Overview of Long-Term Care

This chapter will discuss the basics of entering and leaving long-term care, including:

• long-term care services;
• costs and funding;
• wait times;
• placements;
• consent to admission; and
• ending a residency.

Overview of Long-Term Care

When a person has complex needs and requires daily personal care and health care, they may need long-term care rather than assisted living. Long-term care is commonly referred to as residential care, nursing homes, care homes, care centres, extended care, or geriatric care.

Long-term care services provide 24-hour professional supervision in a protective, supportive environment. This is appropriate for adults who have complex care needs and can no longer live safely or be cared for in their own homes or an assisted living facility. Residents of long-term care may be vulnerable due to age, disability, illness, or frailty, and depend on caregivers for continued assistance or direction. A significant proportion of LTC residents have some degree of difficulty making decisions without support.<ref>British Columbia, ”Long-Term Care Services”, online: <www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/long-term-care-services>; British Columbia, Ministry of Health, Home and Community Care Policy Manual, (6 February 2023) at ch 6.C, online: <www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>. </ref>

It is important to note that long-term care does not mean nurses are present 24/7. Most daily care and support in long-term care is provided by health care assistants who care for numerous residents according to individualized care plans. Care plans are developed in consultation with a nurse practitioner, physician, or other members of the person’s health care team. Health care assistants are supervised by a licensed practical nurses or registered nurses on site.

Each regional health authority oversees long-term care facilities within their region, but it does not mean that they operates them. Generally, there are two types of long-term care facilities:

1. Long-term care facilities owned and operated by a regional health authority. These are subsidized by public funds, and residents pay a monthly fee based on a percentage of their after-tax income (within a defined range).

2. Long-term care facilities operated by providers who have a contract with a regional health authority. These are partially funded, but not directly operated, by the regional health authority. Most of the individual rooms are partially subsidized by public funds, with residents paying a monthly fee based on income. However, some providers also offer private-pay rooms in the same facility, where residents pay the full cost.

Some long-term care facilities are part of a “campus of care” that includes different levels of care in the same location––for example, independent living, assisted living, long-term care, and dementia care. This enables people to move more easily from one level of care to another as their needs change and can also enable couples with different levels of care needs to live near each other.

Facilities in either category a) or b) are regulated by the Community Care and Assisted Living Act and the Residential Care Regulation. They must be licensed through their regional health authority. See Appendix A for links to the health authority licensing office.

In addition, the Continuing Care Act and Continuing Care Regulation define the government’s role in setting standard fees for services (which operators are not permitted to increase independently) and allow for individual exemptions or fee waivers in certain circumstances. The legislation also sets out the right of the government to appoint inspectors and to appoint an administrator of a facility if an operator is deemed to be placing residents at risk.

Older adults may also be cared for in hospital:

1. Extended care - Some long-term care may be provided in an extended care wing of an acute care hospital, or in an extended care building which is near a hospital. Extended care residents may have health care needs that are higher than can be met in other long-term care settings. Extended care is regulated by the Hospital Act and Hospital Act Regulation and funded by the Ministry of Health.

2. Private hospitals - have only private-pay rooms and are not subsidized by the regional health authority. All costs are covered by the residents. However, private hospitals must be licensed by the Minister of Health and are regulated by Part 2 of the Hospital Act and the Hospital Act Regulation. The Community Care and Assisted Living Act does not apply to private hospitals.

The long-term care services discussed in this chapter focus on publicly subsidized options and private care options under a) or b). All are overseen by the Ministry of Health through regional health authorities<ref>British Columbia, “Regional Health Authorities“, online: <www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities>. </ref>.

For an overview of long-term care, see the government website.

You can also find information about long-term care in a particular region by looking at the appropriate regional health authority website. There you can find details about local facilities, admission criteria, fee structure, and links to the inspection history of facilities. See Appendix A for health authority listings.

References

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Seniors First BC, February 2024.