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The Subsidized Care Dilemma: Aging in BC

Jan 27, 2012

by Wolf Saar, Director of Practice, VIA Architecture

Volf Saar (credit: Wolf Saar)

Last July, my father turned 90. In November, he moved into a nursing home. This was not an entirely unexpected event considering that he has Parkinson’s and has seen a slow decline in his mobility and his ability to avoid falls. With my 87 year old mother becoming increasingly frail (and, at the time, approaching a hip replacement) it was determined that the safest and most feasible alternative for dad was a move to a place where he could receive 24 hour skilled care. The time of “aging in place” ended for my dad.

The experience of being the adult child of two aging parents took on a new dimension as we shifted attention from in-home care to institutionalized care. Since my parents live in Burnaby, BC while I live in Seattle and my sister is in Calgary, every interaction is either remote or requires a road trip for me or an airplane ride for my sister. As an architect, I naturally approached the move with a designer’s eye. My focus ranged from pragmatic to sensual in trying to control the process from afar.

As a bit of background, I’ve observed that in British Columbia, subsidized care is generally of a high quality, although there is a decidedly “institutionalized” approach to this care, necessitated by tight budgets and government infrastructure. As my father’s needs exceeded what an assisted living facility could provide, there were few alternatives between the standard regimens of subsidized in-home services and full-on nursing care. My experience in the US has been primarily in the “private pay” realm and, although that exists in BC as well, our family’s resources did not allow us to consider the option. How wonderful it would have been to have greater choice and the opportunity to direct and have more control where my father lives but, in BC, government-subsidized skilled care nursing is provided on a “first bed available” basis.

My sister and I were wary of this policy and worried that he would end up somewhere less than ideal so we felt fortunate when he was admitted to George Derby Centre, an attractive facility that incidentally caters to veterans. Never mind that being Estonian, my father fled the Russians in the early days of the war and eventually settled in Berlin where he experienced WW II from the “other side” as a photographer for a US agency stationed in Berlin; he jokes that many of his fellow residents were dropping bombs on him! Aside from this quirk, the facility appears well-funded, well-maintained, and well-managed (although they seem to have some issues with misplaced laundry)…

Volf Saar (credit: Wolf Saar)

The quality of care and a hallmark arts and crafts facility (my dad has become an emerging weaver!) is offset by a decidedly institutional feel, reinforced by the size of the facility and long corridors clogged with medical carts and other tools needed in the care of the residents. The demands of operational efficiencies were a visible driver in the design. Large common rooms serve as both dining rooms and day rooms and, in their goal to be “flexible” appear to be kept simple in lieu of providing a richness of scale to promote varied interactions and experiences. The proximity of the nurses’ station to these common areas adds to the institutional character. I am consistently dismayed when visiting nursing homes when I see seating around the nurses’ station encouraged. Residents seem attracted by a sense of being where all the action is.

The living units themselves are small dorm-like single-occupancy rooms with a private accessible bathroom. Aside from being small and especially challenging when a wheelchair encounters furniture brought from home, the fact that residents personalize these units helps offset some of the sense that this is a “temporary” situation.

The subsidized system in BC has provided an enormous peace of mind to my parents as they have aged knowing that they will be cared for as health declines and this has indeed been the case. The cost to them is a fraction of what a private-pay alternative would be and the care is good. The down side is that choice is limited. Availability is by geographic region therefore the number of facilities available is limited. The size and type of facility that a resident initially enters is dictated by the available bed policy. Once in a facility, the resident can be put on a waiting list to go elsewhere but that wait can be lengthy and the stress of yet another move can be daunting. Generally, the philosophy and approach to care is standardized. Certainly, a place like George Derby that has put attention to the creation of a home-like experience within a large complex is more successful than others. Creative options like smaller groupings of residents or adult family homes are not evident in the government-provided arena.

My father is well-cared for and has found a few touchstones such as art-making that seem to focus his activities but aside from that, he “exists” day to day and, as is the case with many of his fellow residents, is fairly isolated. As I go through this experience I often wonder how the progressive concepts that the senior living field is engendering elsewhere and in the private-pay world could be transferred to make this time in his life fuller and richer.