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A L H I

Issue #1

Winter, 2015

Newsletter of the Alberta Labour History Institute

Then Now & NextPreservationCollection Education

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ALHI

History of aHealth Crisis

Labour Film FestFeb, 05!

Who is ALHI?

Exploring Alberta Labour’sPast Present & Future

Exploring Alberta Labour’sPast Present & Future

Issue #1

A L H I

People’s HistoryReal History

Welcome to the first issue of Then, Now and Next, the official e-newsletter of the Alberta Labour History Institute (ALHI). Founded in 1999, ALHI is dedicated to collecting, preserving and educating the public about the history of Alberta workers and their organizations. Over the years we have collected hundreds of hours of oral history interviews with labour leaders and activists, as well as ordinary working Albertans. We have also collected and preserved hundreds of historical photographs and artifacts that are an important part of the story of working people in Alberta.

ALHI has worked with many trade unions and labour organizations to collect and celebrate their history. For example, we played a key role in celebrating the centenary of the Alberta Federation of Labour (AFL) in 2012 by producing a book on the history of labour in Alberta from pre-contact to 2012, as well as several topical booklets, posters and videos. In 2012 we held our first biennial labour history conference. Our annual labour history calendar and website are other tools we use to educate people about Alberta labour history.

This first issue of Then, Now and Next features an article that chronicles the government-created crisis in senior care. You will also find information about the upcoming Labour Film Night at the Garneau Theatre on February 5th that we are co-hosting with the Edmonton and District Labour Council (EDLC). I hope to see you there.

James Muir, PresidentAlberta Labour History Institute

The centre of the controversy was the approximately 700 seniors currently residing in acute care hospital beds while awaiting placement in Alberta’s increasingly stressed “continuing care” system. That means that somewhere around 8.5 percent of the Province’s 8311 acute care beds are being used as long-term care beds.

This is a very expensive situation since an acute care bed costs somewhere around $1000 per day more to operate than a long-term care bed in an auxiliary hospital or nursing home – and more than that for the “designated supportive living (or nursing home light) beds preferred by government policy makers.

Something must be done about (or to) these “bed blockers” according to new Health Minster Stephen Mandel because they are using up valuable resources, depriving others (presumably more deserving) of beds and stretching waiting lists.

When Alberta’s Premier Jim Prentice announced that the government would open 464 new continuing care beds over the next 12 months to free up beds seniors were taking up in acute care hospitals, he was highlighting decades of government incompetence and neglect in seniors’ care.

A BRIEF HISTORY OF GOVERNMENT-CREATED CRISIS IN SENIORS’ CARE

Jim Selby

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Sadly, this is not a new problem

Flash back to 1958. The Alberta government, shocked by the realization that 18% of patient days in acute care hospitals were incurred by patients who really needed long-term care instead, set in place a three-part plan to accommodate seniors. The result: vigorous construction of provincially-funded, community-owned and operated seniors’ lodges, the 1959 Auxiliary Hospital program and the 1964 Nursing Home Act.

The stated intent of all three programs was to release expensive acute care beds and to provide access to se-niors’ care based upon need rather than ability to pay. Sounds familiar, doesn’t it?i

Run for your lives: it’s the baby-boomers

The retirement of the massive baby-boom generation (that huge demographic bulge made up of people born between 1946 and 1964) has just begun. Over the next 25 years it will put a strain on seniors housing and health-care programs.

But it is not as if the government didn’t see it coming. It was being discussed in government policy papers in the late 1980s. You would expect that the government would deal with the coming surge in the numbers of seniors by constructing more lodges, nursing homes and auxiliary hospitals. Instead, they began a deliberate process of limiting the amount of money spent on seniors housing and health.

By 1991, before the infamous Klein cuts to health care, seniors care in Alberta had been seriously eroded. In 1991-92, the year he took office, a report noted that: “The level of funding for long term care facilities is inade-quate and does not recognize care requirements of facility residents. Facility operators are forced to manipulate the system any way they can to cover their expenses, because the system is not being funded for the hours of

22,533

400,000

600,000

800,000

200,000 24,042 24,935 25,569 26,458 26,932

2013 2014 2015 2016 2017 2018 2021 2026

1,000,000

455,800

476,300

497,800

520,100

658,500

819,100Senior’s Population VS Continuing Care Beds

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care required.” ii In the Klein years, matters became worse as beds were taken out of service as demands were increasing.

Now, all the cuts and restraints instigated in seniors’ care are becoming a full-blown crisis. Even if you add in the 8,497 Designated Supportive Living (DSL) beds which provide a lesser level of care than the Long Term Care (LTC) beds for 2014, there are still only 48.0 continuing care beds per 1000 Albertans over the age of 65 – barely two-thirds of the proportion in 1981. iii

Year Bed Numbers LTC Beds / 1000

Nursing Home Aux. Hospital Total Both Albertans +65

1971

1981

1991

2014

5671

7255

8064

8843

2473

3503

5432

5527

8144

10758

13496

14370

68.6

71.4

61.1

30.2

2013 2014 2015 2016 2017 2018

5,000

10,000

15,000

20,000

14,554 14,608 14,575 14,193 13,846

13,054

7,979

9,43410,360

11,46612,612

13,878

What Kind of Beds are Provided? Long Term Care VS Designated Supportive Living

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A consistent policy of fiscal restraint ahead of seniors’ needs

The root of the problem appears to be that the Alberta government, at both the Ministerial level and through their “arms-length” proxy, Alberta Health Services, have made cost-containment their number one priority. Apparently, if some seniors’ fall by the wayside or through the cracks in the system as a consequence, so be it. If seniors don’t get the care they need, or can’t afford decent care in the “user-pays” system in pace in the DSL system, that is all part of responsible governance.

The two most obvious consequences of the primacy of the bottom line in government seniors care policy are a lack of beds for seniors overall and a lack of beds at the highest level of care.

The number of long term care beds in Alberta have actually been frozen for many years. These are beds in nurs-ing homes and auxiliary hospitals that provide the highest level of care for seniors. The government has actually planned to reduce the number of these beds over the next five years iv- although a statement by the Premier has placed actual bed reduction at this level in doubt.

With the freeze on long term care beds, virtually all of the increase in seniors’ care beds has been in the Desig-nated Supportive Living category – DSL4 and DSL4D (the D stands for dementia). DSL4 facilities do not require that a Registered Nurse (RN) be present - as is the case in Long Term Care facilities. The DSL4 level only requires a Licensed Practical Nurse (LPN) to be present, and the DSL3 level only requires the presence of Health Care Aides.

Although these DSL beds cost AHS much less to fund, there have been concerns raised that seniors’ are being placed in facilities that cannot provide the level of care they require. When health issues arise that DSL facilities are not capable of addressing, the standard response has been to simply send the seniors to the nearest acute care hospital in an ambulance. That pretty much has to be the case since there are no LTC beds open.

For-Profit Seniors’ Care

Another outcome of the move to DSL beds has been the growing dominance of for-profit operators within the

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What Does the Growth of DSL Mean?Long Term Care Designated Supportive Living

4,969

34% 4,238

29%

5,407

37%

387

5%

3,119

44%

3,563

50%

Public Non-Profit For-Profit Public Non-Profit For-Profit

seniors’ care sector. Since seniors’ care is not under the Canada Health Act, it has been seen as a good place for investment by real estate developers and large American seniors’ care corporations.

Since long term care was more or less equally divided between publicly-owned, non-profit and for-profit opera-tors, the public sector facilities set the standard for wages and workloads that had the effect of pushing up the overall quality of work in the industry. This is very important to seniors care, since continuity of staff (low turn-over rates) are vital to best quality care.

However, the Alberta government has deliberately outsourced seniors care facilities in the DSL category, remov-ing a very important public sector influence on work in the sector.

A Low-wage strategy through de-unionization?

A quick look at the extremely low unionization rate in the for-profit DSL facilities suggests another way in which the government may be trying to reduce overall costs of seniors’ care v. By essentially contracting out seniors res-idential care largely to the for-profit sector, AHS is creating a counter-balance to the upward push on wages and working conditions created by the highly unionized public facilities in the old long term care field.

A funding variance in the DSL sector tends to corroborate the existence of a “low-wage” policy in seniors’ care. Unlike the long-term care sector where all facilities get funded with a common formula for wage rates, in the DSL sector, each operator negotiates a separate funding level that has left some facilities unable to pay the going wage and benefit rates. This has led to an increasing number of labour disputes as seniors’ care workers reject below market working conditions.

As well as increased labour unrest, this low-wage policy expressly creates a higher turnover of staff as skilled el-der care workers leave for better paying jobs in Alberta’s tight labour market. As stated earlier, high staff turnover has a negative impact on the quality of care for seniors.

The Move to Download Costs onto Families

A low wage strategy is not the only cost-saving for the government of the new DSL model of care. When a Hinton

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Public (AHS)Total Beds:429

VoluntaryTotal Beds: 3,775

For ProfitTotal Beds: 4,293

Union (410)

Non-Union (19)

Union (2,352)

Non-Union (1,423)

Union (1,251)

Non-Union (3,042)

95.6%Union Beds

62.3%Union Beds

29.1%Union Beds

DSL Unionized Beds By Ownership

long-term care facility was transformed in to a DSL in 2006, residents suddenly found themselves on the hook for a whole list of services that had been free of charge previously. Laundry, linens, medical supplies, medications, ambulance transportation and other “services” suddenly became cost items for seniors. vi

What cost containment?

Of course, all the penny-pinching in seniors’ care – the underfunding of LTC and DSL; the freeze on construction of LTC beds and the inarguably insufficient amount of DSL beds constructed in the last decade has not really saved the government anything.

Consider that it costs about $1000 per day more to keep a senior in an acute care hospital than it does to keep them in a long-term care facility (perhaps $1100/day if compared to DSL). That means that 700 seniors in acute care hospitals are costing the government $700,000 per day more than they should – roughly $250 million per year. You have to wonder what genius thought restricting/freezing the construction of badly needed new long term care was going to save the government money?

All they had to do was look at why all the seniors housing and care programs were started in the first place.

Furthermore, opening a few hundred spaces is going to do nothing to address the crisis in seniors care. There have always been more people waiting in the community for seniors’ beds than are waiting in acute care hos-pitals. The population of seniors is continuing to grow. Unless the government actually admits it has made a mistake and embarks on construction of thousands of new top level long-term care seniors’ beds (not DSL), the acute care hospitals are going to continue to be the only place where seniors’ in need can go – and it is going to cost the province billions in unnecessary expenses.

i Protti; Historical Development of Alberta’s Nursing Home Plan, 1976

ii Long Term care Committee, Alberta Healthcare Association, Funding Issues: long Term Care; 1991/92

iii The Long Term Care Facilities Sector Role Statement Working Group, Gov. of AB, Continuing Care Centres of Tomorrow, 1994; AHS, Beds Staffed and in Operation, March 31, 2014; Statistics Canada. 91-520 X. Population Projections for Canada, Provinces and Territories. Table 15-10. Population by age group and sex, high-growth scenario (H), July 1st — Alberta, 2010 to 2036

iv Alberta Health Services; Detailed Capital Submission for Seniors Care Facilities Across Alberta to 2017/18. 2013

v AHS wage rate tables for unionized facilities; ALRB certification and collective agreement databases; AHS; beds staffed and in operation; March 31, 2014.

vi Armstrong and Deber; Missing Pieces of the Shift to Home and Community Care: A Case Study of the Conversion of an Alberta Nursing Home to a Designated Assisted Living Program; 2006.

End Notes:

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ALHI’s First Film FestivalExplores the Legacy of theBritish Miners Strike

Brought to you by the Alberta Labour History Institute (ALHI) and the Edmonton and District Labour Council (EDLC).

ALHI & EDLC Launch Labour Film Festival

FOLLOW US ON TWITTER: @LabourFlicks

In an era of globalization, austerity and corporate consolidation, examining the past and cur-rent struggles of working people and their organizations is essential for strategic discussions we need to have. Film is a natural medium to bring people together in order to begin these discussions.

Our first film festival will be held on February 05 at Edmonton’s historic Garneau Theatre. We are screening two films that have been released on the 30th anniversary of the seminal British miners strike. The first feature is an award winning documentary Still the Enemy Within. The film is a “heartfelt tribute to the communities who were hammered by political, not economic, forces during the strike”.

The second film Pride celebrates the allegiances that sprang up across class and gender bound-aries during the miners strike. One reviewer describes it as a film that has “a spine-tingling charm by the bucket-load. I laughed, I cried, and frankly I would have raised a clenched fist were both hands not already occupied wiping away the bittersweet tears of joy.” The best part is that thanks to our generous sponsors admission to both films is free! Make sure you join us and bring a friend.

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Still the Enemy Within is a documentary that provides "a unique insight into one of Britain’s most dramatic struggles, the 1984-85 Miners Strike. No experts. No politicians. Thirty years on, this is the raw first-hand experience of those who lived through the UK’s longest strike. Follow the highs and lows of that life-changing year.” Edmonton’s ONE NIGHT screening of this film will be its first in North American outside the film festival circuit. Don’t miss it!

Thursday, 5 February 2015Garneau Theatre (8712 109 street)

7:00 p.m. Still the Enemy Within 9:30 p.m. Pride

Admission is free!

Alberta Federation of Labour Alberta Union of Provincial Employees Canadian Labour CongressChivers Carpenter, LawyersMetro Cinema Society Edmonton

Pride is also based on the 1984-85 Miners’ Strike. The film depicts a group of lesbian and gay activists who raised money to help families affected by the strike at the outset of what would become the Lesbi-ans and Gays Support the Miners Campaign. Recently nominated for a Golden Globe award, Pride is a poignant dramatization of the solidarity that develops between two different communities each fighting for social justice.

THANKS TO OUR SPONSORS!

FEB, 05

TWO MOVIES

ONE NIGHT

ZERO COST!

W W W. L A B O U R H I S TO R Y. C A

ALBERTA LABOUR HISTORY INSTITUTE

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