1

CommunityEngagement

Issues and Insights from the BCGEU’s Dialogue on Seniors’ Care in British Columbia

May 30, 2011Kelowna, BC

2

Executive Summary

CommunityEngAGEment

In response to growing concerns about the state of seniors’ care in BC—reflected in the media, research reports, and the everyday lived experience of our province’s seniors— the BC Government and Service Employees’ Union (BCGEU) recently launched a provincial campaign to Build a Better Future for Seniors. Because the seniors’ population in the Okanagan area exceeds the provincial and national average, Kelowna represented a model community from which to draw on experience and expertise around this issue. Numerous campaign activities took place in the region throughout May, 2011, including a public engagement event on May 30 in Kelowna. Nearly 60 key stakeholders from the area’s seniors’ care sector participated in this event. A brief panel discussion set the context for a structured dialogue session that followed. Adam Lynes-Ford, from the BC Health Coalition, spoke about the BC Ombudsperson’s investigation and report on seniors’ care. Anita Zaenker, representing BCGEU, discussed workforce-related issues, drawing on findings from a recently released HR strategy report. And local writer Barbara Shave offered some cogent reflections from the seniors’ perspective. For the dialogue exercise, stakeholders were asked to apply their regional knowledge more broadly to issues of seniors’ care for the province. Working in eight small groups, participants explored the question: What can we do to ensure that BC seniors—now and in the future—receive the best quality home and community care?

Issues and solutions identified through the dialogue session focused on three broad categories: BC’s healthcare infrastructure; BC’s seniors’ care workforce; and various socio-political factors.

The working groups called for an expansion of BC’s home and community care system to better meet existing and emerging needs. They also recommended an increased investment in the province’s seniors’ care workforce to address recruitment and retention problems in the sector and improve quality and continuity of care. Finally, a number of broad-based social and political changes were proposed to address inequities impacting BC’s seniors.Building a Better Future for Seniors: May 30th Dialogue on Seniors

Care, Kelowna BC

3

ContentsThe State of Seniors Care in BC 3Engaging Stakeholders in Solutions 4- Panel Presentations 4-5- Participant Dialogue 6Recommendations 7-8Conclusion 9

Introduction

The State of Seniors’ Care in BC

“We’ve put more effort into helping folks reach old age than into helping them enjoy it.”

~ Frank A. Clark

According to current information on British Columbia’s demographic profile, our province’s population is aging. StatsCan data shows that 15 percent of BC residents are currently over the age of 65; by 2036, seniors are expected to make up 25 percent of our population.

The Okanagan region is already well ahead of that curve. Seniors, based on 2006 census data from the Regional District of the Central Okanagan and the Okanagan Similkameen, represented 19 and 26 percent of the population respectively.

These demographic realities have serious implications for the current and future healthcare requirements of our province’s seniors. Already, a number of media and research reports reveal that BC’s healthcare sector is not adequately meeting the diverse and complex needs of seniors in their communities. And as BC’s aging population grows, the situation is predicted to worsen.

The BC Government and Service Employees’ Union (BCGEU) represents more than 16,000 provincial healthcare employees, including seniors’ care providers. The sector employs: care aides; community health workers; licensed practical nurses; health science professionals; activity workers; dietary and housekeeping staff; and administrative workers. These workers are witness, on a daily basis, to the problems plaguing BC’s seniors’ care sector.

For this reason, the union launched a provincial campaign to Build a Better Future for Seniors. One of the key campaign activities involved coordinating a public engagement event on the state of seniors’ care in BC. The Okanagan region’s demographic made Kelowna an ideal location for such an event. The May 30 panel discussion and dialogue brought together nearly 60 key stakeholders from the seniors’ care sector, who were asked to apply their regional knowledge more broadly to issues of seniors’ care for the province.

This report summarizes the issues and insights arising from the meeting.

4

Engaging Stakeholders in Solutions

Adam Lynes-Ford, BC Health Coalition

Adam Lynes-Ford is the Medicare Campaigner with the BC Health Coalition, a province-wide network of organizations and individuals that champion the protection and expansion of a universal public healthcare system. The Coalition’s Home and Community Care campaign publicizes cutbacks to seniors’ care and the privatization of seniors’ services, while working to address shortcomings in the provincial healthcare system’s continuum of care. Adam Lynes-Ford gave an overview of the issues that prompted the BC Ombudsperson’s province-wide investigation and report on seniors’ care. The investigation, which began in 2008 and is not yet concluded, was the most extensive ever undertaken by that office. Hundreds of complaints were brought forward, exposing problem areas with access to information and services, quality and standards of care, monitoring, enforcement, and complaints processes. The Ombudsperson released her first report in December 2009, focusing on BC seniors living in residential care facilities. The report, entitled “The Best of Care: Getting it Right for Seniors in British Columbia (Part 1),” included ten recommendations for systemic change. A review of these recommendations was intentionally omitted in order to create an unbiased atmosphere for dialogue participants to generate ideas of their own. The Ombudsperson’s second report, encompassing a broader range of seniors’ care options including home support and assisted living/community care, is scheduled to be released in the Fall 2011. The BC Health Coalition and other organizations, Adam stated, actively raise awareness about the Ombudsperson’s report and recommenda-tions as part of their advocacy efforts, but organized citizens’ action can help ensure that the recommendations are fully implemented.

Panel Presentations

The May 30 dialogue on seniors’ care in Kelowna engaged nearly 60 invited guests from BC’s seniors’ sector. Participants included: frontline service and support providers; owners/operators of residential care facilities; representatives from health and seniors groups; post-Secondary instructors; First Nations elder care leaders; and elected representatives. The early evening meeting began with an informal reception, where guests had the opportunity to interact over food and refreshments. During the structured portion of the event, attendees were introduced to the dialogue concept and the event format. The first activity involved an ice-breaker exercise where, working in pairs, participants shared stories about an important lesson learned from an influential elder they have known. Next, three brief panel presentations examined a variety of issues relating to seniors’ care in BC, providing a context for the structured dialogue that followed.

BC Health Coalition’s Adam Lynes-Ford discusses pubic concerns prompting the BC Ombudsperson’s investigation and report on seniors’ care

5

Barbara Shave, Columnist/ Author

Anita Zaenker, BCGEU

BCGEU’s Anita Zaenker presents on issues impacting BC’s seniors’ care workforce

Anita Zaenker is a staff representative in the Research and Campaigns department of the BC Government and Service Employees’ Union. Her work supports improving conditions for the union’s 16,000 healthcare sector members. She also serves on the BC Health Coalition steering committee, the Seniors’ Care HR working group, and the Community Action Initiative collaboration to address mental health and substance use. Anita Zaenker discussed workforce-related issues in BC’s seniors’ care sector. Her presentation drew on findings from a report released in December 2010 by the Seniors’ Care Human Resource Sector Committee, a stakeholder-based committee of employers, unions, post-secondary institutions, and government. The report is entitled: “Planning, Attracting,

Engaging, and Sharing Knowledge: A Human Resource Strategy for the Community Health Workers, Residential Care Aides and Licensed Practical Nurses in BC’s Private and Not-for-Profit Sector.” The report describes how political and economic pressure to reduce healthcare spending has led governments to explore alternative models to finance and deliver healthcare services. Often, this involves contracting out skilled, unionized work to subcontractors at reduced wages and benefits. Also, employers rely on casual employees instead of offering permanent employment. The report documented significant staff turnover in residential and home care sectors, as well as negative impacts on the cost, acceptability, and safety of seniors’ care. Staff turnover was attributed to the absence of stable employ-ment, high workload-related stress and injury, contracting out, and a downward trend in wages and benefits. The report outlines four goals and more than 20 recommendations to improve employee retention and reduce staff turnover in the sector. The specifics of these recommendations were not discussed so as not to interfere with the dialogue exercise. However, Anita indicated that the HR committee had already made progress on several recommendations.

Local author and columnist Barbara Shave provided engaging and cogent reflections on the seniors’ experience.

Barbara Shave is an Okanagan-based writer, retired school teacher, widow, and grandmother. She sits on numerous commu-nity boards and committees, teaches creative writing, and is a tireless advocate for seniors’ issues. Since moving to Kelowna ten years ago, Barbara has published more than 350 columns and two books on her seniors’ reflections: “Gray Matters.” Barbara Shave provided a local seniors’ context and personal perspective to the Kelowna forum. Her entertaining anecdotes about life as a senior elicited laughter, while simultaneously exposing some unfortunate truths about how seniors are regarded—or sometimes disregarded. Elders in Aboriginal culture are traditionally revered, as Lenora Holding explained in her greeting on behalf of the Westbank First Nation. However, the tendency in contemporary western society, Shave pointed out, is to talk about and treat seniors as though they are invisible. “Seniors are all too often barraged with prejudicial messages… often by people with the noblest intentions… that patronize, marginalize, stereotype, or dehumanize,” she said. Dialogue participants appreciated Shave’s humourous accounts about com-ing to terms with seniors’ discounts, enduring references to the elderly in the past tense, and being the recipient of impersonal gifts signifying a life past its prime. But the more serious underlying message from her presenta-tion was clear: “being old doesn’t change the basic human need for dignity.” Participants carried that awareness and sensitivity to their discussions about the future of quality seniors’ care in BC in the ensuing dialogue session.

6

Participant Dialogue

Following the panel presentations, participants broke out into eight small working groups to respond to the open-ended question: What can we do to ensure that BC seniors—now and in the future—receive the best quality home and community care? Although all of the invited guests were based in the Okanagan, they were asked to apply their regional expertise on a larger scale by examining seniors’ care as a provincial issue. Guidelines for constructive communication were reviewed with participants by each group’s designated table host; the table hosts also monitored time and ensured that everyone in their respective groups contributed to the discussion. Participants shared information, listened respectfully to one another, and were encouraged to generate responses that reflected the diversity of their perspectives and experiences. At the end of the discussion period, a representative from each working group volunteered to report out on their top five solutions to the brainstorming question.

Working in small groups of 6-8 participants each, dialogue participants collectively generated ideas about quality home and community care for BC seniors

Engaging Stakeholders in Solutions

7

Issues and solutions identified through the dialogue session focused on three broad categories: BC’s healthcare infrastructure; BC’s seniors’ care workforce; and various socio-political factors. As well, while the eight small groups participated independently in the dialogue process, their recommendations revealed a number of recurrent themes.

Each group selected a host to focus discussion, a recorder to take notes, and a spokesperson to report out to the larger group

Recommendations

CommunityEngAGEment

BC’s Healthcare Infrastructure

All of the dialogue working groups recommended changes to the provincial healthcare infrastructure. Quality, continuity, and affordability of care for BC seniors, dialogue participants stated, were attainable only through a greater investment of financial and human resources to seniors’ services and the elimination of privatized health care. Key recommendations included:• Ensure a reliable, predictable level of funding dedicated to seniors’ home and community care• Expand home support services to improve and extend independent living for seniors• Increase the number of residential care beds required to meet existing and emerging needs of

BC’s aging population• Increase home and community palliative care services and resources to allow patients to die with

dignity and support families involved in the palliative care process• Eliminate for-profit health care• Stop contracting out healthcare services and retendering contracts• Create cost efficiencies through collaboration and centralizing provincial services: foster

interdisciplinary collaboration; create an umbrella network for seniors’ organizations; establish an online database of information, including seniors’ organizations, resources, services, and care

“With over one-quarter of our population being 65 or older within the next 20 years, we need to figure out how to get seniors represented at all levels of decision making.”

~Dialogue Participant

8

Participants were encouraged to propose recommendations that reflected the diversity of their perspectives and experiences.

BC’s Seniors’ Care Workforce

Most of the working groups participating in the dialogue also proposed concrete recommendations to strengthen BC’s seniors’ care workforce. Strategies to attract and retain skilled seniors’ care service and support providers are required in order to meet the current and future needs of the province’s aging population. Key recommendations brought forward included: • Increase wages and improve working conditions

to address recruitment and retention challenges in the sector

• Address quality and continuity of care problems by investing in workforce and reducing reliance on subcontractors and casual staff

• Increase direct care hours allocated per patient to improve quality of care

• Decrease administrative workload for support providers so additional hours can be devoted to client care

• Increase funding for professional/skills development opportunities for workers

• Formally endorse the HR recommendations from the Seniors’ Care Human Resource Sector Committee report

Socio-Political Factors

A number of recommendations put forward by the groups participating in the dialogue focused on broad-based social and political changes to address inequities impacting BC’s seniors. Recommendations ranged from progressive social and public policy to fair taxation, and from awareness campaigns to grassroots organizing. A selection of key proposed solutions is summarized below:• Establish an independent officer of the Legislature to advocate on behalf of seniors and issues

related to seniors’ care, support, and services• Implement a fair taxation system to adequately finance health care and seniors’ services• Elect provincial leadership that prioritizes seniors’ issues• Implement recommendations from the BC Ombudsperson’s report on seniors’ care• Advocate for greater representation of seniors at all decision-making levels to ensure inclusion and

prioritization of issues• Structure services and supports for seniors on a model of seniors-centred care• Establish quality care and best practices standards for seniors’ care• Launch public awareness/advocacy/publicity campaign to improve social attitudes towards seniors

and address issues of seniors’ care in BC• Promote and increase citizen involvement in seniors’ and health advocacy groups

“We need to call on this government to address the recommendations of the Ombudsperson—before the next provincial election.”

~Dialogue Participant

9

Conclusion

Expanding BC’s home and community care system makes sense. As our province’s aging population grows, investing more in community-based health care remains critical. Accessible, public, and high quality home support and residential care services, in addition to community resources, will keep seniors healthier in their homes and will reduce the burden on the province’s acute and primary healthcare services. Further, investing in the staff who provide seniors’ care is the best way to address chronic recruitment and retention issues in the sector. Dedicating resources to staff training and development, maintaining adequate staffing levels, and ending privatization and contracting out will create a strong and vibrant seniors’ care workforce. A stable healthcare sector with skilled service and support providers will ensure that seniors receive the quality and continuity of care that they need. Finally, introducing progressive social and public policy will reinforce and enhance the solid foundation of a robust public healthcare infrastructure. We are still a long way from truly Building a Better Future for Seniors in British Columbia. The building blocks are there: we have the need, the interest, the vision, the skills and expertise, and the resources. What is still required is leadership: a commitment and willingness to make the investment in our healthcare system, for our seniors today and for tomorrow.

CommunityEngAGEment

“Participants were very much engaged—and the shared experience and insight [about] the current and future needs of our seniors was sobering. What astounded me most was the realization that we are ‘in the know’…. And likely, for the first time ever, we are able to see the freight train coming and have to make changes so that we are prepared for the future.”

~Dialogue Participant

cep 467/ cope 378

Community EngAGEmentIssues and Insights from the BCGEU’s Dialogue on Seniors Care in British Columbia

June 2011

Prepared by: BC Government and Service Employees’ Union

Acknowledgments:Service and Support Staff, BCGEU Okanagan Area OfficeDarryl Walker, President, BCGEULenora Holding, Westbank First NationsPresenters: Adam Lynes-Ford, Anita Zaenker, Barbara ShaveDialogue ParticipantsCommunications/Photos/Video: Erin Sikora, Chris Anderson, Holly ReidCoast Capri Hotel, Kelowna