Wednesday, July 24, 2013

Exclusive: Health ministry "requested" seniors wheelchair tax

The B.C. Liberal government didn't just change policy to allow health authorities to impose a new, $25 a month wheelchair fee on seniors in care. Documents I received under Freedom of Information say that it ultimately asked Fraser Health Authority to charge the controversial levy.

“A proposal to introduce Wheelchair Rental Fees at the Owned & Operated Residential Care Sites was submitted in the (Program Budget Marginal Analysis) process,” said a May 6 Fraser Health briefing note on wheelchair maintenance fees in residential care facilities. “Subsequent to that submission, the MOH (Ministry of Health) requested FH to implement wheelchair maintenance fees to align with a similar proposal made by (Vancouver Coastal Health). This request was based on a desire to have similar practices in all Health Authorities and to align with the practices in (Community Care and Assisted Living Act) facilities.”

The briefing note and undated Wheelchair Rental Revenue report were released to me by Fraser Health via Freedom of Information. The report forecast “Moderate risk that implementation will cause significant political concerns.”

The appropriateness and acceptability of the charge were both deemed “moderate overall negative impact.” 

“Complies with policies but the additional cost may be burdensome for some residents and families,” said the report. “Staff may have difficulty charging for equipment that used to be free. Families/residents may object to user payment.” 

The report estimated $266,000 net revenue for 2012-2013 and 2014-2015 combined. 

Maintenance charges for wheelchairs of seniors in-care are permitted under the Ministry of Health’s Home and Community Care regulations. Fraser Health planned to collect fees from residents’ comfort funds and offer a waiver for those who cannot afford to pay the $300 a year. 

“Residents will be encouraged to purchase or rent wheelchairs from outside healthcare equipment vendors and the cost to purchase a wheelchair ranges from $1,000 to $3,500 for a manual wheelchair and a typical wheelchair rental from an outside vendor is $70-$100 per month,” said the briefing note.

The briefing note estimated that 60% of the 1,178 residents in Fraser Health-owned and operated facilities use a wheelchair from the aging Fraser Health-owned fleet.

“A wheelchair rental program would serve as a cost recovery initiative that would finance the cost of replacement equipment and ensure that equipment is maintained in optimal condition. This rental program will not apply to other mobility devices such as walkers and canes,” said the briefing note.

I asked both the Ministry of Health and Fraser Health for comment. In particular, I wanted them to tell me the date of the Ministry of Health request to Fraser Health. 

A Fraser Health statement provided by email, credited to Keith McBain, Executive Director for Residential Care and Assisted Living, said:
“The decision to implement the wheelchair maintenance fee occurred after many discussions, some dating back to the end of 2012, and were part of a larger discussion regarding the general issue of charging of fees in residential care. The over-arching concern was the lack of consistency across the residential network of care, not just within Fraser Health, but the whole province. Residents in contracted facilities or in the community, faced one reality with regards to wheelchair purchases and rentals; while those in owned and operated facilities faced a very different one. 
“Understanding that this decision would likely meet public resistance, we did not limit our decision-making because the decision is unpopular. We have a responsibility to all members of our community. Seniors living at home or in a contracted facility, are required to buy or rent their own wheelchairs, walkers or canes at considerable cost. However, seniors living in an owned and operated facility can borrow a wheelchair for personal use at no charge. To bring consistency, the maintenance fee is being introduced as of September 2013. We recognize that this may pose a financial burden to some residents, so a hardship waiver process has been established. Each case will be considered on an individual basis, but no senior requiring a wheelchair will be denied one. 
“We will continue to maintain our existing stock of wheelchairs, but will require more as some of these will need to be retired and demand increases. It is also important to keep in mind that when a wheelchair goes from one person’s use to another, it must go through several infection control measures which can be costly. 
“The intention has never been to cause stress or anxiety to our seniors, but to establish some consistency across the entire residential care network.”
What does the Health Ministry say? Spokesman Ryan Jabs sent me a link to a June 14 information sheet

“Fraser Health should be able to provide you some details on your questions,” Jabs wrote.

Like McBain, Jabs didn't answer the question about the date when the Ministry of Health requested Fraser Health charge the fee. 

The information sheet emphasizes the $1.7 billion annual subsidy for residential care and assisted living, which covers more than 31,000 beds. It said the new policy requires operators to clearly explain fees and all health authorities have hardship provisions in place for clients unable to pay. 

“Residents in B.C. are left with at least $325 a month for personal expenses and other allowable charges,” boasted the information sheet. “This is one of the highest minimum retained incomes in Canada.”

The controversy was at the top of the list in Question Period on July 24 when NDP Leader Adrian Dix asked Health Minister Terry Lake a simple, straightforward question and got spin in return.

NDP Leader Adrian Dix: "Last month we learned the Fraser Health Authority will begin charging the Premier's $300-a-year wheelchair tax on vulnerable seniors in residential care, taking advantage of a government policy change that enabled the tax. Today we learn that not only did the government enable the new tax on vulnerable seniors, it actually made it happen. A Fraser Health briefing note obtained through freedom of information shows: "The Ministry of Health requested Fraser Health to implement wheelchair maintenance fees.
"Can the Minister of Health confirm that in fact it was on the ministry's instructions that Fraser Health decided to charge this uncaring tax, and can he further confirm if the ministry asked other health authorities to do the same?" 
Health Minister Terry Lake: "I would remind the member opposite that British Columbia currently spends $1.7 billion every year to subsidize the province's comprehensive residential care and assisted-living services. That is an increase of $600 million in the last 12 years.
"While residential care is a person's home, and while the public health system covers the cost of medical and health care needs, residents pay for the cost of their personal equipment and supplies just as they would if they lived in the community, as I explained during estimates debate yesterday.
"But I will say this. No vulnerable senior citizen will be denied a service if they cannot afford a particular equipment or aid in a publicly subsidized residential care space in the province of British Columbia."

What do you think? Are you a senior in care who uses a wheelchair? Are you a relative of a senior in care who uses a wheelchair? I want to hear from you. You may comment below or email me.

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