SUMMARY
Thousands of Albertans live in long-term care facilities. They deserve to be as healthy and happy as possible in a setting that maintains their dignity and their connections with others. Achieving that goal is a complex and highly sensitive task, perhaps the most sensitive in the provincial healthcare system.
These persons are best served by a system designed around them, not around buildings or administrative bodies. It should be a system of patient centred care dedicated to meeting each individual’s needs.
The province has 170 long-term care facilities containing more than 14,000 beds. They serve a constantly changing population with constantly changing needs. For many individuals, long-term care is actually transitional, end-of-life care. The numbers, the sensitivity of the task, and the many differences between individuals and the places where they are cared for combine to produce risk.
We reported in 2005 that the Alberta government and its health agencies lacked much of the information they needed to manage the risk.1 Nor were all the right tools available to ensure that long-term care operated efficiently and with the best regard for people’s health and dignity.
The Department of Health and Alberta Health Services have made strong improvements since then. They now have significantly more information on service quality and financial performance. This assists their planning for and management of Alberta’s long-term care system.
AHS and the department have also established patient care based funding. This is an important mechanism that directs funding toward individuals’ needs. It enables AHS to determine care needs and monitor outcomes for each resident, and it allows AHS to assess the performance of each facility. AHS recently reviewed its patient care based funding model and published its results in the fall of 2013. The review concluded the model has a solid foundation,3 although some improvement is needed.
What we examined
Our overarching objective was to conclude whether improvements made by the department and AHS resulted in a system that provides adequate provincial oversight for health service delivery in long-term care facilities.
This follow-up audit focused on service delivery in long-term care facilities, and did not include home care or supportive living. Over the years, we followed up on individual recommendations. However, this was the first time our follow up looked at all outstanding recommendations, and did so in the context of the big picture of provincial long-term care system.
What we found
The department and AHS have gathered strong momentum and are moving in the right direction. They have:
- considerably improved the availability and consistency of facility cost data and resident care outcomes data
- introduced key provincial performance monitoring processes
- implemented a care funding model that takes Alberta a step closer to having a patient-centred model of long-term care service delivery
Why this is important to Albertans
The importance of long-term care goes beyond the $910 million that the province has spent on it last year alone. If long-term care delivery isn’t done right, it can have significant negative impact on the cost and capacity of the rest of the healthcare system. More importantly, without good systems to support long-term care delivery, some Albertans may not have an opportunity to spend their final years in the best possible health.
We examined whether all these changes now provide for adequate oversight of long-term care in Alberta. We found strong movement in the right direction.
A further step is necessary. The improvements of the last decade have tended to concentrate in the areas of process and administration.