What is (and isn’t) in Alberta's new Continuing Care Act

Everything seems to be changing for Alberta's healthcare system, and that includes the likes of long-term care via the Continuing Care Act. It passed royal assent in 2022 and came into force this year on April 1. The new legislation regulates the “full spectrum” of continuing care services in the province including “continuing care homes, supportive living accommodations, and home and community care.”The Act covers “authority and oversight for licensing, accommodations, and the delivery of publicly funded health care in the continuing care system. It includes requirements for licensing, compliance and enforcement actions, and appeals.”It also sweeps away the previous legislation covering these areas, repealing the Nursing Homes Act, the Supportive Living Accommodation Licensing Act, the Long Term Care Information Act, and the Resident and Family Councils Act.So, what do those working in healthcare think? The Alberta Union of Public Employees (AUPE) has gone through the act line by line. That, plus insights gathered in government consultation sessions, have led it to conclude that the Act won’t be good for the health of Albertans.“This legislation is purely to create a wild west for private, for-profit, and not-for-profit operators to be able to do as they wish. There's very little improvement in the quality of care that seniors will receive,” says Sandra Azocar, vice president of AUPE. “These changes are going to open up this area even further to privatization.”Other groups, including the United Nurses of Alberta (UNA), also object to the new Act. “So we are taking the care out of continuing care,” said president Heather Smith, in a statement.While the Alberta government says its new Act is a modernized piece of legislation that will “address changing needs and expectations,” some worry it lacks protections around fees, care ratios and home care. All this comes against a backdrop of worries about larger changes in how health services are managed in the province. Care costsGuidance related to fees are not present in the legislation, and have been relegated to regulations, which are not yet available. “There has been little oversight or public transparency as to how much these fees will be,” says Azocar. “They will eventually be written down, but it's not quite as protective. It allows companies to increase fees without having as much oversight by the public. The only ones that will know are the people that are actually living in these facilities.”If fees can soar unhampered by the law, Azocar says that makes offering continuing care more attractive to profit-minded companies.“This business model allows for incredible amount of profit to be made. But this is healthcare. People forget that senior care is healt care. And this shouldn't be a business.”Guaranteed careWhile previous Alberta legislation promised 1.9 hours of nursing and personal care a day, with 22% of it via a registered nurse or registered psychiatric nurse—an amount widely agreed upon as far too low, especially with Ontario’s 2020 rules offering at least four hours—this new Act does not mention care hours at all.“We are moving to zero hours of care. This is extremely dangerous,” said Smith.The Alberta Medical Association (AMA) made a submission when this new legislation was being drafted, saying the government should, “Recognize that there are more levels of care needed now than when there were when the Nursing Home Act and regulations were enacted.” The Nursing Home Act is from 2000.Azocar says the government told the AUPE that operators will get funded for 3.62 hours of care. “That doesn't mean that they actually provide those hours of care. They receive funding according to the amount of people and the complexity of the care. But if somebody doesn't go to work or is on leave, those people don't always get replaced. So the operators still get that money, but the residents don't get the care.”Many of the critics of the Act represent staff who will be impacted by such rules on the job. The UNA says it worries the government will allow more people with limited training to work in continuing care.Azocar, whose organization represents 98,000 members, 15% of whom work in this sector, says a lack of control impacts everyone. “What happens is staff are being asked to do more with less. And for patients, that means they get less care and the quality of care is compromised.”The home care questionThe new Act lacks clarity about how home care will be provided and funded. The AMA’s submission states that, “Home care support is essential. Improved home care services can defer or avoid admission to facilities. Currently, home care services are stretched to the limit.”The Act does make numerous recommendations regarding offering more and improved home care with better technology, more services—including those related to palliative, recreation and occupational and speech therapy—and increasing recognition and support for case coordination and caregiver burden.But Azocar has seen nothing in the Act, or an indication of future regulations, that will address how home care will be funded and organized. “We need to be in a situation where the government needs to have better upstream thinking and how this is going to impact real people.”Bigger changes afootAs early as this fall, Alberta Health Services will be split into four different organizations, one of them being continuing care. This change is triggering increased worry across the Alberta health care community. “We don’t know what it’s going to look like” says Azocar.Already, wait times for long-term care in the province are a problem—one estimate puts the wait as long as two years. Just last month, an Edmonton stroke patient was discharged to a hotel. Hence, many wonder how vulnerable seniors in the province will be protected by this new legislation.“It's a success of our healthcare system that we keep people alive longer and healthier. But by the time they need care, it's not going to be there,” says Azocar. “That’s a failure of society as a whole, but also this government. These changes are not going to do anything to improve that.”

What is (and isn’t) in Alberta's new Continuing Care Act

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