View source for Introduction to Navigating Home Care and Senior Housing

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== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide?  ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed?  ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is only for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation also outlines the Public Guardian and Trustee’s abilities to act as a substitute decision-maker for financial decisions, called a statutory property guardian.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])


==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: &lt;[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution&gt;].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: &lt;https://www.canlii.ca/t/84lk&gt;.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: &lt;https://www.canlii.ca/t/9lrn&gt;.
# ''Residential Care Regulation'' BC Reg 96/2009 online: &lt;https://www.canlii.ca/t/89ln&gt;.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: &lt;https://www.canlii.ca/t/842m&gt;.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: &lt;https://www.canlii.ca/t/84gj&gt;.
# ''Health Professions Act'' RSBC 1996 c 183 online: &lt;https://www.canlii.ca/t/842p&gt;.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: &lt;https://www.canlii.ca/t/bmzj&gt;).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: &lt;https://www.canlii.ca/t/84bw&gt;.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: &lt;https://www.canlii.ca/t/849l&gt;.
# ''Patients Property Act'' RSBC 1996 c 349 online: &lt;https://www.canlii.ca/t/848s&gt;.
# ''Mental Health Act'' RSBC 1996 c 288 online: &lt;https://www.canlii.ca/t/846j&gt;.
# Health Justice “Home“ online: &lt;https://www.healthjustice.ca&gt;.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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