1,185
edits
Changes
no edit summary
Licensed residential care facilities have three essential features that set them apart from other supportive living environments, such as assisted living. Each is an important consideration when applying and interpreting the law in this area.
:a) A person cannot be admitted to a subsidized residential care facility or extended care facility without having specific care needs. The person must have a level of care need that cannot be appropriately met in the community. ([[Chapter Three Legal Issues in Residential Care References|1]])Today, that means the person requires what is referred to in the British Columbia health system as “complex care”.
:b) All licensed residential care facilities (including private pay hospitals and extended care facilities) have a responsibility for monitoring on-going care needs, identifying significant changes and meeting the current and changing care needs of the residents.
To be eligible for residential care, the person must:
* Have a health care need that requires 24-hour nursing and personal care ([[Chapter Three Legal Issues in Residential Care References|2]])
* Be a citizen of Canada or have permanent resident status *
* Be 19 years of age or older
'''In order to be eligible for residential care at a subsidized rate, the person must also agree to the release of financial information to the health authority in order to determine financial eligibility. If they do not agree to that financial disclosure, or they are not capable of consenting, they are assessed at the highest rate.'''
Some health authorities state in their public information that the individual must also exhaust all other home care community options. ([[Chapter Three Legal Issues in Residential Care References|3]])Nothing in the Ministry of Health eligibility criteria requires this. The primary issue for most residential care admissions is that the person meets the high threshold of needing 24 hour care. For subsidized residential care, the person must also meet the financial eligibility requirements for the public subsidy.
The most common reason for people to need residential care these days is a blend of physical health and cognitive factors for the prospective resident, as well as environmental factors such as risky living circumstances and caregiver burnout. The prospective residential care facility applicant is often a person with multiple and complicated chronic health conditions, with or without dementia that has progressed to the moderate to advanced stages.
* their conditions are clinically complex (meaning they have multiple disabilities or complex medical conditions that require professional nursing care, monitoring or specialized skilled care);
* they are moderately to severely cognitively impaired; or
* they have severe behavioural problems on a continuous basis.([[Chapter Three Legal Issues in Residential Care References|4]])
To determine the prospective resident’s health care needs in the community the Ministry of Health uses a standardized tool called the Resident Assessment Instrument (or RAI). That assessment tool helps to identify needs and degree of urgency for placement. A specific version of the standardized assessment tool Resident Assessment Instrument Minimum Data Set (RAI MDS 2.0) is used in residential care facilities for the assessment and care planning.
For any type of health authority decision made about prospective or current residents, an exception is always possible. It may be rare, but it is possible.
:''“Health authorities may authorize exceptions to policy in client specific circumstances, based on assessed need. Health authorities must maintain a record of waivers and any exceptions to provincial policy and report these, with the relevant background information such as rationale and timeframe for the exception, to the ministry.”''([[Chapter Three Legal Issues in Residential Care References|5]])
==Moving to Residential Care==
[[File:Residential care.jpg | right | frame | link=| <span style="font-size:60%;">Copyright www.shutterstock.com</span>]]
A prospective resident (or applicant) may come from a variety of places while waiting to move to a residential care facility. This includes living at home, in an assisted living residence, in a hospital, an alternate level of care (transition care facility) ([[Chapter Three Legal Issues in Residential Care References|6]]) , in a non-subsidized residential care bed, or in a subsidized residential care bed that is not in their preferred facility or community.([[Chapter Three Legal Issues in Residential Care References|7]])
Placement in residential care is based on a system of “priority access”. According to Ministry of Health policy, clients on the waiting list are prioritized based on the urgency of their care needs. That priority is established by the assessment process administered by health authorities and is commonly referred to as the “first available bed” or “first appropriate bed” process. (The Ministry of Health now prefers the term “first appropriate bed.”) ([[Chapter Three Legal Issues in Residential Care References|8]]) In recent years, the health authorities in British Columbia have given priority for residential care placement to people transferring from hospital over those at home or in another facility. ([[Chapter Three Legal Issues in Residential Care References|9]]) The health authorities, not the private care facility operators, manage the waitlists for all funded beds in the residential care facilities.
'''Important Note: If the resident or substitute decision maker decides to pay privately, the resident will be placed further down the waitlist for a publicly funded bed because the person’s situation is no longer considered as urgent by the health authority.'''
===Transfers===
People who are not able to move directly into their preferred facility can put their names on a waiting list to be transferred to their facility of choice. The health authorities maintain transfer waiting lists in addition to the lists of people waiting for initial placement. ([[Chapter Three Legal Issues in Residential Care References|10]])In practice, transfers from other residential care facilities are becoming far less common, in part because of the complex care needs. Today the average length of residence for people from the time of their admittance to the care facility to the end of life is only six to eighteen months. Families find that the waiting time to transfer commonly exceeds that, ([[Chapter Three Legal Issues in Residential Care References|11]])and one health authority states it does not permit transfers within the first two months.([[Chapter Three Legal Issues in Residential Care References|12]])
==Costs==
===Cost of a (subsidized) residential care facility===
The cost of publicly funded residential care services is shared between the Ministry of Health and the person receiving services. The Continuing Care Fees Regulation sets out the fees payable for subsidized residential care, identifying a maximum and minimum rate. This is referred to as a “client rate”. ([[Chapter Three Legal Issues in Residential Care References|13]])
The Ministry of Health and the health authorities pay for the cost of care in publicly funded residential care services. The resident pays the “accommodation costs” in what is sometimes referred by the Ministry as a “co-payment”.
Accommodation in some older residential care facilities may consist of 3 or more beds to a room. Most new residential care facilities have semi-private rooms (2 beds in a room), or a private room has a single bed in a room. Multi bed rooms are considered “basic accommodation,” with private rooms commanding a higher rate.
The Resident Bill of Rights for Residential Care Facilities, private hospitals, and extended care units in hospitals identify a responsibility on the Operator to “advise persons who are being admitted of all fees, charges, and policies”, and “provide an avenue to file concerns or complaints.” ([[Chapter Three Legal Issues in Residential Care References|14]]) This requirement is reinforced by s. 48 (1) (a) of the Residential Care Regulations.([[Chapter Three Legal Issues in Residential Care References|15]])
People in subsidized residential care will pay up to 80 per cent of their after-tax income to cover the cost of housing and hospitality services including meals, routine laundry and housekeeping (“the accommodation costs”), subject to a minimum and maximum monthly rate. The actual amount paid must leave the individual with at least $325 (effective February 1, 2012) remaining from their income each month. For many British Columbia residents, this remaining amount often may be all that is available to cover all their “optional costs” (for examples, telephone, own wheelchair, “preferred” incontinence or grooming supplies, recreational activities). There is considerable variation among Operators in what is included in the accommodation cost, and what can be charged extra, and how much can be charged.([[Chapter Three Legal Issues in Residential Care References|16]])
The resident “co-payment” ranges from $958.90 per month to $3,059.00 per month. The minimum rate is adjusted annually based on changes to the Old Age Security/Guaranteed Income Supplement rate as of July 1 of the previous year. The maximum client rate is adjusted annually based on changes to the Consumer Price Index.
===Applying for subsidized residential care.===
The cost of subsidized residential care is typically borne by and paid by the individual resident. It is based on income not assets. To apply for subsidized residential care, residents first must consent to disclosure of the income tax information they provided to Revenue Canada. This consent to disclose is required annually. If there is a spouse, the spouse must consent as well. If either person does not consent or cannot consent, the resident will be assessed at the highest residential rate.([[Chapter Three Legal Issues in Residential Care References|17]])
This default position can cause considerable hardship for the individual and a spouse, partner, or family. According to the Home and Community Care policy, a spouse or other person can only give consent to provide the income tax and other financial information for the purposes of determining financial eligibility if they can show they have legal authority to do so (that is through a power of attorney, section 7 Representation Agreement, or as a Committee of the Estate). ([[Chapter Three Legal Issues in Residential Care References|18]]) Documentation of that legal authority is required. After calculations, the health authority informs the Operator of the appropriate client rate and is not permitted to share any income information. ([[Chapter Three Legal Issues in Residential Care References|19]])
===Hardship Waiver (“Temporary Rate Reductions”)===
As previously noted, the statutory authority for client rates is covered by the Continuing Care Fees Regulation. The person may have low income, or may have higher income but his or her spouse is still living at home. If paying the full client rate would cause serious financial hardship, the resident or his or her substitute may apply for a temporary reduction of the rate.
This is referred to as a “hardship waiver” in the regulations. The Ministry of Health and health authorities use the term “temporary rate reductions”. These waivers or reductions are also available for other costs such as wheelchair fees. Residents and families may not be unaware these waivers exist, how to apply, or the need to re-apply annually. For others, the fact these are referred are called hardship waivers is itself embarrassing and stigmatizing, ([[Chapter Three Legal Issues in Residential Care References|20]]) especially given the fact that many older people and their families do not want to be thought of as “charity cases”.
===Cost of private pay (unsubsidized) residential care facility=== ([[Chapter Three Legal Issues in Residential Care References|21]])
In a private hospital or any unsubsidized care bed in a private pay facility, residential care services are accessed by the individual directly from the Operator. The facility staff conducts an assessment to decide whether or not the facility can provide the services that are being requested. In private pay facilities, the services and accommodation received are part of a private business arrangement between the Operator and the person in care and are defined through the contract.
All aspects of service provision are agreed to by the individual and the Operator in the contract. Government does not provide any financial assistance to individuals or Operators for the service. ([[Chapter Three Legal Issues in Residential Care References|22]])
{{REVIEWED | reviewer = BC Centre for Elder Advocacy and Support, June 2014}}
{{Legal Issues in Residential Care: An Advocate's Manual Navbox}}