As the north wrestles with a rapidly aging population, Northern Health has developed a five-year seniors' health action plan to address the growing needs of those over 65.
In the next 15 years, that group will see a 78 per cent jump in their numbers. Compare that to a total population increase of seven per cent in the same time frame.
To address that influx, Northern Health has broken down its strategy into three areas of focus: supporting more age-friendly communities, providing integrated primary and community care for early recognition of frail seniors, and taking a rehabilitative approach to hospital and residential care.
"It's about living in the community and being healthy in the community and what we can do in the primary care environment to support people earlier and ensure we have the proper community supports in place," said health authority CEO Cathy Ulrich in an interview with area reporters after its board meeting Wednesday.
That's because the vast majority of seniors prefer to remain independent as long as possible.
"The principal aim is to assist seniors to live well, retain their independence, and where possible, to avoid or minimize the duration of hospital stays," the report said.
The board plans to achieve these goals without a stated increase in residential care beds, despite projecting an increase in demand for them, and "within the existing funding envelope" - no dollar amount is connected to the plan.
"A number of these programs can be done within existing resources. It's about changing the way that we work," Ulrich said.
"I am not as confident of that," said Isobel Mackenzie, the B.C. seniors' advocate.
"I am not saying it absolutely can't be done but I am cautiously optimistic that they could do that."
Mackenzie's initial response to the outline was positive.
"It's actually paralleling a lot of what I am saying," said Mackenzie by phone Thursday from a Terrace parking lot on her way to Smithers for work. "Seeing how these objectives are achieved and measuring how effectively we've achieved them, that's the harder part.
"It's very encouraging to see recognition of things like transportation and housing as key elements of determining the health of seniors," said Mackenzie, in reference to the first focus: community.
Two thirds of people over the age of 85 live independently without any standardized public health support, she said.
"When you think of it that way, you realize there's a lot of things supporting healthy aging that's not directly in the healthcare system," she said, and while a health authority can't control those factors, it can lobby the provincial government "about the costs that are coming into the healthcare system that could be diverted if we had less costly support for seniors before they come into the system."
Residential care
In two years, based on its current service realty, Northern Health projected it would need 1,441 beds to keep up with demand for residential care. It has 1,092 right now.
That comes as no surprise to Mackenzie.
"When we look at the wait times for residential care beds in northern health, they are astronomically greater than the rest of B.C.," said Mackenzie, giving data to show how far off it is from the provincial rates: northerners, on average, wait about 120 days for residential care, she said.
The average province-wide is 36.
In the north, 27 per cent are admitted within 30 days of assessment compared to 67 per cent for the rest of the province.
Prince George has, by far, the longest wait times, followed by Dawson Creek.
"It is a gap so I think (we need to be) looking at what's creating that extra waiting time," Mackenzie said.
"Part of it is that there may be some beds occupied by people who could live in community with either with home support or assisted living."
Northern Health's action plan doesn't commit to creating any more beds - the goal of the plan is to provide better care elsewhere so that those projections can decrease.
Mackenzie said that isn't necessarily a bad idea.
"There are numbers that say in Northern Health there's up to 25 per cent in residential care who could under certain circumstances live in assisted living or in the community with enhanced supports."
One solution Mackenzie's office is pushing requires legislative change. It deals with how the province describes assisted living. A senior can only get help with two of six categories of care that fall under "prescribed services."
The key issue is whether the senior can direct their care, Mackenzie argued, and not whether the nature of care fits more than two of the six "prescribed" categories.
"We've already said it's OK to need that service," she said. "I think there is a dividing line around ability to direct.
"Even if you find 10 per cent in Northern Health, shifting them from residential care to assisted is going to free up your beds right there."
Home support
Northern Health's plan said it hopes to standardize home support, but provided little detail.
"There will be changes coming, I just don't think we're ready yet to predict what those might be, because we will use an engagement process with staff and the unions around how we do that work," Ulrich said.
Northern Health has adult daycare problems, respite beds in its residential facilities for families that need short term care for elder loved ones and said it plans on training staff to better understand geriatrics and gerontology.
Training people to execute the plan isn't the problem; rather it's finding people in the first place.
Mackenzie said the north faces unique workforce challenges when it comes to home care workers. Whereas in the Lower Mainland a $20- to $22-an-hour job that requires a nine-month certificate might be considered, that's not the case in a resource-rich economy.
"There is this unique phenomenon up here in these resource towns where they're pulling out of the very workforce you'd be tapping into - (the workforce) is getting pulled out to these lower-skilled but high-paying jobs."
Northern Health launched the plan after consultations with families, seniors, advocacy groups and providers in 2013.
But Lorna Dittmar, chair of the Prince George Council of Seniors advocacy group, said she wasn't satisfied with the discussion around the home support system.
"(It's) really broken because what happens is they keep bringing new people in the time," said Dittmar, who hadn't yet read the final plan.
"There was no consistency."
Dittmar said she'd like to see more training - and a job description for home care workers "to be more person-centred."
"Sometimes somebody wants you to have a cup of tea or a little chat - that keeps seniors healthier than anything else. Really and truly. Getting your bum washed and getting yourself dressed is very nice but it's nice to have somebody to have a chat with you," she said.
"That doesn't happen. They're in and out."
Mackenzie echoed those sentiments from conversations she's had.
"I think there's frustration amongst many seniors that the home support program delivers what they don't need but doesn't deliver what they do need," she said. "We've become very prescriptive in a care plan for home support."
Mackenzie, meanwhile, said she was encouraged that Northern Health has started to recognize support for "burned-out caregivers" and its use of the term "flexible" to describe its new approach to support.
For Dittmar, it's a simple solution:
"Look to families first and see what you can do to help them look after a parent and humanize your services because that's more critical than anything. It truly is."
