Senior Homes fall in different categories depending on the level of care required by the resident and on whether the room and care are partly subsidized by the Alberta government or totally paid by the resident.
Some of the Alberta Health Acts and Regulations are specifically aimed at providing a framework for various care categories. As shown in the table below, these are: Home Care, Supportive Living and Long-term Care, all falling under the umbrella category of Continuing Care. Because they receive government funding, all of the entities in Table 1 must follow the Continuing Care Health Service Standards. The facilities listed must also follow the Alberta Health Accommodations Acts and Regulations.
|Facilities : Accommodations|
|Home Care||Supportive Living||Long Term Care|
The “D” prefix in DSL3 and DSL4 refers to “Designated” facilities where the health care is subsidized by Alberta Health Services (AHS). These facilities are subsidized through contracts between AHS and the provider. All residents of designated facilities must first be assessed by Home Care before placement. The “D” suffix, on the other hand, refers to facilities reserved for residents with dementia who require a secure environment. AHS provides on its website a description of the various DSL and LTC facility categories and admission guidelines. A brief summary of the categories is also available in Section 3 of the Introduction to Seniors Housing or Lodging in Medicine Hat document provided by the City of Medicine Hat Seniors Services and the AHS Moving to a New Home in Continuing Care publication.
Other Facility Categories
Albertans have access to a variety of non-government-subsidized Supportive Living (SL) facilities. These include SL1, SL2, SL3 and SL4 facilities. Some SL2 and SL3 facilities are referred to as Seniors’ Lodges, which are available to lower income residents.
Non-subsidized facilities tend to be more expensive and can usually be accessed more easily and quickly than subsidized “Designated” facilities since they do not require a Home Care assessment and applicants are not placed on a waiting list maintained by AHS through a Placement Office. It should be noted that, although they must still follow the appropriate accommodation standards, non-government-subsidized facilities do not directly fall under the Continuing Care Health Service Standards. This can limit the ability of residents to file health care related complaints to AHS.
There are many possible paths through the Alberta Health Care system depending on a number of factors such as:
- The availability of local family support in the home,
- The rate of progress of the disease,
- The type of dementia and other possible disabilities,
- The occurrence of a sudden illness requiring hospital attention.
Figure 1 below illustrates four of the many possible paths:
- This is a path progressing very gradually from the home, through non-subsidized and subsidized facilities leading eventually to palliative care without any intermittent visits to the hospital. In practice, such a smooth path is probably not very common.
- This is a more accelerated path where the patient is transferred from the home to a secure DSL4D facility with one or more visits to the hospital before eventually being transferred to an LTCD facility as the dementia, and possibly other ailments, progress. In this case the family members have decided for an end-of-life at this facility.
- This path is similar to the previous case except that the person is transferred to the hospital for special treatment and subsequently moved to an LTC facility due to the need for more extensive care.
- This path involves a temporary transfer from the home to a facility for respite to relieve the home caregiver from accumulating stress and fatigue. On this path, end-of-life occurs at the hospital due to, for example, a sudden severe illness or complications following surgery.
|Figure 1: Four of many possible paths through the health care system for a person with dementia.|
Acronyms and Synonyms
Partly due to historical reasons, different names are used for the same type of facility category. This can cause some confusion when visiting and selecting a facility. Examples include:
- Supportive Living is sometimes referred to Assisted Living.
- DSL facilities are sometimes given the acronym DAL (Designated Assisted Living).
- Long-term Care (LTC) facilities are often referred to as Nursing Homes, which is an older term used in the regulations.
Many senior homes do not distinguish between DSL and SL units and omit the prefix “D” when referring to their “Designated” DSL facilities. The simplest way to clarify their terminology is to ask them if a Home Care assessment is required for admission. If it is required, they are then most likely referring to a DSL facility. There may be a few exceptions such as where a resident is subsidized directly by AHS and is admitted into a non-designated SL facility after a Home Care assessment. Apart from these relatively infrequent exceptions, DSL and LTC facilities differ from non-designated SL facilities as follows:
- The health care portion is subsidized by the government.
- Maximum rates are prescribed by Alberta Health.
- Admission requires an assessment by a Home Care Case Manager.
- Placement is done through the Placement Office.
- The facility must follow the Continuing Care Health Service Standards (CCHSS).
- The facility is audited by AHS to ensure that it is compliant with CCHSS.
- A resident or caregiver can make a complaint related to health care to the AHS Patient Relations Department.
- Because it is contracted by AHS, a complaint may also be made to the Alberta Ombudsman.
Although the “D” suffix in DSL4D denotes dementia, it really refers to a secure (locked) unit designed for the safety of the resident. DSL4D residents do suffer from some form of dementia. However, not all residents with dementia are actually placed in a DSL4D facility. The decision is based on the likelihood that the resident will wander outside the facility. Although not all LTC facilities are secure, the “D” suffix is commonly omitted when referring to LTCD facilities.
Many facilities call themselves “Senior Homes” in spite of the fact that DSL and LTC facilities will admit younger Clients suffering from a disability. Facilities also often internally use their own names that differ from AHS acronyms for particular units within the facility.