Alberta Health has received the report on facility-based continuing care (FBCC) in the province. 

The report, compiled by business advisory firm MNP, provides 42 recommendations under 11 policy directions. A major goal in the reported is a recommended shift of continuing-care delivery from facility-based to home-based care.

MNP compiled the review from advice and expertise provided by a panel chaired by MLA Richard Gotfried (Calgary – Fish Creek), as well as a review of existing literature and data, and input from Albertans.

Gotfried described the review as “a huge undertaking.”

“I believe we are on track to make meaningful changes to the model of continuing care service delivery, which will benefit Albertans,” he said

Currently, 61 per cent of continuing care is delivered as Long-Term Home Care, while 39 per cent is facility-based. The review recommends shifting the proportion to 70 per cent home care and 30 per cent facility-based care by the year 2030.

The need for continuing care services in Alberta will grow by 62 per cent in that time.

Policy directions in the review include making quality of life the top priority for continuing care and enhancing quality of care for people with dementia. The review also calls for increased staffing levels and more hours of direct care for people in FBCC.

In addition to increased staffing levels, the review recommends that Health Care Aides have a greater role in team decisions regarding a client’s day-to-day care.

While the report acknowledges the increase in staffing will cost almost $500 million in operating costs, most of that ($452 million) would be offset by the savings realized by shifting more care to home-based rather than facility-based. 

The shift to more home care will also save $1.7 billion in cumulative capital costs.

Health minister Tyler Shandro said the government “will now move forward with an action plan, including new continuing care legislation, to strengthen and modernize our continuing care system.”

The Alberta government says it is prepared to immediately implement some of the review’s recommendations, including:

• Providing direction to support couples and companions to remain living together in continuing care facilities, if they choose.

• Enhancing public reporting on continuing care inspections.

• Phasing out shared rooms in continuing care facilities, including an immediate halt on admissions to rooms where there are already two residents. 

• Updating design guidelines for continuing care centres to include learnings from COVID-19 and targeting capital funding to support a greater variety of models for upcoming builds.

• Providing capital grant funding to support Indigenous groups for continuing care services in the communities where they live.

• Expanding community care and services options to enable more people to stay at home.

The review also looked at fees and charges for FBCC. It recommended that accommodation charges—the room and board portion of the care and service provided—be increased annually at the rate of inflation, with flexibility to allow for greater increases.

The review found that in many cases, especially among non-profit operators, the accommodation charges do not cover room and board expenses. These expenses are often covered with money that had been budgeted for care.

FBCC is provided by a combination of Alberta Health Services-run facilities, private not-for-profit organizations and private for-profit companies.

Many of the recommendations arise from lessons learned during the Covid-19 pandemic, the review says. Some of these are relevant to day-to-day care, and others are specific to pandemic or outbreak situations.

These include recommendations on staffing, leadership, and communication as well as provision of personal protective equipment for residents and staff, and measures to reduce isolation among residents and caregivers.

Carole Estabrooks is a professor at the University of Alberta’s faculty of nursing, and a was a member of the advisory panel. She described the review as “unusually forward.”

The recommendations, she said, “will be transformative for Alberta’s facility-based continuing care system and importantly for the care of older Albertans who need designated supportive living and long-term care.

“Not only will it set a new bar in Canada,” Estabrooks said, “it will go a very long way to eliminating the fear that many of us have of one day needing care ourselves.”