Wait Lists for Health, Social Services Rising for BC Seniors

Older adults are living longer, but wait lists for services to support healthy aging in British Columbia (BC) have increased — sometimes dramatically — over the past 5 years, a new report revealed.

The “Monitoring Seniors Services 2024” report, published online last month by BC’s Office of the Seniors Advocate, tracks trends over time of older-adult demographics, healthcare, completed surgeries, home support, long-term care (LTC), housing, rent and income supports, and abuse.

“All the data we look at show that we’re not keeping pace with the growing number of seniors,” Seniors Advocate Dan Levitt told Medscape Medical News. “There is less home care, LTC beds, rent subsidies, and subsidized seniors housing available today per population compared with 5 years ago.”

Bill VanGorder, advocacy and education officer for the Canadian Association of Retired Persons (CARP), added, “The finding that PharmaCare coverage for seniors’ medications decreased to 31% from 33% in 2019-2020 is concerning to CARP. Members are frustrated with the state of Canada’s health system and believe we can and must do better,” he told Medscape Medical News. As one member said, “My dog is getting a medication that my doctor is waiting to get for human use.”

What Data Show

The data in the monitoring report tell a “worrisome” story, according to Levitt. The older-adult population in BC has grown 45% over the past 10 years and will continue to increase, yet the new data highlight the following trends over the past 5 years:

• Wait lists for knee and hip replacements for patients aged 65 years or older increased by 53% and 59%, respectively.
• There were 6500 people waiting for a publicly subsidized LTC bed in 2023-2024, a 150% increase; in 2023-2024, the average wait time for someone admitted to LTC from a hospital was 36 days, whereas the wait was 225 days for someone in the community assessed as eligible but not urgent.
• There were close to 14,000 applications for seniors subsidized housing in 2023-2024, a 59% increase; only 6% of total applicants received a unit in 2023.
• The number of recipients of a Shelter Aid for Elderly Renters subsidy decreased by 8%, and the number of clients per 1000 seniors decreased by 18%.
• The number of unfulfilled HandyDart (a shared ride service) ride requests increased by 44%, whereas rides provided decreased by 15%.

In addition, the “Better at Home Program,” which delivers transportation, housekeeping, meal programs, and other services to help those who remain at home, is providing more support to more people, but the wait list has increased by 56%.

“The vast majority of seniors want to age in place, and we must do a better job helping people live safely at home — and out of hospital and LTC — for as long as possible,” Levitt said.

Cross-Ministry Solutions 

Levitt and others are advocating for a cross-ministry plan to address fragmentation and the confusion that may occur when seniors try to access services. For healthcare alone, older adults often must go to different places to get the care they need, Levitt said. “There’s no one-stop shop, no geriatrics hospital. There’s a children’s hospital, but not a seniors’ hospital.”

Even if all the required healthcare services were on a single site, it wouldn’t help because there’s little coordination or communication among providers, he said. Importantly, the dearth of geriatricians also affects wait times. “There are way more seniors than there are children, but there’s way more pediatricians than there are geriatricians.”

Levitt and colleagues at the Office of the Seniors Advocate have written to BC Premier David Eby to request that he mandate a cross-ministerial approach led by the Ministry of Health, Levitt said. “We certainly are optimistically expecting to see health, housing, transportation, and other ministries put together a specific action-oriented plan with measurable targets.”

VanGorder agreed. “CARP knows that seniors face issues relating to many departments of the provincial government. Other provinces have a mechanism for formal integration across departments for issues that concern seniors. BC needs this too, and it would be a good first step to improving services to seniors, avoiding duplication, and fostering new approaches.” 

Vivian Welch, PhD, senior investigator at Bruyère Health Research Institute, Ottawa, Ontario, Canada, and applied public health chair at the Public Health Agency of Canada and Canadian Institutes of Health Research, also favors an integrated plan. “Dan Levitt’s call for a cross-sectoral seniors’ plan is an important approach for governments and communities to address, since all sectors need to be involved and integrated if we are going to see a successful and holistic solution for older adults,” she told Medscape Medical News. “We need to be considering healthcare alongside housing, social services, and public safety if we want to ensure that older adults see the maximum benefits from these services,” she said.

Community support service programs are part of this solution, she noted, pointing to Ontario Access Community Support Services as “a great example of how to bridge the gap by providing older adults with access to a navigator who, in turn, helps identify and connect older adults with needed services such as care at home, caregiver support, meals, transportation, and palliative care.” 

“However,” she said, “they cannot do it without cross-sectoral action and integration.” 

Amy Hsu, PhD, also of Bruyère Health Research Institute and chair of primary health care dementia research at the Brain and Mind Institute, University of Ottawa, Ottawa, Ontario, Canada, told Medscape Medical News that “the unique cultural and linguistic needs of the growing number of ethnic and racial minority seniors in Canada must also be considered” in any cross-sectional solution.

“One third of Canadian seniors are immigrants, and about 63% of immigrant seniors are unable to speak either official language [English or French] fluently,” she said. “Providing language-concordant care is vital to the quality and safety of care for minority seniors who need health and social services.”

Immediate Steps

While these systemic changes are being considered and ultimately implemented, certain steps to reducing wait lists can be taken immediately, Levitt said. One way could be to make the shingles vaccine free for those who can’t afford it, rather than using a sliding scale for payment. “That’s important because 1 in 3 British Columbians will get shingles in their lifetime; older people are more likely to get it, and it’s debilitating and leads to healthcare system costs.”

Another strategy would be to do away with the copay for seniors who receive 1 hour of home support a day, he said. “Over the course of a year, they’re going to spend $9000 for that copay for publicly funded home care. If that senior is making $31,000 a year, which is just slightly under the median income for seniors in BC, they have $22,000 a year to live on: To pay for rent, food, and everything else.” 

The result, he said, is that “we have seniors who have given up their license because they can no longer drive, but they keep their car because they might need a place to live. And we do have seniors living in cars now. If we can eliminate that copay, it would put $9000 back into the pockets of seniors and it would give them supports to live in their community.” 

Clinicians who have senior patients should spend time with them to understand not only their health issues but also their social situation, he advised. “They can certainly work with social workers and other community supports to make sure those seniors are not isolated and lonely and that they’re socially engaged in the community. Clinicians need to find networks that seniors can latch on to for support outside of just healthcare.”

Ontarian Seniors Affected

The findings from the new report “are not unique to the BC context,” Hsu noted. “In Ontario, for example, the average wait time for admission into an LTC home from the community has increased by about 30% since 2019-2020. There simply aren’t enough providers and care options.” 

In response, Home Care Ontario recently launched a campaign entitled “Home Not Hallways” as part of an effort to deliver over 16 million more hours of home care to Ontarians. The campaign says, “It is time to break the cycle of trying the same old solutions year after year that have only resulted in worsening hallway healthcare and an ever-longer [LTC] wait list” that now includes nearly 48,000 seniors.

Ontario also recently launched the Support for Seniors and Caregivers Act, 2024, proposed legislation that includes a 3-year, $114-million suite of initiatives to enhance quality of life and care for the province’s seniors. The approach spans multiple ministries and aims to provide enhanced dementia care and supports, assistance for families and caregivers, and more opportunities for seniors to build stronger social connections in their community.

Levitt, VanGorder, Welch, and Hsu declared having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.