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
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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
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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
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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
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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
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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
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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
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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) :
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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
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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
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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.
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Assises légales au Québec
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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
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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
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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
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En aucun temps, il ne peut recourir à une substance chimique
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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
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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
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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
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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
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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
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