Saskatchewan’s ‘silver wave’ is crushing its nursing homes, whose operators say funding from government is unequally distributed and insufficient to meet the needs of the province’s seniors.
Operators of long-term care homes say the dollars they get from government haven’t kept pace with the growing medical needs of their residents, which are becoming more complex as people live longer lives.
“If you walked through a facility 30 years ago and you walk through the facility today, you wouldn’t recognize it. It’s vastly different,” Emmanuel Care President and CEO Scott Irwin said. “Funding has not kept pace with that shift.”
There are 8,824 long-term care beds in Saskatchewan serving a range of people with medical needs that can’t be met at home, in personal care homes or with community services. The vast majority are seniors.
Statistics Canada estimated 15.5 per cent of Saskatchewan residents were 65 or older in 2016 — below the national average, but more than a 10 per cent increase from just five years before in 2011.
In the 1990s, Saskatchewan’s then-NDP government began pushing to expand home care services, so seniors could comfortably and safely live at home for longer.
At the same time, policy changed so that only “heavy care” patients — those who require “regular and continuous medical attention” — would be insured at those facilities.
That means, increasingly, long-term care is no longer as long-term.
“When I first went into long-term care in 1981, we had residents who had been there for 10, 15 years,” said Karen Knelsen, chair of the board of directors for Jubilee Residences. “That does not happen now.”
Jubilee operates two long-term care facilities in Saskatoon, a city that recently accepted an award for being “age-friendly.”
But Knelsen said sufficient care is harder and harder to provide because of the growing medical needs of residents. She sees it partially as a symptom of overcrowding in the province’s acute care centres, like hospitals, even though the health authority says people with those needs are not typically placed in long-term care.
“People are much more frail when they come. They need much more care. They have needs we never used to meet in long-term care,” Knelsen said. “When I first went to long-term care, we would have never admitted anyone who was fed by a tube. Now that’s common.”
Knelsen said that’s often difficult for staff, who can form close relationships with residents. It isn’t uncommon for them to attend their funeral services, she said.
It’s also affecting the homes’ budgets.
Brian Martin, executive director at Mont St. Joseph Home in Prince Albert, said the implication is that residents have much greater acute care needs than they would have just a few decades ago, even if they’re still classified at the same level.
“The sad reality is nothing basic, nothing substantive has changed in how special care homes are resourced,” Martin said.
He and other operators said extra effort from staff is the reason the homes have managed to make do.
“One of the reasons I still work in a special care home is because of the daily miracles they provide,” said Martin, who has worked in the sector since 1976. “I’m so damn proud of them.”
Knelsen and Irwin echoed the thought.
“I don’t want to say it’s all doom and gloom,” Knelsen said. “One thing long-term care facilities have are staff that really want to be there. They just go above and beyond. If we didn’t have such dedicated staff, we’d be in much worse shape.”
Irwin, Knelsen and Martin all operate affiliated care homes, which work on contract from the Saskatchewan Health Authority and receive most of their funding from it. In the 2018-19 fiscal year, the province’s care homes collectively received $226,757,324 to operate 3,212 beds.
But that funding isn’t distributed equally. Before the SHA existed, principles and service agreements between homes and their respective health regions varied substantially in how many dollars each received for the same work. That’s still the case — both for affiliate homes, which make up around 30 per cent of all long-term care homes in the province, and those operated directly by the SHA.
Dalene Newton, the SHA executive director who oversees continuing care in the Saskatoon area, said a steering committee she co-chairs aims to create a universal agreement on principles and services to bring a “common approach” to funding. She described it as a chance for the new authority to leverage its position to standardize care in the province.
“With the opportunity of the SHA and what it brings to us provincially, there’s a need to have a consistent approach in that agreement,” Newton said.
Negotiations were slated to finish in November, but were not completed due to what SHA spokesperson Amanda Purcell called the “comprehensive nature” of the agreement. Newton now aims to have a draft by the end of March.
Knelsen and Irwin said they were encouraged by conversations with the authority thus far and felt they were being heard. But they also said the crisis is deeper than funding.
“This is a complex issue that requires a societal conversation about what this is worth to us,” Irwin said.
Photo by Matt Smith, Saskatoon StarPhoenix