Roy Cammack has seen, and smelled, some of the horrid conditions B.C. seniors live in.
"I've been in some places that are like kennels," said Cammack, a notary public and certified professional consultant on aging (CPCA). "Really awful, with the smell of urine that can make your eyes water, and you go in and find there are poor people living there."
Although the number and quality of seniors residences throughout the province has improved, those advancements have created a labyrinth of options and regulatory hurdles that seniors and their families must blindly navigate to get the care they need.
Cammack's staff has logged hundreds of hours working to ensure that just one client gets the care he needs.
That client, a 77-year-old war veteran who gave power of attorney to Cammack, is fortunate to be able to access that type of support. Many seniors can't.
"Most people are looking for assistance, and it's very challenging because there are many levels of getting evaluated by the health authority … there really isn't a single 'hand-holder.'"
Seniors care has become big business in B.C. as children born after the First and Second world wars enter retirement, but a joint Business in Vancouver-CBC investigation has revealed that both the public and private sectors have failed to deliver the care that B.C.'s elderly population needs.
The number of seniors in the province is expected to double to 1.46 million by 2036.
The need for care will only grow.
BC Ombudsperson Kim Carter has found 176 different ways the province could improve seniors care in B.C., but what is the government's plan?
Health Minister Mike de Jong told BIV he's taken the ombudsperson's recommendations to heart and plans to have a B.C. seniors care advocate in place by the end of this year or early next.
"When a 30-year-old graduate from law school would find it challenging to navigate through the myriad of statutes and regulations that impact upon the world seniors live in, we have to simplify that," said de Jong.
A fractured system
In her most recent report on seniors care, a 448-page tome that's part of the largest investigation the ombudsperson's office has ever undertaken, Carter revealed a complex maze of regulations for different levels of seniors care in B.C.
For example, 71% of residential care facilities are regulated under the Community Care and Assisted Living Act; the Hospital Act governs the other 29%.
"This means that depending on what legislative framework you fall under, everything from inspections to standards to costs to benefits may be different," said Carter, "and there doesn't appear to be a good solid policy reason for this."
She also found:
•an inadequate support system for seniors and their families;
•a lack of standard reporting across health authorities, especially on abuse and neglect in facilities;
•inadequate oversight of assisted living operators and facilities; and
•a lack of regulation around basic care necessities, such as a minimum standard for the number of weekly baths that seniors in residential care receive.
Carter also recommended a comprehensive information hub be created to help families and seniors navigate through health care options.
The ombudsperson hoped to have most of her recommendations in place within 18 to 24 months.
De Jong told BIV that was a "fair" timeframe. But apart from simplifying regulations, many questions remain as to how the government plans to address the growing need for care.
Private care plans
In the past, the private sector has stepped in to build care facilities to house seniors while at the same time turning a profit.
But many private care providers aren't keen to build assisted and residential care facilities, which provide higher levels of care but are far more regulated than independent living buildings.
"You're stuck with regulation, and you're competing with subsidized housing," explained Peter Gaskill, president of Vancouver-based Pacific Arbour Retirement Communities. "It's not a free market."
Even when private operators can make the numbers work, they have to charge so much that most seniors simply can't afford to move into private assisted living and residential care buildings.
"The biggest demand is on the residential care, complex care side … but the problem is it's not a well-developed private pay market," said Azim Jamal, CEO of Retirement Concepts, one of the province's largest seniors care companies. "It's very shallow because that kind of housing costs well north of $200 per day for the occupant."
That, in turn, has caused many private companies to build pricey independent living buildings that provide resort-style living with little or no health-care services.
The problem, as revealed last week in BIV ("Home economics failing seniors" – issue 1176; May 8-14), is that so many companies have rushed to build independent living suites that there's now a gross oversupply and high vacancy rates in many buildings.
Those vacancy rates threaten the viability of many seniors housing businesses, but care providers don't want to admit the situation is that bad.
BIV placed several phone calls to independent living buildings in B.C. inquiring about their occupancy rates – a key indicator of the health of the business.
Only one building would divulge its occupancy rate.
"People will lie to you [about their occupancy rate]," said Karen Holmgren, executive director of Cedarbrooke Chateau in Mission, which slipped into receivership last year with a 54% occupancy rate.
"For the most part, everybody in the industry is hurting," she said, adding that Cedarbrooke's occupancy rate has since climbed to 72%.
On top of that, the private, profit-making side of the seniors housing business continues to suffer from a poor reputation.
The stigma of private care
A scandal erupted in 2008 when it was revealed that Victoria's Beacon Hill Villa, owned by Retirement Concepts, halted new admissions following complaints of abuse and neglect.
Jamal, however, insisted the level of care provided by his company is better than publicly funded seniors facilities.
"Everything we do is better than government buildings," Jamal said. "Anyone who wants to come in and compare our buildings to the government, I would love it … come and compare me."
But private operators still struggle with the stigma that their care is second-class.
Alice Edge, BC Health Coalition co-chairwoman and Council of Senior Citizen Organizations of BC past-president, said the lack of regulatory standards has made seniors and their families vulnerable to exploitation by private seniors care operators who charge extra for the same level of service available at publicly run facilities.
"The mantra that more privatization will ease the burden on the system is not so, because it does cost more money for seniors," said Edge. "There are people out there who are absolutely struggling and they will go without care, without medication, without a nutritious diet because they don't have the ability to find out what kind of services are available to them."
Even the health minister said some "nefarious" developers have taken advantage of seniors.
"I have seen too many examples of situations where seniors are suffering because of – how do I put this – private-sector abuse," de Jong said.
Katrine Conroy, the NDP critic for seniors' health care, isn't convinced the private sector should even be involved in seniors care.
"I question whether the private sector is the best place for that because of the issues that happen," Conroy said. "You look at a non-profit facility, the money goes back into that facility; it doesn't go back into the pockets of shareholders, owners.
"I agree that when people have a business they need to make a living off of it, but you wonder at what cost?"
Even Gaskill, whose Pacific Arbour invests deeply in the communities it provides housing in and remains focused on delivering top-notch housing, questioned how focused some companies are on the care they provide.
Before Pacific Arbour, Gaskill was one of the founding executives at Chartwell Seniors Housing REIT (TSX:CSH.UN), a large, publicly traded seniors care provider.
"We cared about the old people … but I think we spent a lot more time sitting around talking about how we're going to make this next deal fly and how much money can we make from this deal," said Gaskill.
Chartwell closed a $930 million deal earlier this month with U.S.-based Health Care REIT to buy more than 8,000 Canadian seniors housing suites.
Despite changing demographics and the incoming demand for seniors care in B.C., a shift in government policy could sound the death knell for new seniors care homes.
De Jong said the government is interested in working to improve home care options, which would allow seniors to stay in their homes longer and reduce the need for assisted living facilities.
"I have yet to find a senior or senior couple who wouldn't prefer to stay in their own home if they could," said de Jong.
The NDP's Conroy agreed.
"I think you can provide more care because it's more cost effective," said Conroy. "I think the seniors are happier, healthier and have a quality of life that they should have. It works."
But Jamal said that option would likely be more costly as aging seniors require more and more hours of care per day.
He added that the government simply can't keep up with the demographics.
"That's the billion-dollar question," said Jamal. "It's something the public expects the government to pay for, [but] government can't afford to … what's going to happen?"
He believes the government should change its regulations around private accommodation and allow residential care providers to build semi-private suites that would reduce the per-suite cost and make them more affordable for seniors.
"If they don't change that we're going to be in a really challenged scenario."
De Jong suggested that housing facilities in urban areas be built taller to allow for more density.
He added that the Liberal government has taken steps to exempt some seniors from the need to pay property taxes, making it easier for them to stay in their homes.
Edge believes the government should build more residential care facilities to relieve growing pressure on the system.
Although the province claims it has added thousands of new beds in recent years, it has effectively replaced beds eliminated a decade ago.
Edge said those closures have increased health-care costs in hospitals.
And what about all the vacant independent living suites? Could they be converted into assisted living or residential care beds to better meet the needs of seniors?
Not so, said experts, who point out that assisted living and residential care buildings have completely different design requirements.
"Residential care is a completely different animal," said Marc Kinna, COO of Baptist Housing. "It's very, very difficult to retrofit a building to residential care."
Although both sides of government and the private and non-profit sectors claim to have solutions to the seniors housing issue, there doesn't yet appear to be a clear plan to resolve the situation.
De Jong said his government has been addressing the issue for years, pointing out that wait times for residential care beds have been dramatically reduced.
But the ombudsperson's report noted that the average time seniors have had to wait to be placed in subsidized residential care has been rising in the past three years.
The provincial average was 67 days in 2011, but some patients at Interior Health and Vancouver Island Health have had to wait nearly three years before getting placed.
Conroy argued that the ombudsperson's report is evidence the government hasn't done enough.
"Ten years and we still have 176 recommendations," she said. "We still have seniors struggling to get services."
Unless private care beds suddenly reduce their rates, Edge said it's unlikely the lion's share of B.C. seniors will be able to afford that type of care.
"I've heard from administrators of private facilities who have said they had couples who used up all their financial resources and are technically having to be evicted," Edge said.
"If we're going to base the care we provide based on a senior's ability to pay, we are hooped as a nation."
Although few people agree on what needs to be done to address the seniors housing crisis in B.C., everyone agrees that something needs to change – and soon.
"We have to act now so that the seniors who need the help now can get it," said Conroy. "We don't have time to wait. We're talking about people who are in their 90s who need support now. Can they wait 10 years? Probably not." •
Has the government created enough beds?
669the number of new residential care beds the province created between 2002 and 2010 (excluding Interior Health Authority, which didn't provide numbers for 2002-05)
43%the increase in the number of B.C. seniors over the age of 80 (202,912) between 2002 and 2012
Big money in seniors housing
$931Mthe value of Chartwell Seniors Housing REIT's (TSX:CSH.UN) May 4 deal with U.S.-based Health Care REIT to buy more than 8,000 seniors housing suites in Canada
$120Mthe value of Leisureworld Senior Care Corp.'s (TSX:LW) deal last month to buy three Lower Mainland seniors care homes
Health authority funding ($) for residential care, 2002-03 to 2010-11 (in millions)