Long Term Care in Alberta

GOVERNMENT-SUBSIDIZED NURSING HOMES

How Nursing Homes are organized and administered

Nursing homes in Alberta provide room and board and a range of care services, from personal care with nursing supervision to skilled medical and nursing care. Nursing home fees are set by the government. Admission to a long term care facility (nursing home) is based on an assessment of need conducted by a Continuing Care Placement Coordinator with Alberta Health Services. To apply for Long Term Care, Alberta residents may call a centralized government authority, Health Link Alberta, at 1-866-408-5465 (LINK) or 811. The staff there will find and refer applicants to their local Continuing Care Placement office where a Placement Coordinator will work with them to find a suitable centre for assessment and admission if required.

Eligibility/Requirements for Admission

To be eligible for subsidized care services clients must:

• be eligible for registration with the Alberta Health Care Insurance Plan,
• have lived in Alberta for three consecutive years at any time previously, or must have lived in Alberta for one year immediately prior to applying, and must have been a resident of Canada for 10 years or more.

Income/Asset Test

An Income/Asset test does not form part of the assessment by the Alberta Health Services (AHS) for admittance into a nursing home. However, low income seniors may be eligible for financial assistance through the Alberta Seniors Benefit program. The Alberta Seniors Benefit program provides support in addition to the federal benefits received under Old Age Security, Guaranteed Income Supplement, Federal Allowance and the GST credit. It is based on income and provides monthly cash benefits to eligible seniors. The lower a senior's income, the higher the cash benefit will be, up to the maximum amount. To be eligible for this program, clients must:

• be over 65 years of age,
• have lived in Alberta for at least 3 months immediately before applying,
• be a Canadian citizen or have been admitted into Canada for permanent residence
• have an income level within limits allowed by program: In general, a single senior with an annual income of $33,410.00 or less, and senior couples with a combined annual income of $54,640.00 or less, are eligible for a cash benefit. These income levels are guidelines only and are for seniors whose income includes a full Old Age Security pension.

Note: Assistance is available for all accommodations (standard, semi, private) as long as, they meet the required set income levels.
Note: Benefits for seniors living in long-term care and designated assisted living facilities are calculated to ensure a senior has at least $357.00 in disposable income every month after paying their accommodation charges.

The amount of cash benefit a senior is eligible for is determined by four factors:

• the type of accommodation the senior lives in,
• his/her marital/cohabitation status,
• his/her income (combined with his/her spouse/partner's income),
• whether the senior is eligible for the federal Old Age Security pension.

The maximum cash benefit from the Alberta Seniors Benefit program (when non-deductible income is $0) for a single senior entering or living in a nursing home is $12,312.00 annually. In the case of a married senior (where one partner lives in a nursing home and the other lives in their home), the maximum cash benefit is $16,104.00 annually.

Medical Criteria

Admission into nursing home consists of an in home medical assessment where the senior is found to have "unscheduled care needs."

Costs for Nursing Homes

RETIREMENT HOMES / RESIDENCES

How Retirement Homes are Organized and Administered

A retirement home in Alberta is a multi-residence housing facility that provides accommodation and services such as meals and cleaning services for older people. Retirement homes in the province are privately owned and operated and not administered by the provincial government. Each facility usually provides a private or semi-private room or complete living suite and then also provides common living quarters, including a lounge area, a common dining room, recreation rooms, cleaning services, social and/or religious programs and some basic health care services. The unit can be paid for on a monthly fee basis, like an apartment, or can in some instances be bought the same way as a condominium.

Admission, fees and waiting lists for retirement homes are controlled by the homes themselves, not by the government. Admission usually depends on the ability to pay and absence of serious medical conditions that require professional nursing care. Residents are responsible for paying their own fees and government subsidies are not available for accommodation in a retirement residence.

Costs for Retirement Homes

GOVERNMENT-SUBSIDIZED HOME CARE

How Government-subsidized home care is organized and administered

Home care is aimed at helping seniors achieve and maintain health, well-being and personal independence in their own homes. Alberta Health Services (AHS) in Alberta are responsible for home care. Referrals for home care can come from many sources including family members, friends and doctors. Once the referral is made, staff assesses the health needs of the individual and the needs of the caregiver. Home care services include professional health care services as well as personal care services such as bathing, dressing, grooming and light household tasks that help to maintain a safe and supportive home.

Eligibility/Requirements for Admission

Eligibility for services and number of hours of care and support to be provided to a particular client are determined based on in home assessment by a co-ordinator from AHS.

To be eligible for subsidized home care, clients must:

• be residents of Alberta,
• be a Canadian citizen or have permanent resident status,
• have a valid health card,
• must have a need that can be fulfilled by home professional health and support services.

Income/Asset Test

An Income/Asset test does not form part of the assessment by AHS. Low income seniors may be eligible for financial assistance through the Alberta Seniors Benefit program. The Alberta Seniors Benefit program provides support in addition to the federal benefits received under Old Age Security, Guaranteed Income Supplement, Federal Allowance and the GST credit. It is based on income and provides monthly cash benefits to eligible seniors. The lower a senior's income, the higher the cash benefit will be, up to the maximum amount. To be eligible for this program, clients must:

• be over 65 years of age,
• have lived in Alberta for at least 3 months immediately before applying,
• be a Canadian citizen or admitted into Canada for permanent residence,
• have an income level within limits allowed by program: In general, a single senior with an annual income of $33,410.00 or less, and senior couples with a combined annual income of $54,640.00 or less.

The amount of cash benefit a senior is eligible for is determined by four factors:

• the type of accommodation in which the senior lives,
• his/her marital/cohabitation status,
• his/her income (combined with his/her spouse/partner's income),
• whether the senior is eligible for the federal Old Age Security pension.

The maximum cash benefit from the Alberta Seniors Benefit program (when non-deductible income is $0) for a single senior homeowner or renter is $3,792.00 annually. In the case of a married senior homeowner or renter the maximum cash benefit is $5,687.00 annually.

Costs

There is no charge for professional health care and personal home care services.

PRIVATE HOME CARE

Alberta Health Services (AHS) resources are limited and go to the neediest. As a result, many seniors get inadequate amounts of AHS services and have to rely on private home care services to receive the appropriate amount of care.

Costs of Private Home Care

Scenario 1: Low level of care (early in the crisis management stage of care)

Mrs. Williams is an 85 year old widow living in her own home. She has osteoarthritis and leg edema. She must wear support stockings to relieve her edema and because her fingers and back are arthritic, she needs help getting dressed. To get around her home, she uses a walking support device or rollator. Both of Mrs. Williams' daughters help her out regularly on weekends and evenings while her son-in-law helps maintain the house and takes care of the lawn.

After fracturing her femur in a significant fall 9 months ago, Mrs. Williams' mobility has been severely decreased and she lost 9 kg or almost 20 lbs as a result. She tells her daughters that she forgets to eat and the food in her refrigerator is spoiled. During their visits, her daughters notice she eats very little and sometimes chokes on her food.

To help her eat safely and address her other needs, Mrs. Williams and her daughters agree it's time for some formal care. She needs her meals delivered to her home, someone to supervise her meals and assistance with dressing and bathing. She would also benefit from a home safety assessment.

Care plan to assist family caregivers part-time

• Meal delivery - 2 meals a day on weekdays provided by Meals on Wheels or another meal delivery program
• Meal supervision - 1 hour a day on weekdays (to include a record of food intake and assistance if patient chokes)
• Personal Care (bathing, dressing) - 1 hour a day on weekdays
• Occupational therapist: to provide initial home safety assessment and recommendations

In addition, there will be expenses for two visits of an occupational therapist including a 1 hr. initial assessment and 45 min. follow up after equipment has been installed. The two visits will cost $245.00 altogether.

Scenario 2: Intermediate Level of Care (late in the crisis management stage of care)

Mr. Leung is a 72 year old widower. He lives with his daughter and her husband in a small community outside the city. Mr. Leung has cataracts in both eyes. He also has dementia which has progressed to the point where he requires continual supervision. He forgets to take his medication, does not eat properly and cannot safely prepare meals. He needs cues for dressing and bathing.

Mr. Leung's daughter and her husband assist him mornings, evenings and weekends but aren't available on weekdays. For weekdays, they enrolled him in an adult day program 2 days per week and hired someone to accompany him to and from the program. For the remaining 3 days of the week they've hired someone to supervise him and keep him company. They've also arranged help for laundry and house cleaning.

Care Plan to assist family caregiver full days, during the week

• Companionship/Supervision: 3 times a week, 8 hrs a day
• Adult Day Program: 2 days a week
• Safety Supervision: to and from the Adult Day Program - 2 times a week, 30 minutes each way
• Laundry/House cleaning: 3 hrs a week

Scenario 3: High level of care (in the dependence stage of care)

Mr. and Mrs. Jensen live in a two-bedroom condominium. Mr. Jensen is 93 years old, alert and aware but physically frail. Mrs. Jensen is 88 years old, diabetic and recently had a stroke. Her balance is poor and she's at high risk for falling. She can only walk short distances and needs help to get around. She also has heel ulcers that make walking even more difficult. For longer distances, she uses a wheelchair.

Her family doctor recommends Mrs. Jensen move to a nursing home. But because Mr. and Mrs. Jensen's daughter promised she wouldn't send her parents to a nursing home, she needs to make alternate arrangements. Options include a caregiver to assist Mrs. Jensen with bathing, dressing, toileting, walking, meal preparation, household chores and transportation to and from appointments. A nurse could monitor and chart her medicine use and blood sugar levels, clean her heel ulcers and change her bandages. Mr. and Mrs. Jensen would also benefit from a home safety assessment by an occupational therapist who may recommend safety bars, raised toilet seats, better lighting, removing clutter and securing loose rugs.

Care plan to assist family caregivers full-time, every day

• In-home meal preparation - 7 days a week, 2 hours daily
• Private caregiver - 7 days a week, 8 hours daily to assist with bathing, dressing, toileting and walking and relieve spouse of caregiver duties
• Private Registered Nurse - 4 times a week for 30 minutes to monitor and chart medicine use and blood sugar levels and monitor and change dressing on heel ulcers
• Laundry - 2 hours every other week
• House cleaning - once a week for 90 minutes
• Occupational therapist: to provide initial home safety assessment, recommendations and a 45 minute follow-up after equipment installation