The BC Health Coalition released The Place of Assisted Living in BC’s Seniors Care System: Assessing the Promise, Reality and Challenges report with the Canadian Centre for Policy Alternatives and the Hospital Employees’ Union.
Assisted living was introduced in 2002 as a less institutional environment for seniors with less complex needs than long-term care. It offered the promise of greater independence and being able to live in a more home-like environment—which are important and highly valued by seniors. Drawing on interviews in different parts of the province with 28 care aides, Licensed Practical Nurses (LPNs), front-line managers, residents and family members, the study offers a preliminary assessment of the quality and appropriateness of assisted living services, the conditions for both residents and workers, and the legislative and regulatory frameworks that govern assisted living.
The key findings portray symptoms of a crisis in our fragmented, under-regulated, and largely privatized system of home- and community-based health care:
- Many seniors have care needs that are not met due to affordability challenges, particularly in private-pay units (where the senior or their family pay the full cost and are charged for each additional service beyond the basic minimum required). For example, LPNs and care aides reported residents using towels as adult diapers or for wound care, skipping meals not included in basic food packages, or wearing dirty clothing because laundry detergent was too expensive or residents could not afford to buy new clothes.
- A significant number of seniors in assisted living residences do not appear to qualify for assisted living under provincial legislation, which requires that residents are able to direct their own care and independently respond in case of an emergency. LPNs and care aides overwhelmingly reported struggling to meet the needs of residents with moderate to advanced dementia or significant mobility limitations – but who were nevertheless living on their own in both publicly-subsidized and private-pay assisted living.
- The assisted living model allows residents to make the choice to “live at risk” in order to remain independent, but it can easily become a way for operators to cope with or justify low staffing levels, and too often leaves residents in situations that border on neglect.
- In subsidized and especially private-pay assisted living, front-line staff reported being unable to do what they ethically know they should as a result of institutional constraints like low staffing levels, a lack of resources and the philosophy of allowing residents to “live at risk.”
- Front-line staff participating in this study reported a high rate of ER visits and hospital admissions of residents in assisted living, particularly due to falls.