British Columbia Nursing Homes
Understanding The Nursing Home System
Definition of Nursing Homes in British Columbia
As per the Ministry of Health Living and Sport, a nursing home is defined as “a facility that is licensed to provide care for 3 or more people who are dependent on a caregiver for assistance with three or more prescribed services”. Prescribed services include:
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- regular assistance with Activities of Daily Living (eating, mobility, dressing, grooming, bathing, and personal hygiene)
- medication storage, administration, and monitoring
- maintenance or management of cash
- monitoring food intake and/or special diets
- behavioural management and intervention
- psychosocial or physical rehabilitative therapy
A nursing home, which can also be referred to as a ‘Residential Care Facility’ is designed for individuals who need 24 hour a day professional nursing care, who have complex care needs, and whose needs can no longer be met at home.
Eligibility
In order to receive nursing home care in British Columbia, you must be:
- a resident of British Columbia
- a Canadian citizen or have permanent resident status
- in need of nursing care due to illness or following hospital discharge.
Government Responsibility
The Ministry of Health Services monitors nursing homes, and the Ministry of Health Living and Sport establishes legislation, policy, and regulations to protect nursing home residents.
Nursing Home Ownership
Nursing homes can be either publicly or privately owned.
Accommodation/Room Type
Most nursing homes have a selection of room layouts from which to choose. A basic, or ward room consists of 3 or more beds. A semi-private room has only 2 beds, and a private room has a single bed.
Applying To A Nursing Home In British Columbia
In order to apply for a nursing home bed, you must contact your Regional Health Authority (RHA) and speak with a Central Intake worker. The RHA coordinates admissions for public nursing homes and publicly funded nursing home beds in private nursing homes. Please see the ‘Applying to a Nursing Home’ tab on the left hand side of the screen to find the contact number for your local RHA. A case manager will conduct an initial assessment to determine if have an urgent need for a nursing home bed. If it is determined that the need for the nursing home is not urgent, you will receive a referral for other resources that will better suit your needs, for example, home care or assisted living.
If the case manager decides that your health care needs are urgent and, therefore, you are eligible for nursing home placement, the case manager, or other health care professional, will visit you at home and conduct a thorough assessment using standardized tools and determine your exact care needs and risks. The case manager will work with you and your family members, and physician to determine the nature, intensity, and length of time that services will be needed.
Waiting List
Your case manager will ask you for a list of nursing home that you prefer and your name will be added to each home’s waiting list, if there is one. However, you are expected to accept the first bed that becomes available, even if it not your preferred nursing home. You are able to request a transfer to your preferred facility once you are admitted, and you will maintain your position on the waiting list. Priority is given to those with the highest need and urgency. Individuals awaiting nursing home placement in the hospital are usually given first priority. If you reject your first bed offer, it is assumed that your care needs are not urgent and you are removed from the priority access list. Once you are offered a bed, you are expected to accept the bed, and move into the facility within 24 hours.
Appeal Process
If the case manager decides that you are not eligible for a nursing home bed, you can
appeal the decision by contacting your RHA.
Admission Documentation
Your case manager may have collected certain documents during the application process. If not, be prepared to bring the following to the home at the time of admission:
- Power of Attorney for Finances (if one)
- Power of Attorney for Personal Care (if one)
- Previous year’s Notice of Assessment if you cannot pay the maximum accommodation rate
- Advanced Health Care Directives
- Health Card
British Columbia Nursing Home Costs
In British Columbia, privately funded nursing homes determine their own rates for nursing home services, although they are monitored and licensed similar to publicly funded nursing homes. The average costs for a private nursing home ranges from $2800.00 to $8200.00 per month.
Publicly funded nursing homes receive funding from the government to subsidize the cost of nursing home care. Some private nursing homes have nursing home beds that are also subsidized by the government. Nursing home residents are expected to pay a portion of their nursing home costs, known as an accommodation fee, which covers room and board expenses. As of January 1, 2011 the minimum resident accommodation fee is $897.00 per month, and the maximum rate is $2932.00 per month. Nursing home accommodation fees are adjusted annually on January 1 according to the consumer price index.
| Daily Accommodation Rate | Monthly Accommodation Rate | |
|---|---|---|
| Minimum Rate | $29.40 | $897.00 |
| Maximum Rate | $96.13 | $2932.00 |
A resident’s ability to pay the minimum or maximum rate does not determine the placement into a ward, semi-private, or private room. The nursing home decides which residents will receive each type of room based on several factors, such behaviour (a resident who exhibit disruptive behaviours may be assigned to private room as to not disturb other residents), availability, and care needs. Some nursing homes will charge an additional fee for a semi-private or private room.
To calculate the accommodation fee, you will be asked about your income, not about assets. And, you will not be required to sell your house to pay for your nursing home care.
Discretionary Spending
In determining the fee a nursing home resident pays each month, the resident must have a comfort allowance of $275 per month available for personal spending.
Government Subsidy
The government of British Columbia subsidizes nursing home beds in public nursing homes. There are some beds in private nursing homes that receive government subsidy.
Applying for A Rate Reduction
It is relatively uncommon for a resident to be unable to pay the minimum accommodation fee because this rate is based on Old Age Security and Guaranteed Income Supplement amounts. However, if a resident cannot afford the minimum rate, you may be eligible for a rate reduction.
Short-Stay Respite Beds
Respite care gives temporary relief to caregivers, or allows them to go on vacation knowing that their loved one’s care needs are met. As of January 1, 2011, the fee for respite care is $29.52 per day. To apply for respite care, contact your local RHA.
Programs and Services That Are Covered
Resident accommodation fee and government subsidy will cover the costs for the following programs and services:
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- room furnishings (typically a bed, bedside table, closet or wardrobe, chair, and dresser)
- meals and snacks
- laundry services
- linens
- housekeeping
- activities
- social programs
- medication administration
- assistance with Activities of Daily Living
- physician care
- pastoral services
- personal care services
- basic medical supplies
- professional nursing care
- some mobility aides for general use
Programs and Services That Are Not Covered
The following programs and services are not covered by either resident accommodation fees or government subsidy, and therefore required resident out-of-pocket costs.
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- hairdressing
- T.V. cable for personal use
- transportation
- personal newspaper delivery
- tuck shop
- dry cleaning
- some medical equipment for individualized use
- personal in-room phone
Medication
Some medications are covered under the Government Plan. Drugs not covered under this program will require you to pay out of pocket.
British Columbia Nursing Home Policies, Programs, And Services
Although nursing homes vary according to some programs and services, the following are fairly standard across all nursing homes.
- All nursing homes permit visitors, however each home can determine their own visiting hours.
- Residents are able to bring personal items to make their room feel like home. It is recommended to bring in items such as pictures, decorations, and a bedspread depending on room size and dimensions.
- Residents are permitted to bring some personal appliances, however, all must be approved by the home to ensure that they meet safety requirements. Some examples of appliances that are not permitted due to safety concerns are a hot plate, kettle, electric blanket, heating pads, toaster, iron, coffee maker, and heater.
- Homes are required to have an attending physician, however some homes may allow a resident to keep their own doctor if he/she has visiting privileges in the home.
- The home will tailor meals and snacks according to a resident’s dietary restrictions. Some residents may need to be referred to a registered dietitian for an assessment.
- Each nursing home is required to abide by and post the Residents Bill of Rights.
- Nursing Home residents should be given the opportunity to support, establish, and sustain a Resident’s Council.
- Nursing home family members should be given the opportunity to establish, support, and sustain a Family Council.
- Each nursing home must provide activity programs and some programs should be offered in the evening, weekends, and outside the facility.
- Each nursing home should provide spiritual or religious programs.
- All nursing homes differ in the degree to which they offer palliative care. Some homes may provide comfort measures to a resident in their final hours, whereas other homes may also have a separate room for palliative residents. The room may allow family members to spend the night with the dying resident.
Restraints
Although homes may vary in their use of restraints, they should all have a least restraint policy, which typically requires that restraints are only used if:
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- it is used as a last resort
- the resident is harmful to self or others
- all other interventions were unsuccessful
- the restraint is as minimal as possible
- the resident is assessed on a regular basis to ensure for resident safety and comfort, and to establish if the restraint is still required
- the family is informed
- the use of the restraint is documented, as well as each time the restraint is assessed
Hospital Leave of Absence
If a nursing home resident must go to hospital to receive care, the nursing home must hold the bed for up to a maximum of 30 days. During this time, the resident must continue paying the accommodation fee. After 30 days, the nursing home must discharge the resident and offer the bed to a client on the waiting list. If, after the 30 day period, the resident in hospital is ready to be readmitted to the nursing home, they will receive priority status if there is a waiting list. The resident in hospital may be able to hold the nursing home bed beyond 30 days if they pay both the accommodation fee and the government per diem rate, however this should be first approved by the Long-term Care Office, and it will depend on bed availability.
Vacation and Weekend Leaves of Absence
A resident can be away from the nursing home for up to 4 days at a time without affecting their bed status. An absence greater than 3 days is considered vacation leave. A resident can go on vacation for a maximum of 30 days per calendar year and they are required to pay the accommodation fee while on vacation. If the resident wants to extend their vacation, such that it goes beyond 30 days, they can hold their bed if they pay the accommodation rate, as well as the government portion of the nursing home costs.
British Columbia Nursing Home Regulations And Inspections
All nursing homes in British Columbia that provide three or more prescribed services to three or more persons that are unrelated to them must have a valid license, which must be posted. Nursing homes are required to abide by the Community Care and Assisted Living Act, and Adult Care Regulations. Most nursing homes in British Columbia are accredited by Accreditation Canada (formerly the Canadian Council for Health Services Accreditation). Accreditation Canada is an independent, non-government agency that evaluates health care facilities. This is a voluntary program, and a home can operate without this designation. Homes that have been through this process, and have been granted accreditation are presented with a plaque, which most prominently display.
Nursing Home Inspections
Medical Officers, or Licensing Officers, regularly inspect nursing homes, and the inspection reports are made accessible to the public (please see the “Government Report” tab on the left hand side of the screen to read the reports on-line). Upon completion of the inspection, each home receives a rating depending on the issues that the Officer uncovered. A High Risk rating necessitates that a nursing home is inspected every 6 months. Medium Risk homes are inspected on an annual basis, and Low Risk homes are inspected every 18 months. The Licensing Officer will give the nursing home specific deadlines to correct problems and the Administrator must notify the Officer to when the concerns have been addressed and corrected.
In the follow-up visit, the Licensing Officer will check to ensure that problems identified in the annual inspection have been corrected, and this will be indicated on the follow-up report. . If a violation has not been corrected, and it is reissued, or if a resident is deemed to be at risk, the nursing home may face consequences that affect their license status. For example, an officer may:
- place conditions on the facility’s operating license
- suspend the license
- cancel the license
Making a Complaint
If a resident or family member/friend has a concern or complaint against a nursing home, I suggest that you first speak with the relevant staff member to make them aware of the problem. If the problem is not dealt with properly or in a timely fashion, or if the complaint is of a serious nature, speak with the Administrator.
You also have the option of filing a complaint with the Community Care Facilities Licensing Program. As per the Community Care and Assisted Living Act, a Medical Health Officer, or designate must investigate every allegation and complaint. Your complaint will be investigated even if you wish to remain anonymous.
