Recommendation 1: Enhance the capacity of the assisted living registry to enforce the Community and Assisted Living Act by substantially increasing the number of assisted living investigators, and by developing policies that build on the inspection provisions in the act.

These policies should:

• Mandate yearly inspections of all private-pay and publicly subsidized assisted living residences; and
• Mandate all publicly subsidized and private-pay assisted living residences to post clear and detailed information about how and where residents, families and staff can access the complaints process of the assisted living registry, including public reporting on compliance.

Address existing and future needs of the assisted living workforce

Recommendation 2: Adopt a process for moving the wages and benefits for health care workers in assisted living to an existing provincial standard established by the appropriate health sector bargaining association and the Health Employers’ Association of British Columbia.

Address existing and future needs of the assisted living workforce

Recommendation 3: Create a workforce development plan to address the recruitment and retention challenges in assisted living, and ensure that clear training standards are developed for all staff working in front-line and health-care supervisory positions in both private-pay and publicly subsidized assisted living residences.

Address existing and future needs of the assisted living workforce

Recommendation 4: Mandate the new provincial health sector occupational health and safety organization (announced in 2019) to analyze injury levels and risk factors in assisted living, and develop an injury-prevention strategy and plan for the sector.

Address existing and future needs of the assisted living workforce

Recommendation 5: Include in the health authorities’ service contracts with assisted living residences the requirement that they collaborate with the joint occupational health and safety committee at their site to develop comprehensive processes for monitoring injury rates, identifying risk factors and preventing and reducing injuries rates over time.

Support the Seniors Advocate to work with a broad-based multistakeholder advisory committee to conduct a review of seniors’ assisted living residences

Recommendation 6: This would determine how to operationalize Bill 16 in ways that support a broad continuum of affordable seniors’ residences and care services and ensure access to high-quality assisted living services for all British Columbians who could benefit from them. This review would include an outreach plan to gather input from residents in assisted living, their families and friends, assisted living staff and community members on how this sector should be reconfigured, and on the services and staffing supports required to ensure a sustainable and viable relational model of care.

Support the Seniors Advocate to work with a broad-based multistakeholder advisory committee to conduct a review of seniors’ assisted living residences

Recommendation 7: The review would also address the oversight issues not covered by the assisted living registry (e.g., tenancy and quality-of-care issues), the need for provincial regulations or protocols for information sharing, and the need for assessment processes to determine if assisted living is the appropriate level of care for a resident.

Support the Seniors Advocate to work with a broad-based multistakeholder advisory committee to conduct a review of seniors’ assisted living residences

Recommendation 8: To ensure that the review reflects the current reality of both publicly subsidized and private-pay assisted living residences, the Seniors Advocate would begin by conducting three mini audits:

• To determine the proportion of residents currently living in assisted living residences who do not qualify for assisted living (as defined by the Bill 16 amendments) and identify the extent to which there are problems related to inappropriate prescribing and the lack of safeguards in medication storage;
• To determine the percentage of current residents in long-term care who do not require this level of support and who could be more appropriately supported in an assisted living residence (instead of relying on RAI-MDS data as is currently the case); and
• To determine the number of assisted living residents using emergency services, and the reason for and frequency of these visits and the costs to the system.

Support the Seniors Advocate to work with a broad-based multistakeholder advisory committee to conduct a review of seniors’ assisted living residences

Recommendation 9: In addition, the Seniors Advocate would request a report from each health authority outlining:

• How they are using the funding provided by the Ministry of Health (i.e., $26 million over three years) to increase staffing and care coordination for assisted living residents and to identify the gaps and challenges with the implementation of Bill 16; and
• The current pressure on the health authority for acute home support and home health resources from the assisted living sector, and the potential increased pressure on these resources moving forward.

Recommendation 10: Establish an expert panel of both academic and practice leaders in relational care to help shift assisted living from a philosophy of living at risk to a philosophy of relational care.

This panel’s work should begin with a report for the review process (above) on how to replace Managed Risk Agreements with Relational Care Agreements. Such agreements would acknowledge both the resident’s autonomy and the responsibility of assisted living operators to engage with residents and provide them with the support, education and social connections required to maintain and/or enhance their well-being and autonomy. The report would:

• Define and apply relational care principles to an assisted living environment;
• Outline a relational-care-planning process to be used with each resident when they enter an assisted living residence and a process for updating it at regular intervals;
• Describe the educational materials and quality-improvement processes needed to support a relational care framework and improve practice over time;
• Include strategies for ensuring that front-line staff and residents, and their family and friends, feel safe and respected in these processes; and
• Recommend how to facilitate the shift to relational care and processes for monitoring progress (i.e., through the inspection processes for assisted living residences).