Losing Ground

The state of health care for Alberta’s seniors has long been a serious concern, with a decade-long shift from long-term care beds to less-resourced, less-expensive, and less-regulated “supportive living” spaces leaving the frailest seniors at greater risk of not receiving the proper level of care. At the same time, government policy has allowed a significant, front-line presence of private for-profit companies in delivering long-term care to seniors.

Residential Care in Alberta

As of March 31, 2016 there were 14,768 long-term care (LTC) beds in Alberta and 9,936 designated supportive living (DSL) beds. Including an additional 243 palliative care or hospice beds gives a total of 24,947 continuing care beds in 2016.

The trend in Alberta since 2010 has been a relatively stagnant number of LTC beds coupled with significant growth of DSL beds. In 2016, Alberta had 377 more LTC beds than it did in 2010, or an increase of 2.6%. The number of DSL beds, on the other hand, increased by 4,770, or an increase of 92.3%. Accordingly, the percentage of Alberta’s continuing care beds that were classified as DSL as opposed to LTC grew from 26% in 2010 to 40% in 2016. This means that nearly half of the beds available in the province for elderly Albertans in need of 24-hour health care do not have a registered nurse on-site and are not subject to minimum staffing requirements.

Of the 24,947 continuing care beds that existed in 2016, 5,258 (21%) were operated by AHS or a regional health authority, 10,808 (43%) were run by for-profit corporations, and 8,881 (36%) were run by non-profits. Since 2010, the number of continuing care beds in government-run facilities has decreased, while the number of privately owned beds, and to a lesser degree non-profit-owned beds, has increased significantly. In the last seven years, Alberta has lost 333 beds in public facilities while private, for-profit facilities have added 3,255 beds.

Since 2013, there has been little to no movement by either the previous Progressive Conservative government or the current NDP government to address the shortage of long-term care beds. The current government has fallen far short of its election commitment to open 2,000 public long-term care beds by the end of 2019, including 500 new beds in 2015. It has also continued the previous government’s approach of deregulating and privatizing residential senior care: of the 951 continuing care beds added after the NDP formed government, 75% have been supportive living and 55% have been in for-profit facilities.

The dearth of LTC beds has been a problem that has grown over many years and will become even more acute in the future, as the senior population in Alberta is growing both absolutely and as a proportion of the overall population. The growth in the older senior population (85 years and over) coupled with a stagnant number of long-term care beds has meant that the bed availability rate (the number of LTC beds per 1,000 aged 85 and over) has fallen almost in half since 2001.

Comparing Levels of Care

The level of care provided in long-term care facilities varies significantly by ownership type. Publicly run LTC facilities provide more health care to residents than do privately run and non-profit-run facilities. On average between 2011 and 2013, registered nurses (RNs), licenced practical nurses (LPNs), and health care aides in public facilities provided 4 hours of direct health care to each resident each day, compared to 3 and 3.1 hours per day in non-profit facilities and private, respectively. Critically, over the three years of data no type of facility met the level identified by a landmark US study as the minimum required to limit preventable decline in the health of residents.

Each type of facility failed to provide the minimum recommended level of care from RNs and health care aides, and each type of facility surpassed the minimum recommendation for LPNs. Public facilities on average provided residents with the highest level of staff time from RNs and health care aides, while non-profit facilities provided residents significantly more time with LPNs. Private facilities, however, provided residents below-average levels of care from each type of staff.

The data shows little divergence in hours of care provided by recreational staff and therapists (mostly physiotherapists) among the three types of facility ownership. There were significant divergences in some of the service staff categories, with a much larger administrative staff presence per resident in non-profit facilities and far less staff responsible for meeting the food requirements of their residents in private facilities.

According to Statistics Canada’s Long-Term Care Facilities survey, public facilities are the only ones that on average over the three years examined spend most of their revenue on nursing staff. On average between 2011 and 2013 public LTC facilities spent 59% of their total revenue on employing registered nurses, licensed practical nurses, and health care aides. In comparison, private facilities spent 48% of their revenue on nursing staff over that same period, and non-profit facilities just 44%.

Conclusion

Long-term care in Alberta continues to be defined by three troubling realities:

1. The availability rate of long-term care beds, measured in relation to seniors at and over the age of 85, has plummeted over the last 15 years.
2. For each ownership type, the average facility is understaffed. Between 2011 and 2013, none of the facility ownership types – public, private, and non-profit – provided the required 4.1 hours of care to residents per day.
3. The provincial government continues to fund for-profit long-term care facilities despite the fact that they provide an inferior level of care compared to publicly run facilities.

With these three major issues, it is clear that elder care in Alberta remains in a state of crisis.

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