Care Facilities & Other Seniors Housing
Seniors Living Accommodation
The Life Course
Aging In Place
Studies show that older adults prefer to stay in their own homes if they possibly can. Approximately 93% of BC’s seniors will live out their lives in an independent living arrangement. It is no surprise, then, that most care for the elderly is provided at home, whether by family or by hired help. While many consider in-home care preferable to institutional care, there are public benefits and legal considerations that come into play as well.
Home and Community Care
Home and community care services are based on need. Depending on the service, may be subsidized according to income or provided at no cost. Case management services are provided in both the home and community.
Home Care Goals
Home care has four general goals:
1.Maintenance and Prevention
2.Long Term Care Substitution
3.Acute Care Substitution
Home Care Includes
- Nursing care in your own home;
- Meals delivery;
- Rehabilitation therapy to
- strengthen muscles
- offer tips about easier ways to perform tasks
- Tips about equipment and changes to residence to live more independently;
- Home support workers to help with personal care such as bathing, dressing, or grooming.
Community Care includes
- Adult day centres, which bring people together for health, social, and recreational activities;
- Assessment and treatment centres that try to find out:
- what is wrong when you have a health problem and
- what kind of medical treatment would help you
Adult Day Services
Adult day programs assist seniors and adults with disabilities to continue to live in their own homes by providing supportive group programs and activities that assist with daily activities or give clients a chance to be more involved in their community.
Activities vary with each centre. They may include:
- personal care services, such as bathing programs and administering medications;
- therapeutic recreation and social activities;
- caregiver respite, education and support; and
- in some centres, meals and transportation may also be provided or arranged.
Clients may attend an adult day program in addition to receiving other services, such as Meals-on-Wheels and home support through for example Better At Home. Many programs are connected with residential care facilities, while others operate independently.
Respite services allows the care giver for an older adult some time off (respite). Respite Care may be provided:
- at home through home support services,
- in community through adult day services, or,
- on a short-term basis in a residential care facility, hospice or other community care setting.
•Older Adult must meet the general eligibility criteria for Home And Community Care services
– and –
•Their needs are such that they or their family/friend caregiver could benefit from respite services.
To arrange respite care:
•They can contact the Home And Community Care office of their Health Authority
– or –
•they can have a health care professional make a referral on their behalf.
The government also has a set of web pages on Care Options and Costs. It covers the following:
- Publicly Subsidized or Private Pay Services
- Community Nursing
- Community Rehabilitation
- Adult Day Services
- Home Support
- Choice in Supports for Independent Living
- Caregiver Respite/Relief
- End-of-Life Care
- Assisted Living
- Group Homes
- Family Care Homes
- Short-Term Residential Care
- Long-Term Residential Care
It provides the following information for an older adult looking into care options:
- Are You Eligible?
- How to Arrange for Care
- Who Pays for Care?
- Managing Your Care
- Concerns and Complaints
Many older adults have purchased condominiums or ‘strata’ as they are called in BC (because BC law is based on the Australian law and retained its terminology). Strata properties have two essential elements:
(1) the division of a property into units (which are individually owned) and common elements (which are collectively owned by the unit owners);
– and –
(2) a system of ‘democratic’ governance that allows the owners to manage the property collectively.
We have put the words democratic in scare quotes, as the complaints of strata members often have to do with how democratic the governance of the strata really is, and how much their concerns are being considered and addressed. Successful strata governance requires a careful balancing of the rights and obligations of individual strata unit owners, with the interest of the majority of owners or the strata itself. The issues that arise often involve what the BCLI has called “large scale themes such as protection for minorities, democratic decision-making and accountability. Unlike other jurisdictions, BC’s legislation does not contain offence and penalty provisions in respect of non-compliance with the act, regulations, or the strata corporation’s own bylaws. As we tell those living in strata, strata have been referred to as a “fourth level of government,” with little help available from the other three levels of government. Disgruntled strata owners may use a mediator, arbitrator or expensive judicial review proceedings in the BC Supreme Court.
Note – the Government of British Columbia is creating the first-ever online tribunal in Canada that will offer a full array of online tools to allow strata residents to resolve many common strata disputes outside of court. The Civil Resolution Tribunal is expected to be operational in 2016. The CRT will deal with strata disputes between owners and strata corporations for the following matters:
- non-payment of monthly strata fees or fines;
- unfair actions by the strata corporation or by people owning more than half of the strata lots in a complex;
- uneven, arbitrary or non-enforcement of strata bylaws (such as noise, pets, parking, rentals);
- issues of financial responsibility for repairs and the choice of bids for services;
- irregularities in the conduct of meetings, voting, minutes or other matters;
- interpretation of the legislation, regulations or bylaws; and
- issues regarding the common property.
The tribunal will not decide tribunal matters that affect land, such as:
- ordering the sale of a strata lot;
- court orders respecting rebuilding damaged real property;
- dealing with developers and phased strata plans;
- determining each owners’ per cent share in the strata complex (the “Schedule of Unit Entitlement”).
Strata property law has its own distinctive terminology:
strata plans – are legal survey documents. Strata plans delineate the boundaries of individual units and common elements. They must be deposited in the land title office, and must meet a number of detailed requirements to be accepted for deposit.
Strata lots – individually owned units on the strata plan are called strata lots or units. Each strata lot has its own land title. Common property – parts on a strata plan that are not strata lots are called common property. Common property is an open-ended category, which may include things like building lobbies, elevators, and hallways.
Strata corporation – when a strata plan is deposited in the land title office a ‘strata corporation’ is created. All the owners of strata lots become members of the strata corporation. Major decisions involving the common property must be taken at a strata corporation level. The strata corporation (Annual General Meeting) must meet at least once a year.
Strata council – At each annual general meeting the membership elects a strata council from its members. The strata council manages or oversees the management of day-to-day operations of the strata property.
Leasehold stratas. Leasehold stratas are a strange legal hybrid of tenancy and condominium law. In a leasehold strata, the land is subject to a ground lease. The occupants of each strata lot are tenants as to that lot. The landlord of a leasehold strata must be a legislatively identified public authority. The list of bodies that qualify as public authorities is rather short. Expanding opportunities to create leasehold stratas could contribute positively to housing affordability in British Columbia, but the legal rights and obligations of the parties need to be better clarified.
BCCEAS Info Sheet
A common complaint is about smoking by other strata residents, including marijuana smoke. Here is our information sheet about this: Second Hand Smoke In Your Strata.
BC Government Strata Website
The BC government recently revamped its resources for strata owners and managers with a new comprehensive website. These are the various sections:
- Roles and Responsibilities
- Sections and Types
- Meetings and Voting
- Information and Record Keeping
- Bylaws and Rules
- Finances and Insurance
- Repairs and Maintenance
- Strata Legislation
- Strata Associations
- Strata Guides (Archived)
- Getting Legal Advice
- Stakeholder Resources and FAQs
Find it Fast Find it Fast, one clickable page listing all the strata housing topics.
Strata associations offer useful information for strata owners and strata council members.
- CHOA (Condominium Home Owners Association of BC)
- VISOA (Vancouver Island Strata Owners Association)
- CCI Vancouver Chapter (Canadian Condominium Institute)
BCLI Strata Property Law Study
Note – Strata Property Law is being reviewed by the BC Law Institute. They are examining the options for reform in the following of strata-property law:
(1) fundamental changes to a strata—with a priority focus on cancellation of a strata plan and dissolution of a strata corporation;
(2) complex stratas;
(3) leasehold stratas;
(4) common property;
(6) insurance; and,
(7) land-title issues.
The goal of the project is to make recommendations for reform, illustrated by draft legislation, to help in the development of the next generation of strata-property law in British Columbia. The report on phase 1 of the project is available here: Report on Strata Property Law: Phase One
Listed below are some websites with FAQ’s (Frequently Asked Questions) about strata living in British Columbia:
- VISOA (the Vancouver Island Strata Owners Association) is a non-profit organization of strata owners serving strata owners. It has a helpful website including a FAQ section.
- CHOA (the Condominium Home Owners’ Association) is a non-profit strata association with a very helpful website including indexed archives of hundreds of “Condo Smarts” newspaper columns written in reply to questions from strata owners and councils.
- The Financial Institutions Commission (FICOM) is a regulatory agency of the provincial Ministry of Finance that handles some of the paperwork filed by owner developers of strata developments. FICOM has some strata related information and a page on strata FAQs.
- The Homeowner Protection Office has developed some frequently asked questions (FAQ) about managing strata repairs.
- The Strata Property Group at the Vancouver law firm Clark Wilson LLP has an extensive FAQ section.
- The Associated Property Management firm in Kelowna also publishes strata FAQs.
- Many strata residents and strata council members also find it useful to review Mike Mangan’s book “The Condominium Manual” written to explain BC strata law for the lay person.
The Law Society’s PLTC manual on real estate includes information on the Strata Property Act. Real Estate
Independent Living Facilities
¨There are many places that provide independent living opportunities for older adults, such as:
- low-income housing
- over-55 apartments, and
- retirement communities.
The older adult must be able to live alone without needing medical care on an ongoing basis. They should be able to function without assistance in all daily routines:
- meal preparation
- taking their own medication
- other personal care
- doing their own laundry.
BC Housing is a provincial government agency that offers subsidized housing. Tenants pay 30 percent of their gross household income for rent. BUT – there is a minimum amount of rent that you must pay even if you are a low-income senior.
People who require help the most are housed first. An older adult may be eligible if:
- they are a resident of BC aged 55 or older;
- their rent exceeds 30 percent of your income; and,
- their gross household income is below an amount set yearly.
Housing Registry – BC Housing
Many affordable housing developments are listed on the Housing Registry, a centralized listing and application service maintained by BC Housing. The Housing Registry includes public housing and some non-profit and co-op housing providers. Other non-profit and co-op housing providers maintain their own registries. To apply to developments listed in the Housing Registry, one completes and submits an Application for Accommodation form.
BC Housing Seniors Page
BC Housing has a Seniors Programs Webpage with information for Seniors on how to apply for:
- HAFI – Home Adaptations for Independence
- SAFER – Shelter Aid for Elderly Renters
- Assisted Living
- Seniors Supportive Housing
- Seniors’ Rental Housing
- Seniors’ Subsidized Housing
Choices in Support for Independent Living
Choices in Support for Independent Living (CSIL) is an alternative for eligible home support clients. CSIL was developed to give those with physical disabilities and high-intensity care needs more flexibility in arranging home support services. They receive funds to purchase their own services and they manage, coordinate and are financially responsible for recruiting, hiring, training, scheduling and supervising home support workers. Family members who provide care and assistance may be eligible to be paid under this program.
BC’s Supportive Housing Facilities provide specially modified rental homes in selected subsidized housing developments, primarily to low-income seniors who need some assistance in order to continue to live independently.
Support services include
- one meal per day,
- 24-hour emergency response,
- weekly housekeeping/linens, and
- social and recreational activities.
Those eligible pay 50% of their income to live in these units. An older adult may be eligible for SSH if:
- they are a low-income senior or person with a disability who would benefit from an accessible home;
- they require some support services to continue to live independently; and
- they are able to manage their own lifestyle.
Assisted living facilities provide housing, hospitality services and one or two personal assistance services (referred to as ‘prescribed services’), such as regular assistance with activities of daily living, medication services, or psycho-social supports. In British Columbia, assisted living services are regulated under the Community Care and Assisted Living Act (the Act). The Community Care and Assisted Living Regulation defines the prescribed services. An assisted living operator may not offer more than two prescribed services to residents. By contrast, an operator of a residential care facility may offer three or more prescribed services.
Assisted Living is intended for adults who can live independently and make decisions on their own behalf but require a supportive environment due to physical and functional health challenges. Units can vary from one room to private, self-contained apartments. Both publicly subsidized and private-pay assisted living residences that meet the definition of an assisted living residence under the Act are required to be registered with the provincial assisted living registrar.
Assisted living facilities usually include:
- a private housing unit with a lockable door;
- personal care services (may include assistance with tasks like bathing, grooming, dressing and mobility or tasks delegated by a health care professional);
- two meals per day, one of which is the main meal;
- access to basic activity programming such as games, music and crafts;
- weekly housekeeping;
- laundering of towels and linen;
- access to laundry equipment for personal laundry;
- heating or cooling as necessary to maintain the safety and basic comfort level of the residence; and
- a 24-hour emergency response system.
In addition to the general eligibility criteria for home and community care services, to be eligible for assisted living services, an older adult must:
- require both hospitality services and personal care services;
- be able to make decisions on their own behalf that will allow them to function safely in an assisted living residence, or have a spouse who is going to live with them and is willing and able to make decisions on their behalf;
- be at significant risk in remaining in their current living environment; and
- have agreed to pay the assessed client rate and any additional optional charges for services, programs or supplies that are not included as a benefit but are offered by the service provider.
To read the general eligibility criteria for all home and community care services, go to: Are You Eligible?
Assisted Living Registrar and Registry
The Assisted Living Registry is part of the Quality Assurance Branch of the Health Services Policy and Quality Assurance Division. The mandate of the assisted living registrar under the Community Care and Assisted Living Act is to protect the health and safety of assisted living residents. The registrar administers the assisted living provisions of the Act, which require assisted living operators to register their residences and meet provincial health and safety standards. To meet this mandate, the registrar:
- administers the registration of all assisted living residences in British Columbia, whether they are publicly subsidized or private-pay.
- establishes and administers health and safety standards, and administrative policies and procedures.
- ensures timely and effective investigation of complaints about the health and safety of assisted living residents.
- has authority to inspect residences if there is a concern about the health or safety of a resident.
- refers issues that are not within the registrar’s jurisdiction to the appropriate authorities.
See this webpage for more information on the Assisted Living Registry and contact information: Assisted Living. The Ombudsperson was critical of this area of seniors housing, referring to a ‘protection gap’ since the residents are not covered by regulations other than the regulations dealing with registration and health and safety. Any other concerns with the quality of services provided is considered a ‘consumer’ issue. While occupation of these residences should be considered residential tenancies, and while the Residential Tenancy Act was amended to cover Assisted Living, this regulatory regime was opposed by those in the housing industry, and these amendments were never proclaimed in force.
One of the most common complaints we hear is about smoking by other residents, including marijuana smoke. Here is our information sheet about second hand smoke: Smoking Complaints – Assisted Living.
Assisted Living Resources
Government of BC
The government has also produced a ten page booklet on assisted living, through the office of the Assisted Living Registrar: Information About Assisted Living for Seniors
The best resource on assisted living is a comprehensive study done by the BC Law Institute – Report on Assisted Living in British Columbia. [Note – our Executive Director Martha Jane Lewis was a member of the study group].
Seniors Services Society
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The housing options chart is available for download here: Seniors Housing Options – Seniors Services Society. The same information in document form is available here: Types of Seniors Housing
Residential care facilities provide 24-hour professional nursing care and supervision for seniors and people with disabilities who have complex care needs and can no longer be cared for in their own homes. The older adult requires 3 or more ‘prescribed services’ and in assisted living up to 2 ‘prescribed services are provided
Residential care services include:
- professional nursing care;
- meals and snacks, including any special diets;
- medication storage and administration;
- personal assistance with daily activities, such as bathing, dressing or grooming;
- a planned program of social and recreational activities; and,
- Management of residents’ cash (e.g. – comfort fund).
Case managers (such as a community nurse, physiotherapist or occupational therapist) act as co-ordinators to help clients obtain home and community care services. They determine the nature, intensity and duration of services that would best meet clients’ needs and arrange their services (a “care plan”). The case manager will stay in touch with the client to arrange care services and make any adjustments necessary in the event their care needs change.
During an assessment visit, the case manager or other health care professional, such as a palliative care co-ordinator, discusses the client’s situation and their health care needs. Together, the client and case manager develop a care plan. At that time, the case manager will assess whether the client’s needs can be met while they remain at home or would be better met in an assisted living residence, residential care setting or a hospice.
A Care Plan can include plans for:
- adequate nutrition monitoring medication,
- bills being paid and banking is done,
- medication review
Applying for Residential Care
The government of BC has a booklet – Planning for Your Care Needs – Help in Selecting a Residential Care Facility. It sets out a number of issues to be considered in selecting a facility, including a useful checklist for preparing for a facility tour.
Another booklet Choosing a Care Facility or Home also sets out a number of questions to and things to be looking out for. It contains space and tick boxes to use in comparing three facilities.
The Office of the Seniors Advocate for BC has developed a Residential Care Quick Facts Directory which provides key information in a standardized format for all of BC’s subsidized residential care homes (292 facilities). The directory can be view online or download (almost 600 page pdf!). It will be updated regular.
Legal Issues in Residential Care: An Advocate’s Manual
BCCEAS has developed an online ‘wikibook’ or ‘ebook’ on legal issues in residential care – Legal Issues in Residential Care: An Advocate’s Manual. The manual takes a client-centred, advocacy perspective to describe and understand the common legal matters affecting people who apply for or live in residential care facilities, as well as those who care about and support them. The focus of this e-book is on:
- licensed residential care for adults–including the for profit and not for profit care facilities, private hospitals, and extended care hospital beds.
- legal issues in these facilities-which includes policies, procedures, regulations, laws, any administrative review or appeal processes.
It is not intended to be a comprehensive statement of the law, but a useful foundation for considering any legal issues arising. The e-book begins with an overview of the statutory framework for residential care facilities and residents’ rights declarations. The subsequent chapters focus on five key areas of law in residential care:
- Legal issues related to admission and transfer – such as the admission process, and transfer from hospital or other settings, consent to move into a residential care facility (particularly where the prospective resident has diminished capacity), use of the Mental Health Act as a transfer mechanism; the care plan and the contract, and responsibility for fees.
- Legal issues arising while living in residential care – which includes for example, residents’ rights, standards of care, professional care, informed consent, inappropriate use of physical and chemical (medication) restraints, resident safety (including preventing harm from other residents), abuse and neglect, control over residents, control over access to residents (visitors).
- Rights, remedies and problem resolutions – how to resolve problems: civil and administrative remedies, enforcement, mandatory reporting, complaints, and criminal law.
- Capacity & consent – treatment and personal care decisions, use and misuse of advance care planning, consent in the context of physical and chemical restraints in care facilities, and improving understanding about the requirements of consent.
- Substitute decision-making – a review of forms of substitute decision making, including the use of power of attorney, advance directives, and representation agreements in residential care.
The wikibook is available on Clicklaw here: Legal Issues in Residential Care: An Advocate’s Manual
Residential Care in the Context of Elder Law
Some of the laws and regulations identified in our Residential Care Manual such as the Community Care and Assisted Living Regulation and the Residential Care Regulation regulate care facilities for persons with chronic or progressive conditions, primarily due to the ageing process. The same laws might also apply to and regulate facilities for also a wider group of people receiving care. This includes facilities providing hospice (palliative) care, homes for people with developmental disabilities or acquired brain injury and facilities for people with substance abuse or mental disorders. The focus in our manual, however, is largely on seniors who make up the vast proportion of the resident population in the care facilities.
Ombudsperson Report – The Best of Care
The Ombudsperson conducted a 3 year investigation into issues in residential care in BC. In December 2009, the Ombudsperson issued The Best of Care: Getting it Right for Seniors in British Columbia (Part 1), the first of two reports on the Ombudsperson’s systemic investigation into the care of seniors in B.C. The first report included ten recommendations made to the then Ministry of Health Services and Ministry of Healthy Living and Sport in the following areas:
- rights for seniors in residential care;
- access to information about residential care; and,
- the role of resident and family councils.
On February 14, 2012 the Ombudsperson released The Best of Care: Getting it Right for Seniors in British Columbia (Part 2) – a 400 plus page report in 2 volumes – Vol 1 and Vol 2. . The report makes 143 findings and 176 recommendations. The recommendations are designed to improve:
- home and community care;
- home support;
- assisted living; and,
- residential care services for seniors.
The Ombudsperson releases updates each year on the status of the recommendations – the most recent being from June, 2015.
A hospice is a residential home-like setting where supportive and professional care services are provided to British Columbians of any age who are in the end stages of a terminal illness or preparing for death.
Services provided in a hospice may include:
- medical and nursing care;
- advance care planning;
- pain and symptom management; and
- psychosocial, spiritual and bereavement support.
BC Palliative Care Benefits Program
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People living at home and nearing the end of their life can receive:
•free medications for pain and symptom relief
•some medical supplies and equipment.
Approved medications can be obtained through a local pharmacy.
Who Can Apply?
Seniors who are not likely to live longer than six months are eligible.
How to Apply
A doctor must certify that the person is eligible for coverage and submit an application.For prescription drug benefits, a doctor submits an application directly to PharmaCare (Plan P).
A copy of the application form is sent to the local health authority for medical supplies and equipment.
BC Housing – Seniors Housing Page
BC Housing has a webpage for seniors with information and links for applying for:
- HAFI – Home Adaptations for Independence
- SAFER – Shelter Aid for Elderly Renters
- Assisted Living
- Seniors Supportive Housing
- Seniors’ Rental Housing
- Seniors’ Subsidized Housing
The webpage can be accessed here: BC Housing – Seniors