding Seniors Housing in Canada Federal Government applies consistent, reasonable and meaningful funding structure for supportive /assisted living across Canada. Provincial Government involvement is clearly stated in each Province with flexibility. Municipalities are involved with meeting the local supportive/assisted living needs of seniors. The true cost of providing accommodation, accommodation services and health services are determined and funded accordingly. Vision for Funding Seniors Housing in Canada Seniors and the public understand costs and funding within the entire continuing care system (independent, supportive and facility living) Fulfilling the urgent need for a fully funded training program health care aides & recruitment initiatives. What is your experience with seniors housing and funding? What is your ideal vision for funding seniors housing? Réglementation des Résidences pour personnes âgées au Canada Prévention et sécurité / Safety and Security Utilisation des mesures de contrôle Mariette L. Lanthier, M.A.P., directrice générale, ARCPQ [email protected] Considérations d’ordre général Très peu d’information concernant l’utilisation de mesures de contrôle En Angleterre, on n’applique plus de contentions depuis 100 an Principe de base : on ne peut limiter une personne sans obtenir son consentement ou celui d’une personne significative de sa famille ou son entourage Distinction entre : la mesure qui assure la sécurité de la personne, celle qui entrave la réalisation des habitudes de vie, celle qui favorise la liberté de mouvement ou l’autonomie Plan de la présentation Définitions de termes d’usage courant Origine de l’encadrement législatif Assises légales au Québec Obligations du secteur public Réalité dans le réseau privé d’hébergement Pistes de réflexion Définitions Consentement : c’est une décision exprimée par le client à l’effet de consentir ou de refuser des soins ou des services professionnels. le consentement libre réfère à l’absence de toute contrainte ou influence indue qui pourrait être exercée par le professionnel le consentement éclairé réfère aux renseignements que le professionnel doit fournir au client concernant la nature, la gravité et les risques, s’il y a lieu, reliés à l’intervention proposée afin qu’il puisse prendre sa décision en toute connaissance de cause Si la personne est représentée par le Curateur public, l’obtention du consentement du Curateur est requise. Définitions Mesures de contrôle Contention (Restraint) : mesure de contrôle qui consiste à empêcher ou à limiter la liberté de mouvement d’une personne en utilisant la force humaine, un moyen mécanique ou en la privant d’un moyen qu’elle utilise pour pallier un handicap. Isolement : mesure de contrôle qui consiste à confiner une personne dans un lieu, pour un temps déterminé, d’où elle ne peut sortir librement. Substance chimique : mesure de contrôle qui consiste à limiter la capacité d’action d’une personne en lui administrant un médicament. Définitions Personnes en lourde perte d’autonomie Personnes requérant trois heures par jour de services et de soins quotidiens autres que les services d’hébergement et de restauration Personnes non autonomes Personnes alitées ou ayant des atteintes mentales ou cognitives graves (ne se retrouvent pas dans les résidences privées) Définitions Positionnement au lit ou au fauteuil : ces mesures peuvent être prescrites par le médecin, l’infirmier, le physiothérapeute, l’ergothé -rapeute pour une durée limitée. La condition de la personne doit être réévaluée avant de prescrire la poursuite de la mesure Meilleures pratiques / Pratiques exemplaires (Best Practices) : les lignes directrices appuyées par une documentation découlant d’une recherche soutenue et pouvant évoluer à partir de l’expérience, du jugement et de la perspective d’experts Définitions Prévention / Prudence (Safety) : La prévention réfère à un ensemble des mesures utilisées pour contrer certains risques, pour empêcher l’apparition de maladies La prudence, c’est une attitude d’esprit d’une personne qui réfléchit à la portée et la conséquence de ses actes et prend les dispositions pour éviter des erreurs et des malheurs possibles. Sécurité : L’organisation des conditions propres à créer un état de tranquillité résultant de l’absence réelle de danger. Origine de l’encadrement législatif Préoccupations partagées Situations dénoncées Nombreux décès Enquêtes du coroner Décembre 2002 : adoption des orientations ministérielles qui reprennent des éléments de la Loi sur les services de santé et les services sociaux. Décision d’utiliser des mesures de contention réservée dans le Code des professions aux ergothérapeutes, aux infirmières et infirmiers, aux médecins et aux physiothérapeutes. Réduction, voire élimination par le MSSS du recours aux mesures de contrôle dans les établissements de santé publics au Québec. Assises légales au Québec Le respect des droits fondamentaux de la personne, valeur d’importance dans notre société, est assurée principalement dans : La Charte canadienne des droits et libertés Article 1 Droits et libertés au Canada Article 7 Vie, liberté et sécurité Article 9 Détention et emprisonnement Article 12 Cruauté Assises légales au Québec La Charte des droits et libertés de la personne Article 1 Droit à la vie : Tout être humain a droit à la vie, ainsi qu’à la sûreté, à l’intégrité et à la liberté de sa personne. Il possède la personnalité juridique. Article 3 Libertés fondamentales : la liberté de conscience, de religion, d’opinion, d’expression, de réunion pacifique et d’association. Article 4 Sauvegarde de la dignité : Toute personne a droit à la sauvegarde de sa dignité, de son honneur et de sa réputation. Article 9.1 Exercice des libertés et des droits fondamentaux dans le respect des valeurs démocratiques, de l’ordre public et du bien -être général des citoyens du Québec. Assises légales au Québec Le Code civil dicte l’obligation d’obtenir le consentement de la personne ou de son représentant légale avant de lui prodiguer des soins, quelle qu’en soit la nature. La Loi sur les services de santé et les services sociaux (L.R.Q., chapitre S-4.2) rappelle cette obligation d’obtenir un consentement. Obligations du secteur public Adopter un protocole d’application de mesures de contrôle tenant compte des orientations ministérielles, le diffuser auprès de ses usagers et procéder à une évaluation annuelle de l’application de ces mesures. Réduire au minimum l’utilisation de la contention, de l’isolement et des substances chimiques Développer des mesures de remplacement respectueuses de la personne, de son autonomie, de son environnement et des proches concernés Réalité dans le réseau privé d’hébergement Jusqu’en 2005 aucune disposition législative pour encadrer l’utilisation des mesures de contrôle dans les résidences privées Février 2007, adoption d’un règlement rendant obligatoire l’obtention d’un certificat de conformité au plus tard le 1er février 2009 Encadrement des pratiques pour assurer la sécurité des résidents L’exploitant ne peut recourir à des mesures de contrôle, sauf en situation d’urgence, temporairement et exceptionnellement En aucun temps, il ne peut recourir à une substance chimique Alberta Safety Services Accommodation Standards are legislated applicable to both long term care and supportive living operators. These must be met to hold a license to operate a supportive living facility. Safety Services relate to promotion, planning and monitoring for the safety of Residents, visitors, volunteers and Employees. Safety Services standards are designed to facilitate the safety and well being of Residents, visitors, volunteers and Employees. Alberta Safety Services It is imperative that a Facility maintains the greatest possible sense of safety for all users, including Residents and their representatives, visitors, volunteers, Employees and Service Providers. The Operator is responsible to promote safety through the physical design and layout of the Facility, and the ongoing inspection and maintenance of Facility equipment and safety systems. Standard 15: Emergency Preparedness Plan Standard 16: Prevention of Abuse Standard 17: Resident Safety Standard 18: Water Temperature Safety Alberta Health Services Standards Also legislated mandatory standards, applicable to all publicly funded health services included those provided in supportive living and long term care settings. Standard 1.21 There are operational policies and processes in place for the provision of continuing care health services. Alberta Health Services Standards 1.21 (a) There shall be operational policies and process in place for the provision of continuing care health services which reflect the changing characteristics of clients and current evidence based best practices. 1.21 (b) Operational policies and processes shall include, but are not limited to: • Client health information management • Risk management and the use of managed risk agreements. • Client safety, including falls and injury prevention. • Reportable incidents, including prevention, management and reporting. Alberta Health Services Standards • • • • • • Client abuse, including prevention, management and reporting. Dealing with complications, crisis or emergencies, including basic life support. Prevention and management of aggressive or violent behavior. Care of clients with dementia, cognitive impairment or mental health needs. Personal care of clients including oral care, continence management and safe bathing practices. Wound management. Alberta Health Services Standards • • • • • • • Restraints, including decision-making and review of physical, chemical and environmental restraints to manage client behavior. Pain assessment and management. Palliative care. End-of-Life care. Assessment of decision-making capacity. Biomedical/biohazardous waste management. Emergency preparedness and pandemic planning. Pistes de réflexion Un changement de culture s’impose Il faut nous questionner, revoir nos façons de faire, éduquer les professionnels, sécuriser les familles Il faut innover, éliminer toute contention visant à limiter ou restreindre les individus Il faut devenir des agents de changement Pistes de réflexion Les orientations ministérielles relatives à l’utilisation exceptionnelle des mesures de contrôle : contention, isolement et substances chimiques dont vous pourrez obtenir un exemplaire sur le site du MSSS www.msss.gouv.qc.ca, à la section documentation, sous la rubrique publications Les mesures de contention : de la prévention à leur utilisation exceptionnelle dont vous obtiendrez l’information sur le site de l’Ordre des ergothérapeutes du Québec www.oeq.org Pistes de réflexion Un programme de prévention et de réduction de l’utilisation des mesures de contrôle : le volet clinique : approche individualisée et stratégies préventives le volet éducatif : pour le personnel, la famille et l’entourage de la personne Pistes de réflexion Plan d’intervention approprié : mesures préventives ou de remplacement des mesures de contrôle adaptation de l’environnement pour favoriser une autonomie optimale information adéquate, réévaluation et suivi Thank you! This presentation is available at: www.orca-homes.com www.bcsla.ca www.ascha.com www.arcpq.org