Long Term Care in Manitoba

GOVERNMENT-SUBSIDIZED NURSING HOMES

How Nursing Homes are organized and administered

Nursing homes or Personal Care Homes, as they are called in Manitoba, are residential long term care facilities that provide 24-hour professional nursing care and supervision in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes. The insured personal care home program in Manitoba is provided in licensed personal care home facilities designated by the Minister of Health. Fees for personal care homes are set by the Manitoba Ministry of Health.

Admissions to residential long term care facilities are managed by the Regional Health Authority (RHA) except in the case of Winnipeg, which has a separate Long Term Care Access Centre within the RHA to manage admissions into long term care facilities. Each person wanting admission into a long term care facility must be seen by a number of professional staff including a doctor who will complete an application and assessment form that will be submitted to a panel, where a number of professionals look at the client's needs and decide upon the best option to meet those needs. If the client qualifies for a Personal Care Home, the RHA will assist him/her in choosing a Personal Care Home. 

Eligibility/Requirements for Admission

To be eligible for subsidized care services clients must:

• be citizens or permanent residents of Canada,
• be residents of Manitoba, and
• have health care needs that cannot be adequately managed by the family, home care services and community services.

Income/Asset Test

During an assessment, a copy of the client's personal income tax returns is taken and the cost of residential long term care is calculated based on these returns.

The residential charge structure in Manitoba ensures that all clients have a reasonable amount of disposable income for personal needs. After paying their daily residential charge for personal care services,  a client  should still have at least $4,560.00  per year  (divided by 12 = $380.00/month) disposable income.

Costs

Long term care costs depend on a client's after-tax income and marital status. Costs range from $39.40 to $95.20 per person per day. A few samples of the breakdown are:

Costs for Nursing Homes

For a detailed breakdown of fees according to income and marital status, refer to the Table of Residential Charges issued by the Manitoba Ministry of Health.

The fees for Personal Care Homes include the following services:

• 24 hour nursing services
• personal care services
• physician services
• basic medical supplies
• food and nutrition services
• medications and pharmacy services
• activities/recreation
• access to Occupational Therapists, Speech-Language services and Physiotherapists, if required
• housekeeping
• laundry/linen services, and
• access to transportation (with some exceptions)

RETIREMENT HOMES / RESIDENCES

How Retirement Homes are Organized and Administered

A retirement home in Manitoba 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.

GOVERNMENT-SUBSIDIZED HOME CARE

How Government-subsidized home care is organized and administered

Home support services are designed to help clients remain independent and in their own home as long as possible. 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.

In Manitoba the Home Care Programs within each Regional Health Authority (RHA) manage requests for care in the home. Once a request for service is received, a Home Care Coordinator will conduct an assessment and develop a care plan. If a client becomes ill and is admitted to a hospital, the hospital will inform the Home Care Program, and a plan is made for when the client is discharged from hospital. The number of hours of home care allotted to a client is based on assessment and regional availaability.

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 the Home Care Program a client must:

• be a Manitoba resident,
• be registered with Manitoba Health,
• require health services or assistance with activities of daily living, require service to remain safely in their homes and require more assistance than available from existing supports and community resources.

Income/Asset Test

An income/asset test is not generally part of the assessment for home care. However, clients can access long term care through the Home Care Program. In such a situation a copy of the client's personal income tax returns is taken at assessment and the cost of residential long term care is calculated based on these returns.

Costs

There is no charge for home care provided by the RHA.

PRIVATE HOME CARE

RHA resources are limited and go to the neediest. As a result, many seniors get inadequate amounts of RHA 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 $201.25 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