COMMENTARY: Rate caps needed on special care, memory care homes

As a researcher on the cost of long-term care in New Brunswick, I have heard many stories of the savage draining of savings as seniors go through the long-term care system.

There are four levels of care in the government funded long-term care system in New Brunswick. Seniors who are assessed for levels 3 and 4 care, a higher level of care, go to nursing homes. The rates charged by nursing homes are capped, specifically at $113/day. Seniors who are assessed at levels 1 and 2 care, a lower level of care but nevertheless required care, go to special care homes. In recent years, seniors with dementia, assessed at level 3B, can go to beds in memory care homes. 

There are no caps on the amount that special care and memory care home residents can be charged. Instead, in some of the homes, there is an upcharge or surcharge over government funding rates that residents must pay. In others, the homes state with pride that they don’t have an upcharge.

There is a principle with regard to long-term care in Canada that seniors should only pay — or be subsidized for, if low-income — basic accommodation rates while the province should cover the actual cost of care. In other words, all rates at homes funded by the government should be capped at basic accommodation rates. In New Brunswick, this principle is honoured in the case of nursing homes. There is a cap of $113/day that seniors pay or are subsidized for if low-income. Although basic accommodation rates have been set by the Department of Social Development at $77/day for special care homes and $83/day for memory care homes, the principle of charging this amount is not honoured in some special care and memory care homes because they are able to charge whatever they want.

The absence of caps on special care and memory care home rates results in a two-tier system in the special care home sector between those homes that do and those that do not have an upcharge/surcharge. The special care and memory care homes with an upcharge/surcharge are accessible only to those seniors that can afford the upcharge/surcharge.

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Another impact of the absence of caps is that alternate level of care (ALC) patients cannot afford to leave the hospital to go to special care or memory care homes. It is a major cause of the so-called ALC problem. This fact was recognized in the pilot project awarded to Hillcore at Résidence Moncton where the tender required that there be no “surcharges” at the home.

I have taken this issue to the Seniors Advocate in November 2021; to Ernie Steeves in the pre-budget consultations on Februrary 26, 2022; to Elizabeth Dubee, Assistant Deputy Minister, Long-term Care and Disability Program in the Department of Social Development on December 6, 2022; to Dorothy Shephard, Minister of Social Development on February 13, 2023; and to Kelly Lamrock, Seniors’ Advocate, on February 14, 2023 in regard to his long-term care review.

The reason that the Department of Social Development gives for having to allow the upcharge/surcharge is that special care homes are “private” homes. Special care homes have been under the Family Services Act where caps are not allowed on private providers. On the other hand, caps were allowed on private nursing homes under the Nursing Home Act. 

In late 2022, I learned that nursing homes and special care homes were going to be brought together under a new Seniors Care Plan. Under this legislation, it would be possible to have caps on all levels of care — e.g. nursing homes and special care and memory homes. In addition, it was argued, even by small special care and memory care homes, that they were having to impose a small “upcharge” to cover the costs that were not being adequately covered by Social Development. However, the recent announcement on November 29, 2022 of an increase in funding of $10 per day per resident to special care and memory care homes should take care of this funding problem and make the upcharge/surcharge unnecessary. In fact, funding rates published on the Social Supports NB page on March 13, 2023 show an even greater increase in funding to the homes has occurred.

In Nova Scotia, there are caps on charges at all levels of care. Specifically, there is a cap of $110.50/day for nursing homes and a cap of $65.50/day for “residential care facilities,” their equivalent of special care homes. (Nova Scotia does not have the equivalent of memory care homes.)

Only with caps in place on special care homes and memory care homes will the long-term care system in New Brunswick be fair and compassionate to all seniors in New Brunswick. This is an issue that needs immediate action.

Joan McFarland is a Fredericton-based researcher on long-term care and a retired economics professor from St. Thomas University.