Denied the freedom of choice

Times Contributor

 

Debbie Wakelam wants people to pay attention to the announcement made by Health Minister Fred Horne last month that addresses seniors housing needs.

The government is recommending changes based on the ‘Moving Continuing Care Centres Forward: Concept Paper’, indicating movement towards an ‘aging in one place’ concept, a larger facility model for senior care.

Wakelam said the paper does not provide for alternate care options that were promised in the 2008 Aging in the Right Place document. It promised to provide more options and improve choice and availability as to where Albertans receive services. 

The new plan amalgamates all levels of housing and care into one government department that oversees large development living sites, in which the residents would move from floor to floor as their medical needs increased. 

“Where is our choice or an option in this proposal?” said Wakelam.

In an article in the Edmonton Journal Health Minister Fred Horne said it is an early draft with “very preliminary ideas.” Horne said all Albertans would have a chance to weigh in on the design of the new eldercare system at some point in the future.

Wakelam belongs to the Alberta Seniors Citizens Housing Association (ASCH) that has representatives from all kinds of senior care facilities. She said they gave suggestions to the Alberta Government about housing for senior citizens that incorporated many alternatives to large long-term care facilities. The new plan does not seem to consider that input.

“We made suggestions to them; I think that the decision was already made. They have already built models. They are already going to do this. Although it is a draft, it is already a done deal,” said Wakelam.

There are currently different kinds of nursing facilities and long-term care homes. It can be confusing to the average citizen. 

There are voluntary, non-profit groups, organizations and religious groups that own auxiliary hospitals and nursing homes, and some are still municipally owned or co-owned. They operate under the Hospital or Nursing Home Act. If their services are contracted to the Regional Health Authority, their boards are accountable to the authority, as well as the staff, and clients. 

There are also Private nursing homes. They operate under the Nursing Home Act and are accountable to their owners, their staff and clients and the regional authority – if they have a contract with them. Both are accountable to the Health and Welfare Minister in matters relating to the Act. 

The new move may be a move to simplify this diversity of services.

There is some speculation that privately owned facilities will eventually replace all publically managed homes. The financial strains on public homes include old building upkeep, increasing staff costs and providing fair living costs for low-income seniors, making it a challenge to meet their bottom line. 

There is some evidence that the government contracts are being awarded to large private developers, although smaller facilities are tendering contracts. Wakelam thinks smaller contractors are reviewed and denied in favour of a one-size-fits-all development. The smaller bid complies with the same licensing guidelines and providers are providing the same standards of service. Often smaller contractors are owners living in the community, with established historical relationships with potential clients. Clients are denied the choice of a more intimate style of care because not enough of these types of facilities are approved, or funding for upkeep and maintenance is withheld.

“When I met with Associate Minister (of seniors) George VanderBurg, he said ‘If I had the decision making, I would give private developers the entire job and let them build the thousand beds that I need’,” said Wakelam. “Because you have dementia, why does it mean you have be in one of these facilities? I have two people here and they function quite fine.”

Wakelam has been involved in geriatric home care for more than two decades and is following the Eden Valley Care philosophy. Each of her home mates have various levels of care needs. She worked with Alberta government officials to develop procedures and standards of care for small care homes, like her small four bedroom, age 86+, Meadowlark care home, located in Strathmore.

The Eden Valley approach is person centred, growth oriented and interactive within a home and community setting. www.edenalt.org. It differs from the medical institutional program approach (dining program, bathing program, etc.) to transform a new way of thinking. It asks people to move from thinking of our elders as frail and sickly persons awaiting death in an institution; moving toward making the elderly contributing members of our community, interacting with family members, owning pets and participating in community events.

Wakelam had previously worked in bigger care facilities and didn’t like how the caregivers were expected to care for the residents.

“I didn’t like how we had to do the care. You have so many residents to get up in a limited amount of time. They are sound asleep. You wake them up and sit them in a chair. That is not what these people deserve in their old age. I have one woman that sleeps in quite late and her family is OK with that. Why can’t she sleep in if she wants to? I have one lady that likes to have breakfast in her housecoat.”

She said the smaller care homes offer a more relaxed schedule, a smaller more comfortable living space that is less confusing and intimidating for dementia patients. Agitation is reduced. She says there is less dependence on medication. Participation in daily home activities such as helping in meal preparation or gardening is encouraged.

“Most old people die from boredom, loneliness and feeling helpless. You give them a purpose with simple things such as setting the table and participating,” said Wakelam. 

With the new guidelines, Wakelam doesn’t think her home can meet the large facility requirements. She also wonders if the private amalgamated care will have enough qualified staff to deal with extended needs. She says that the private developers are charging for extra care needs and she wonders if the extended care will be affordable to everyone. She wonders if they phase out extended care in hospitals, will there be place for those not already living in the large facilities, when the medical needs reach a Level 4 stage of care.

“We should build infrastructure appropriate for higher levels of care. Even if they are not attached to the hospital, we still need them,” she said. “Let the industry come forward with ideas.”