How Ontario can improve care for dementia patients

Ontario’s upcoming 2015 budget will make some important changes to the system that care for people living with dementia and their families in residential and respite homes.

The fiscal and economic model of the province has changed greatly since the last budget with the transformation of the province’s economy from the manufacturing and post-war industries into green technology and exporting food and beverages. Both of these developments have affected the way in which resources are shared between the government and the residential care system.

I have experience of providing residential care for individuals with dementia in my native Ontario. I saw the promises and pitfalls of every attempt to reform the province’s long-term care system. The last big attempt in 2002 created huge problems for the government.

Today, as a member of the Community Living Ontario board of directors, I am cautiously optimistic that the new budget proposal will lead to a better home-based service delivery system for people with dementia. However, these care delivery reforms will not go far enough. I am very concerned about the ongoing lack of planning and adequate financing for needed long-term care capacity in Ontario.

That was the main message we heard from patients, caregivers and families across the province.

With our new election budget, the government has made some important reforms to the care system. The first is to eliminate the various levels of administration in the province. What this means is that care will be delivered based on its needs. This is a more efficient form of delivery and opens doors to new kinds of collaborations to achieve the best results.

Secondly, the new budget plan calls for further reform of the fee structure for skilled care homes. The government has committed itself to implementing a patient-focused fee structure for skilled nursing beds, and has made good on its promise of “letting people’s needs be a guiding force in fee determination.”

While we welcome these steps forward, we remain concerned about a number of important issues.

The government has provided an important measure to manage the overcapacity in short-term residential care facilities. The government has said that, as more people are able to become discharged from long-term care facilities and go to short-term care facilities, the province will invest an additional $5 million each year to support a 2,000-bed capacity for short-term housing.

However, we remain concerned about a fundamental lack of long-term care capacity that exists in Ontario.

The government has begun moving some patients from long-term care facilities into shorter-term residential care facilities and respite care.

We will encourage the government to move forward with the recommendations of the Ontario Long-Term Care Homes Association’s national partnership on changing the acute care system. The Canadian Institute for Health Information’s Moving Ontarians program has found that a significant amount of money is being spent on residential care homes to provide respite care. The province must take a fundamental look at how these beds are financed and use a means other than long-term care to pay for these new cases of residential care for people who need respite and who need continued health care.

At Community Living Ontario, we need to make sure our new finance minister understands the importance of involving all levels of government and stakeholders from local to national to provincial levels in developing adequate long-term care capacity across the province.

Media coverage has focused heavily on the treatment of end-of-life care in residential care homes. There is nothing wrong with this, and it is a powerful illustration of the importance of healthcare decisions being made at the end of life.

However, this focus overlooks the basic question: How do we improve quality of life and provide the right care to those in residential care, and are we creating new services or making services more expensive?

We need a means of sharing the cost of care in Ontario and giving greater equity to those who receive care, whether it is at home, a residential care facility or an institutional facility. We also need a way to share costs of caring for people living with dementia in a home, home-based residential care or respite care service.

We need a new focus on long-term care planning. It is our responsibility to ensure that, while providing all of the necessary resources, we are balancing needs and budgets for today and for decades to come.

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