'Replicate the heck out of it': MLA Gotfried argues there's an urgent need to innovate in elder care
'Many opportunities for innovation,' he says after overseeing expert review of continuing care system
Ask MLA Richard Gotfried about improving care for the aging and frail in Alberta, and you'll get a stream of ideas ranging from eight-bed neighbourhood facilities to a home-care network run like a hub in each neighbourhood.
The United Conservative representative for Calgary-Fish Creek oversaw an expert review of Alberta's continuing care system last year. Those recommendations could change the way frail and elderly Albertans are cared for, and significantly impact the lives of the children and spouses who tend to these loved ones when they age at home.
Alberta Health expects to release an action plan and legislation this spring.
Gotfried is no longer formally involved, but CBC News connected with him recently to understand the thinking that went into the recommendations and his hopes for change.
The following question-and-answer format includes excerpts from that interview, which have been edited for length and clarity. Watch for our coverage of family caregiving in Alberta throughout February at cbc.ca/familycare.
Question: MLA Gotfried, I'd like to look specifically at the recommendation to shift health care back into the community. Why do you think that's necessary?
Answer: Well, there's a few issues. No. 1, we hear from individuals and families that they really do want to live in their homes. I always caution people, that doesn't necessarily mean the house — the 1935 raised bungalow that they've been in for the last 40 years. But as much as they can, to age in community.
Also, quite frankly, look at the demographic challenge that we're facing. It's on two sides. We're facing people moving out of the workforce, and we're also now facing the baby boomers, moving into active use of the health-care system. The demographic bubble will be very, very tough for us to keep up with.
How would we ever build what's needed if we're going to house all of these people in a congregate living facility? The only way we can achieve it is to shift some funding from facility-based to home care.
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Q: What could that look like in practice?
A: A lot of the conversation on that is on the campus-of-care model — how we can use hubs of care which may exist already through some of the seniors' facilities.
Talking with some of the industry leaders, both in the not-for-profit sector and the private sector, the idea is for them to have economies of scale. They may have a home-care hub within their facility for the residents. But why wouldn't you use that hub to service the people within a geographical catchment area?
We hear stories of home-care workers riding buses halfway across the city. What if the hub was three blocks away from your home? And if you're still mobile and active, you drive to that place. If you're not, that service comes to you from three or six blocks away.
I went through this with my father in the early '90s. I'm going through it with my in-laws. I've seen all the progression from private residences to congregate living and long-term care. But what are the options in between?
That's a question we get a lot these days. We're hearing from people: What about eight couples in a residential setting? Maybe a duplex lot and purpose-built facilities?
I was in the building industry, so I'm out there challenging my former peers to say, "Who's going to do this? Who's going to take this idea forward, work with government to pilot it?" And if we can prove it, replicate the heck out of it. There's so many opportunities for innovation.
Q: Talking with researchers and family members, many fear the move could download more work onto family members, leading to burnout and some people falling through the cracks. What will keep that from happening?
A: We've been talking with Caregivers Alberta, which represents primarily the family caregivers. They're doing a lot of advocacy because, as you know, what happens is you download and you create burnout, stress, without any having any respite. That's not a solution; that is a stopgap.
We hear many instances of people wanting to move back to their homes, but they don't have the support. So they end up in long-term care, when we probably could keep them out with the proper transitions. So your concerns are correct.
The staffing and training are huge issues as well because the seniors care and home-care industry is not where it should be in terms of remuneration.
There are many private care groups that are now supplementing what's coming from from the public service, which is fine because that means people who do have the financial resources can do that. But we need to make sure there's a minimum — a very, very high minimum standard — that supports people of all incomes.
Q: What do you expect to happen next on this file?
A: What you'll see is the updating of the legislation. There was the original push to have that tabled in the legislature last fall. But with the pandemic, many pause buttons have been hit. My understanding is that there's going to be a significant effort to get that legislation to us in the winter/spring session coming up.
That will be a big step forward because you have to empower that evolution. It will empower more flexibility into the system. It will empower the moving of some of the funding from the facility-based system into a home-care system. It will allow us to fund different types of models to achieve that.
Then the other one is convincing the cabinet and Treasury Board.
Q: If I follow the money, it seems like a key challenge will be convincing cabinet to reinvest the dollars. Is that right?
A: You know, when you're moving money into something, it's rarely viewed as a zero sum game. But the argument here is if we don't move that money now, the capital demands will increase down the road. It's all taxpayer dollars at the end of the day.
We need to decide, particularly post-pandemic, is the funding we're putting toward seniors' care adequate? Or has it been chronically underfunded? Is this why we've have had to pivot to capital programs?
Because if you were funding at the appropriate level long term, that should recognize the servicing of a debt for not-for-profits, or a reasonable, fair but modest return on investment for a private investor. If we want to attract that capital and not have the cost completely on the taxpayers' shoulders.
How do you find that long-term balance without having to turn around it every five years and go: "Oh my gosh, we've run into a shortage of beds again!" Then we have to have a new capital program, which lets you cut ribbons. But you know what? The fact is, if you're doing that every five years, there might be something wrong with the way you're funding a sector.
The CBC team in Alberta is focusing this month on family caregivers — the husbands, wives, children and others who take on care of loved ones. Follow the news and First Person stories at cbc.ca/familycare.