Understanding Waitlists
As of May 1, 2002, a priority access system was introduced. People are now placed on wait-lists based on need - those that have long term health needs that are not possible to manage at home.
Waitlisting for Care Facilities
Peter S. Silin
(Updated March 2007)
The Continuing Care system in British Columbia is a province wide, single-point-entry system. That means that the same programme basically exists across the province and the five new health regions. It also means that almost all services for seniors (home care, adult day centers, nursing homes, other residential care, respite care, and specialized services) can be reached through one office in the region where you live. To find that office, look in the phone book under health authorities and look for continuing care, home care, long term care, or something similar. There may be a central intake number or there may be one listed in the area nearest to where the person who needs services lives.
If someone feels that they need nursing home care or assisted living residential support, they call the continuing care office and ask for an intake worker or case manager or assessor. An appointment is made and someone will come out to see the client. The case manager does an assessment based on the person’s physical, emotional, and psychological state. This includes their memory and other cognitive functions as well as their ability to perform what are called ADL and IADL: the Activities of Daily Living, and Instrumental Activities of Daily Living. The ADL and IADL consist of tasks such as dressing, feeding, toileting, shopping, cooking and cleaning. The case manager also looks at caregiver stress and social supports.
A client used to be [up until May 2002] assessed as personal care, intermediate care (IC) 1, 2, or 3, or extended care (EC). The increase in levels indicated an increase in need for assistance. The basic difference between intermediate care and extended care was the ability to walk or transfer independently using a walker, wheelchair, or other device. If the client was able to be independent, they were classified IC. Someone who needed assistance was EC. (It is a little more complicated than that but that is the basics.) People who were IC2 or IC3 or EC were eligible for placement.
Today, people who qualify for nursing home type of care are said to be in need of “complex care” and the places that provide that care are called complex care facilities. These include both what were intermediate care and extended care facilities. Generally, it is only people who would have been classified IC3 or EC who are eligible. However consideration is taken of caregiver stress and needs and varying circumstances of the client.
People who do not qualify for complex care, may qualify for assisted living. Briefly, assisted living is for people who can direct their own care and who need some help with (supposedly) up to two Activities of Daily Living (ADL). ADL include bathing, dressing, grooming, medication taking. They need to be mobile or at least able to transfer on their own. Generally, assisted living facilities are more homelike than complex care facilities, partly because they are newer. They tend to be more like apartments, even if they are a small “bachelor.”
If a case manager feels that the person needs a nursing home or assisted living, the client must be willing to accept care within three months. It is not an “insurance,” or “what if” situation. If the client is willing to go into care in three months or less, their name is submitted to the committee in that region which places people. The client and family will be asked to choose a preferred placement choice. Although the assessment takes place in the client’s home region, they may request placement anywhere in the province. So for example if the client lives in Kelowna but wishes to be placed near a relative in Victoria, they may request placement in the Victoria area. If the person who is needing housing wants to be outside their health authority, they may have to first be placed in a facility in their area, and then be put on a transfer list to another health authority.
The central committee, and more generally the waitlisting process, now bases admission to care on need and acuity, as opposed to the length of time someone has been on a waitlist. The committees try to match the client to their preferred choice. If a bed is offered and it is refused, the client’s name is taken out of the committee’s pool of names of people needing placement. The client will not be placed in care.
If a place is offered in a facility which is not the preferred choice, the client must take that place. If they wish, they will be put on a transfer list, and transferred to the preferred facility when a bed comes up there. Depending on the number of people waiting for that facility and the number of people from the community being placed, and the number or people awaiting placement from hospital, the wait could end up being quite a while, up to a couple of years.
There is supposed to be some kind of rotation for facilities so that when they have a bed available, it will be offered on a rotating basis to someone in hospital, the next available bed would be offered to someone in the community, and the next to someone waiting for their preferred choice. The rotation is not necessarily in that order, nor is it necessarily followed strictly. Hospital discharge needs, community emergencies, cultural factors, particular skills of the facility, or other factors may impact on the rotation.
Anyone going into facility and their families should understand what happens in nursing homes and how they function. This includes understanding care and care issues. Understanding will help lessen confusion and anxiety, and help family members or residents feel more in control of the process of care. My book, Nursing Homes: The Family’s Journey explains what people need to know and what to watch out for.
©2007 Peter Silin, MSW, RSW.
Peter Silin is the Principal of Diamond Geriatrics, Inc. (www.DiamondGeriatrics.com), a Vancouver based eldercare consultation and Geriatric Care Management company. He can be reached at 604-874-7764.
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Thanks to Peter Silin for providing this updated information to Peace of Mind. Diane, March, 2007.
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