The system's paradox - AHS's conflicting mandates to provide care and to cut costs

When an Alberta senior decides that they can no longer live independently, they enter the continuing care system.

The first thing that will happen is a personal assessment by an AHS case manager, usually a Registered Nurse. This is the single point of entry into the seniors’ care system. From this assessment, AHS will decide which level of care the applicant needs. Or, in another sense, decide what level of funding and for what services and care the person will receive from AHS.

There is a weakness with this system. Since AHS is both the assessor and the funder of continuing care, there is an inherent contradiction between its mandate to spend as little as possible and its mandate to provide the highest level of care a patient requires.

There is a real fear that elderly Albertans might be placed in a lower level of care than they need as a money-saving strategy. There is some evidence for this suspicion – largely based upon bed numbers.

There are European studies that suggest that approximately 4% of people over 65 need the 24-hour-a day medical care that is only provided in Alberta in the Long Term Care facilities – Nursing Homes and Auxiliary Hospitals.

Alberta’s over 65 population is expected to grow very rapidly over the next 20 years. By 2020 there will be 627,700 Albertans in that age category – suggesting a need for over 25,000 LTC beds. We currently have 14,370 and have no plans on the books to build any more. All of the seniors beds currently being built are in the very much less expensive (to AHS) Designated Supportive Living spaces, which also provide a much lower level of care.

In a similar way, we are also facing a shortage of even those DSL beds. AHS has itself had a target of 120 beds per 100,000 Albertans over 75 years of age. Yet by 2018 there will only be 25, 757 combined DSL and LTC beds for a population of 229,800 Albertans over 75 - who should have 27,576 beds. Where will these 1,819 seniors in need of care be staying?

The answer is likely to be in their own homes, provided for by some level of home care. Home care is even less expensive for AHS than the DSL level of care.

If there are no beds or spaces available at the care level a senior requires, they will have to put up with a lower level of care than they need.