Wednesday, September 30, 2015

Concerns of Boomers

 The senior advocate spent some time talking to seniors in my province and in her report listed 13 major concerns of seniors. These are (in no particular order):

1. Being unable to continue to live where they want. Seniors are concerned that, because of a lack of supports and/or because of regulatory roadblocks, they will be forced to move. Across the spectrum of housing, from the single family house to the condominium to assisted living and residential care, seniors identified issues that potentially pushed them to the next level on the continuum prematurely. Some of these issues were financial in nature, others were regulatory, and some related to the lack of adequate supports in a particular community to enable a senior to remain at home.

There were stories of seniors being pushed out of their homes because they could not afford simple repairs and maintenance such as roof replacements or furnace repairs. There were stories of seniors who were challenged by a lack of home care services, who needed assistance with household chores such as snow shovelling or chopping wood. Isolated seniors were challenged by a lack of, or inadequate, transportation.

Seniors universally felt that their first choice was to remain in their own homes, and that all possible supports to achieve this should be fully utilized before a move to the next level on the housing continuum is required. Evidence suggests that, given more support in the community, some seniors could have delayed or prevented the move to assisted living, and that changes to the current assisted living regulations could have delayed or prevented the move to residential care. Seniors voiced that this is particularly significant given the scarcity of residential care that exists in some areas and the fact that, in some cases, residential care is clearly the appropriate choice given a senior’s care needs.

2. Having an adequate income to meet future health and housing needs. Seniors described facing economic hardship as a result of unforeseen expenses and rising costs. Statistics Canada data indicates that most seniors in British Columbia live on less than $25,000 per year. Provincial data shows that more than 52,000 seniors in B.C. live on $17,000 per year or less. In particular, many seniors identified that costs related to their housing, dental care, drugs, eyeglasses and hearing aids are causing current hardship or worry about future hardship. Federal and provincial governments provide a number of programs and subsidies to assist low-income seniors. Most seniors however, voiced their frustration with how they access those programs and with the bureaucracy involved in securing and keeping those benefits. Many questioned the adequacy of some programs that were established years ago and may not have kept pace with inflation. It was identified that no programs exist to help seniors with dental care, eyeglasses and hearing aids unless they were on certain types of income assistance before becoming seniors.

3. A lack of transportation to medical appointments and support services. Many seniors expressed grave concerns about their ability to get out and about once they are no longer able to drive. There were emotional stories from seniors about the trauma they experienced from the driving assessment process, and the devastation they faced upon losing the independence that driving provides. Those seniors who no longer drive appreciate services such as HandyDART, but they also highlighted concerns about the limitations of such services, frustrations around processing applications, wait times, frequency, and the cost for low income seniors.

4. A lack of, and inconsistency with, home care services across the province. The type and frequency of home care services varies significantly throughout the province. Needs appear to be met in some communities, but fall short in others. The elimination of meal preparation, reductions in services due to staffing shortages, changes in staffing, the availability of live in and overnight respite, day programs and residential respite care in some communities and not in others, and concerns about the capacity of the new Better At Home program were among the issues seniors and their family members raised. Inconsistency in the provision of home nursing services, and limited rehab for clients in the community and in assisted living, were also highlighted as gaps

5. The inability to secure a residential care bed at the right time and in the right place. Access to, and types of, residential care bed varied greatly throughout the province. In some communities, the average wait time to secure a first available and appropriate residential care bed (FAAB) is 32 days, whereas in others it is more than 89 days. It is not clear to the Advocate that the Ministry of Health’s FAAB policy is consistently applied in all health authorities. Local conditions significantly influence when and where a senior secures a FAAB. In addition, while provincially, 69 percent of seniors secure a FAAB within 30 days, in some communities only 30 percent of seniors secure that crucial bed within that time. In addition, families expressed significant frustration with the time it takes a senior to secure a bed in their facility of choice. The impact on seniors of the location of their care facility can be profound, as it often dictates the ability of a frail spouse and other family members to visit their loved one. Research clearly supports the positive therapeutic effects on residents of visits from family members. Health authorities recognize that they do struggle on this issue, but there was some evidence to suggest improvements could be made that would allow the objective of the FAAB policy to be met while reassuring families with a reasonable and accurate estimate of time to move to a facility of their choice.

6. Concerns about the quality of care in residential care facilities. Seniors and family members shared stories of their experiences with residential care that ran the gamut from “exceptional” to “appalling”. The care and compassion of staff was the most cited reason for satisfaction, and lack of staff and food quality were most often cited as reasons for dissatisfaction. In some communities, residential care facilities offered a single room with en suite bath, while others had more limited options, including four beds to a room with shared bath, while charging residents the same – 80% of income. Concerns were expressed by unique populations, most notably the multicultural, First Nations and lesbian, gay, bisexual, transgendered and queer (LGBTQ) communities, about discrimination in residential care and assisted living and the lack of culturally sensitive care. Many service providers acknowledged the need for more education and training to ensure that all residents feel safe and respected regardless of their ethnicity or sexual orientation

7. Proper dementia care. Whether seniors were housed in a residential care facility or in the community, there were concerns about the availability of supports necessary to provide proper dementia care. In facilities, this related to the physical environment, the training and clinical expertise of staff, the level of staffing and the use of antipsychotic drugs. In touring several facilities and meeting with service providers, it was clear that best practices are in place in some facilities and not others. Proper training of staff, the proper number and complement of staff including recreational, occupational and physical therapists, and the use and tracking of anti-psychotic medication varied across the province. In the community, there are concerns about getting support when needed and in properly addressing the possibility for those with dementia to wander and get lost. Linking families that are caring for a loved one with dementia to community resources is a challenge in some places, particularly in more rural and remote parts of the province.

8. Fragmentation of services. Seniors recognize that a significant number of services and supports are available to them; however, knowing what those services are and how to access them can be difficult, and navigating the application paperwork involved is daunting. A streamlined system of access, and better awareness of what services and supports are available, is required before the government and health authorities can be confident that the services they offer to seniors are actually being delivered.

9. Caregiver burnout. A significant number of seniors spoke of their role as an unpaid caregiver to a spouse or parent who is most often suffering from dementia. Seniors were unanimous in their commitment to care for their loved one and in their willingness to sacrifice many of their own needs, but they clearly require more support. Additional resources ranging from day programs that have been reduced or eliminated, to respite beds that are either overbooked or not available, to using home support as respite, not just care, were among the supports identified as lacking

10. Elder abuse. Seniors, service providers and stakeholders all shared their worries about the growing abuse of seniors. Concerns include:
abuse by paid caregivers, and questions about the regulatory adequacy of the Care Aid Registry to monitor:
  • the concern about abuse of seniors within families, particularly financial abuse;
  • resident-on-resident abuse in care facilities;
  • conflict between concerns of self-abuse / neglect and personal autonomy.
 11. An ageist society that devalues seniors. A clear message from seniors was their strong desire to ensure that society values what they can do and their sense that they often feel “invisible”. While some seniors do need assistance, seniors actively contribute to their communities in many ways and their contributions should be recognized. Many, many seniors expressed their dismay at the portrayal of seniors as a drain on the system. Seniors spoke of the contributions they make as volunteers, as unpaid caregivers and donors to many philanthropic causes, and pointed to the taxes they pay and have paid in support of services available to all British Columbians.

12. A lack of respect for the decision-making abilities of seniors. While it is recognized that some seniors lack the capacity to make sound decisions, many seniors feel that long before this happens, care professionals and even family members begin to assume they know what is best for seniors. Respecting the right of seniors to make their own decisions will require a paradigm shift for everyone who is involved in the lives of seniors.

13. Challenges faced by the multicultural community. The multicultural community is concerned about a number of challenges faced by seniors who came to Canada from other countries. Their financial status can be precarious as they are often not able to enjoy the full benefit of a number of entitlements, and their isolation and loneliness can be exacerbated by language barriers. While not wholly successful in directly reaching some seniors in the multicultural communities, the Advocate focused, by necessity, more on the stakeholders and providers who serve them

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